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Effort Intolerance
in The Effort Syndrome;
A real physical
abnormality which has absolutely nothing to do with a fear of
exercise (posted 16-11-05)
Introduction
There has been much presumed and said about effort intolerance
in The Chronic Fatigue Syndrome being a consequence of a fear
of exercise, but this is because doctors have been writing such
stuff based on the absence of laboratory evidence, and their
reluctance to believe what they have been told by patients. To
really understand this problem, in the absence of scientific
proof, would involve doctors actually experiencing this problem
themselves, but when that happens their own colleagues have been
sceptical. In an attempt to redress this misunderstanding I will
give a contrasting account of symptoms related to extreme sport
in healthy people, and the symptoms occurring in CFS exertion
crises.
An example of my
experience with sport.
My father played sport everyday of the week, including
night cricket, snooker, darts, and lawn bowls, and he ultimately
died of a heart attack at age 61 while playing table tennis.
I had a similar enthusiasm for physical activities, and practiced
such sports with my father in the evenings. I was also involved
in school sports and athletics, before school, during recess,
and at lunchtimes, and immediately after school before going
home for tea. I also played a lot of sports outside of school,
on the weekends, and at boy scout meetings, and at a private
gymnastics club, and I attended swimming classes at the beach
during school holidays. I was a patrol leader in the scouts,
captain of a lacrosse team, and an instructor in the gymnastics
club.When I was about 19 years old The National Fitness Council
of Australia offered me a scholarship to study Group Work at
The S.A. Institute of Technology. I turned it down in favour
of another scholarship offered by the state government Department
of Community Welfare, and then turned that down in favour of
a third offer from the Commonwealth Government.
(The sport described below was called
lacrosse, and from memory was played with 10 players per side.
It is a bit like the game of hockey except that it is played
primarily by throwing the ball through the air with a lacrosse
stick which was about 4 foot long, with the first 3 feet being
the handle, and the upper section being a net with a triangular
frame about 10 inches across at the top. The objective was to
scoop up the ball from the ground, or catch it in the air, and
pass it from player to player until eventually throwing it past
a goaly into a large framed netted goal enclosure about 8 feet
high, 8 feet wide, and six feet deep. I often played lacrosse
on cold and rainy mornings in several inches of water and mud,
without wearing my spectacles, and without a helmet. The following account provides a description of one
incident in one game.)
When I was 15 years old I was a member of a lacrosse team.
When the original coach left, another coach took his place, but
was often too busy with other duties to attend training sessions
or matches, and after losing more than a dozen games in a row
one captain after another stopped attending. Ultimately, the
remaining members of the team held a meeting to select an on
field captain. I was late for the meeting and when I walked through
the door I was told that I had been elected unanimously because
I reliably attended games and was the oldest. Despite my protests
at not wanting the job, I was made captain anyway. We lost more
than another 10 games when we came to play the top team in the
high school league.
We rolled up with 6 players (mostly small) against the opposition
of 10 (mostly taller) which had several spare players accompanying
them, and, rather than abandoning the game, they gave us some
of their spare players as substitutes. I won most of the opening
plays against the state centreman by using a trick or two. Nevertheless,
it wasn't long before we were losing by about 20 goals to 1,
so I had a backman take my place in the centre with instructions
to swing the ball in my direction in the outfield. The other
members of the team were instructed to distract the opposition
when I got the ball because I was going to hog it in an attempt
to get a goal on my own, for the hell of it. The ball came in
my direction as planned, and after scraping it from the ground
I was being attacked by 2 opponents so I ran back toward their
goal, and as they were still following me, I ran behind the goal,
and then across the back of the field. I then ran forward and
made a full on charge at the captain, who was much larger than
I was, and although I was not going to ram him I did have him
bluffed. At the last moment, I dug my sprigs into the ground
and angled left, leaving the captain behind. I was then being
attacked from the front by two taller backmen, so I ran to the
outfield and along the boundary, with about 4 players positioning
themselves to stop me getting through to the goals. I then raised
my net and ran directly for the goals. When one of their backmen
came charging toward me I feigned a throw, and turned my back,
and swiveled my head and gave a facial expression as if I was
mystified about where the ball went. This temporarily had all
of the opposition looking in the direction of my throw, and at
that moment I ran straight for the goal again. It was then obvious
to those players that I still had the ball, so one of the backman
brought his heavy stick up and over my head and belted it down.
It bounced off the side of my head and grazed my ear, and rammed
into my shoulder. I then turned my back, and then angled my way
straight toward the goal, with only two backmen pursuing me.
I increased my pace, and left them just far enough behind to
be ineffective at stopping me, I then had only the goaly to deal
with. He was the biggest goaly in the league, and seemed to occupy
the entire frontage of the goal, so I raised my net to aim the
ball straight between his eyes, in a bluff aimed at getting him
out of my way. Of course I didn't want to put him in hospital,
so my next move was to pirouette and swing the ball backwards
with a scooping action under his feet. By that time the goaly
had thrown his stick into the air and had run away laughing.
I assumed that he thought that anyone who had ran through every
member of the best team in the league deserved a goal just for
the joke of it. In any event, the ball rolled slowly across the
unguarded line, making the score about 20 goals to 2. In the
meantime, I was still rotating in the pirouette with a lot of
momentum, and I stumbled forward for about 15 yards before losing
balance and falling to the ground. In the process of evading
all ten members of that team I probably ran, mostly flat out,
a distance of more than 200 yards. My heart was pounding, I was
gasping for breath, and I felt the taste of blood welling up
in my throat, but that wasn't an entirely unusual thing for me
to experience in sport. After about a minute I staggered to my
feet, and could hear a lot of raucous cheering and laughing,
and while still struggling to get enough energy to speak I yelled
out to my other team members, "OK fellas, we've got them
worried, now let's finish them off".It was probably only
two or three minutes before I had made my way back to the centre
to continue play. When the game ended about 20 minutes later
we had been massacred 49 goals to 3.
The point of this description is to give some insight into
the fact that I played a lot of sport, mostly for the fun of
it, and anyone who thinks or says that I am, or was afraid of
exercise, has lost the plot.
An example of my
experience with chronic fatigue and exercise.
About 10 years later I developed the chronic fatigue syndrome,
primarily related to sedentary work, for reasons which are outlined
in The Posture Theory, but eventually the problem also affected
me in sport. At the time I was involved in gymnastics, and for
the first time in my life, exertion was giving me problems. On
one occasion I demonstrated a round off back somersault, and
when my feet thudded to a stab landing, a thousand stars splayed
across my eyes, and I felt dizzy, and faint, as if I might collapse.
A few months later I was getting a pounding heart each time I
lifted my left foot, and then my right foot off the ground, and
I was confined to laying down a lot because of the effort of
walking. Some months later I joined a fitness programme where
my fitness level was medically and scientifically assessed. I
was found to have an aerobic capacity of zero, which was generally
attributed to a lack of exercise stemming from laziness. However,
I also had the skin fat profile of an athlete, which only develops
after years of exercise, such as occurs in gymnastics, where
the activities produce a lot of abdominal muscle with very little
fat between the muscle and skin). When I started the fitness
training I was always jogging last behind, overweight, less athletic
looking, and older men. After about 6 months of training 2 hours
per night, up to 4 times per week, I was occasionally playing
social games of volley ball. I wasn't able to run around vigorously
so I divided the floor into 6 squares, one square for each player
on my team, and I stayed strictly in my one sixth space, only
moving two or three paces whenever the ball came into that small
area. In one particular game I started serving when the score
was nil all, and when I finished it was 14 to nil. My last ball
went outside the opponents boundary, otherwise I would have won
the game without any other player needing to serve. It wasn't
until the other 5 players had been through the rotation, that
I had another opportunity to serve, and ultimately won the game
15 to 3. After that several players approached me to be on their
competition team, and weren't happy, and didn't believe me when
I said that I didn't have enough energy to play competitive sport.
Some time after that I became involved in a relay race as
part of the fitness training. I managed to walk fast enough to
imitate running for the normal relays, but then we were required
to squat down and place a 5 kg medicine ball between our legs
and kangaroo hop to the end of the hall, about 20 yards away,
and back again. Because of peer pressure I started, but after
only 10 yards my heart began to rock violently in my chest and
I collapsed to the ground and rolled about on all fours gasping
for breath in a state of severe hyperactivity. I couldn't stay
still because it made my symptoms worse, so when people crowded
around me to help, I told them to keep out of my way and let
me recover. I crawled and stopped, and crawled again around the
perimeter of the hall, until I had enough strength to lift myself
onto a chair, but after a few seconds of sitting still I felt
quite agitated so I fell to the floor again and crawled around
to ease my extreme restlessness. It took me at least 15 minutes
before I was well enough to explain the situation to the staff,
and then I made my way to my car and drove home. I was not able
to do any significant exercise for at least a week, but then
I knew that the right amount of exercise was the only way I was
ever going to recover, so I returned to training and proceeded
at a more prudent pace, having learned from the experience not
to exceed my very low limits. I kept training for another 2 months
when I threw a knee cartilage while playing another game of volleyball.
Conclusion
As any one who reads these accounts can clearly see, there
is a lot of difference between the physical response to exercise
in healthy people, and the response in people with The Chronic
fatigue syndrome. M.B.
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