Article Index

Treatment studies

Orthostatic intolerance and midodrine

Treatment of Orthostatic Intolerance (O.I) using midodrine was addressed by Nicole Baldwin (Salt Lake City, USA). She described O.I. as treatable with midodrine and there are 2 FDA trials happening. Hours of vertical activity (HVA) was used as a measure to assess effectiveness. A pilot study of 23 patients was undertaken, but 12 never started the medication, 5 did not continue (lack of compliance) and 6 ended up taking it at the full therapeutic dose (10mg 3-4 hourly during hours of being upright). Those taking the full dose showed a small but meaningfully useful increase in HVA. Those who continued the medication tended to be those who were worse at baseline. There were improved symptom scores particularly for headaches. Lack of compliance was due to side effects and rebound effects. The drug has a short half life, so frequent dosing is needed. The benefits were small but significant and outweighed the side effects.

Effect of Baduanjin qigong exercises on fatigue

A presentation then followed by Tian-fang Wang (Beijing, China)—the first time we had had attendees from mainland China. She talked about the intervention effect of Baduanjin on the fatigue state in fatigue-predominant sub-health. Baduanjin is a set of qigong exercises. She showed a video to begin with to demonstrate the technique. The exercises were very gentle and simple, and were undertaken for 2 periods of 15 minutes each day. 129 subjects were assessed (62 in the treatment group and 52 controls). Symptom scores declined significantly in the treated group.

Isometric yoga

Takakazu Oka (Kyushu, Japan) then discussed the use of isometric yoga in CFS/ME. The technique consists of 6 slow and simple poses with associated breathing exercises. It is done in a sitting position (mainly because space is very limited in the hospital.) The study had to be designed to avoid post-exertional malaise, bearing in mind also that these patients are deconditioned. The technique also needed to be “mentally” simple. The exercises lasted 20 minutes, and the study was done over 8 weeks. Of the 24 patients studied (in 2 groups—one using yoga and one with conventional pharmacotherapy), one yoga patient complained of dizziness. No one’s fatigue was exacerbated by the yoga. All said their bodies became lighter and warmer and severity of pain decreased. DHEA-S increased and prolactin levels decreased significantly in the yoga group.

Home-based self-management for severe ME/CFS

Fred Friedberg (New York, USA) spoke of the results of a randomized trial looking at home-based self-management for severe CFS/ME. The 137 patients studied were mostly disabled and unemployed. They were assigned to 3 categories: 1. Wait list, 2. Home self-management using web diaries and activity monitors and 3. Home self management using paper diaries and step counters. Fatigue, functioning and depression improved in both of the 2 self management strategies, compared to wait-list controls, and were not significantly different from each other. There is therefore a role for home self management activities in generating improved outcomes.