MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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Phase 3 (page 54 of the Manual) is titled “Ending of treatment, preparing and planning for future self‐
management”. Therapists are told that the purpose of Phase 3 is three‐fold: “1. To aim towards self‐management
and independence with exercise programme; 2. To re‐examine the Borg‐ HR (heart rate) relationship; 3. To examine
how to maintain exercise after discharge”.
The therapist is informed that “Exercise target heart rates are calculated for each individual” and two methods
are described; therapists are told that “The main difference between method 1 and method 2 lies in the resting heart
rate (RHR)” and that method 1 uses “a calculation known to therapists / gymnasiums, and aiming for a normal
heart rate target”, whilst method 2 is “as used in previous CFS/ME research”. Therapists are informed that
method 1 does not take the RHR into account and is simpler to use and that “It is therefore advisable to use
method 1 to start with”.
Therapists are told that: “as a lower intensity workout for a longer duration is both more comfortable and is
recommended for improving overall fitness, 60 – 75% of Max HR can be used as a guide. As this figure is used for
normal, healthy people and is not adjusted for CFS/ME, the objective is to work up to this figure gradually as the
participant recovers” (this assumes that the participant will recover with the intervention, but until the
outcome of the trial is known, this is speculation promoted as fact).
It is potentially dangerous to assume that a target that is appropriate for healthy people is also appropriate
for people with ME/CFS (see the section on cardiovascular abnormalities in Section 2 above). People with
ME/CFS often have a much faster heart rate, even at rest: it has been demonstrated that they have an
increased resting energy expenditure (REE).
For example:
(1) “Chronic Fatigue Syndrome is a clinical disorder that is increasingly recognized in most countries as a major health
hazard. Its classical clinical feature is fatigue associated with sleep abnormalities, difficulties concentrating, memory
impairment and myalgia”
“To this may be added a constellation of other symptoms, including atypical chest pain, gastrointestinal
motility disorders, unexplained attacks of sweating and light headedness. The fatigue is clinically identical
to that found in multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, post‐polio syndrome and the
fatigue that may follow posterior head injury”
“Abnormalities in muscle, neuromuscular transmission, heart and resting energy expenditure have been
found in patients with (ME)CFS”
“These abnormalities may well be secondary to a primary abnormality of central cholinergic transmission”
“We tested this hypothesis using a neuroendocrine challenge paradigm (and) have shown that the pathogenesis
involves up‐regulation of post‐synaptic cholinergic receptors”. (A Chaudhuri T Dinan et al. Chronic Fatigue
Syndrome: A Disorder of Central Cholinergic Transmission. JCFS 1997:3(1):3‐16).
(2) “When individual resting energy expenditure (REE) was predicted on the basis of total body potassium values,
45.5% of the (ME)CFS patients tested had resting energy expenditure above the upper limit of normal, suggesting that
there is upregulation of the sodium‐potassium pump in (ME)CFS.
“There was no evidence that the results were due to lack of activity (which would have affected total body water
estimates)” (Watson WS, Chaudhuri A, Behan PO et al. Increased resting energy expenditure in the chronic
fatigue syndrome. JCFS 1998:4:4:3‐14).