Dr. Todd Davenport - Insights from the Physiology of Post-Exertional Symptom Exacerbation

About: Graded exercise is commonly prescribed after illness to improve symptoms and functional tolerance. Protracted and limited courses of recovery may be associated with post-exertional symptom exacerbation (PESE), which is common after many other forms of viral and bacterial infection including SARS-COV-2. PESE is a constellation of physical, cognitive, and constitutional symptoms that indicate a maladaptive recovery response from activity.
Physiological characteristics of people with PESE differ from deconditioned people in clinically important ways, including differences in the volume of oxygen consumed, heart rate, and ventilation at peak exertion and ventilatory anaerobic threshold. These physiological differences make graded exercise harmful for people with PESE.
This session will discuss the features of PESE compared to deconditioning, the physiology associated with PESE, and introduce the indications and basic principles of energy system first aid for people with PESE.
Citations:
* Barhorst EE, Andrae WE, Rayne TJ, Falvo MJ, Cook DB, Lindheimer JB. Elevated Perceived Exertion in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: A Meta-analysis. Med Sci Sports Exerc. 2020;52(12):2615-2627.
* Chu L, Valencia IJ, Garvert DW, Montoya JG. Deconstructing post-exertional malaise in myalgic encephalomyelitis/ chronic fatigue syndrome: A patient-centered, cross-sectional survey. PLoS One. 2018;13(6):e0197811.
* Davenport TE, Lehnen M, Stevens SR, VanNess JM, Stevens J, Snell CR. Chronotropic Intolerance: An Overlooked Determinant of Symptoms and Activity Limitation in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome? Front Pediatr. 2019;7:82.
* Mateo LJ, Chu L, Stevens S, et al. Post-exertional symptoms distinguish Myalgic Encephalomyelitis/Chronic Fatigue Syndrome subjects from healthy controls. Work. 2020;66(2):265-275.
* Nelson MJ, Buckley JD, Thomson RL, Clark D, Kwiatek R, Davison K. Diagnostic sensitivity of 2-day cardiopulmonary exercise testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J Transl Med. 2019;17(1):80.
* O'Connor K, Sunnquist M, Nicholson L, Jason LA, Newton JL, Strand EB. Energy envelope maintenance among patients with myalgic encephalomyelitis and chronic fatigue syndrome: Implications of limited energy reserves. Chronic Illn. 2019;15(1):51-60.
* Wilshire CE, Kindlon T, Courtney R, et al. Rethinking the treatment of chronic fatigue syndrome-a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT. BMC Psychol. 2018;6(1):6.
Todd E. Davenport, PT, DPT, MPH, OCS serves as Professor and Vice Chair in the Department of Physical Therapy in the School of Health Sciences at the University of the Pacific in Stockton, California, where he teaches in the Doctor of Physical Therapy program.
His research involves translating the evidence related to exercise responses in people with myalgic encephalomyelitis/chronic fatigue syndrome into clinical best practices.
In addition to his academic work, Todd consistently has maintained a clinical practice as a physical therapist at the Kaiser Permanente Medical Offices in Stockton, California.

[@jamesmcafee2777]

Great presentation and helpful material. Thanks Todd & SD Pain Summit!

[@frid123]

Thankyou for all the work you are doing to understand and solve this, and help us! 🙏🙏🙏

[@Dimich1993]

This is a great presentation. And it finally explains why I had an unexplained acidic kidney stone this summer, because during PEM and unaerobic metabolism body turns more acidic!

[@marg716]

👍

[@jaynebailey]

3 years this August can it last that long 2 days after 2nd vac physer but had covid same time 2021 zzzzzzzzzz