Objective: To test the efficacy of a graded aerobic exercise programme in the chronic fatigue syndrome. Design: Randomised controlled trial with control treatment crossover after the first follow up examination. Setting: Chronic fatigue clinic in a general hospital department of psychiatry.

Objective-To measure strength, aerobic exercise capacity and eYciency, and functional incapacity in patients with chronic fatigue syndrome (CFS) who do not have a current psychiatric disorder. Methods-Sixty six patients with CFS without a current psychiatric disorder, 30 healthy but sedentary controls, and 15 patients with a current major depressive disorder were recruited into the study. Exercise capacity and eYciency were assessed by monitoring peak and submaximal oxygen uptake, heart rate, blood lactate, duration of exercise, and perceived exertion during a treadmill walking test. Strength was measured using twitch interpolated voluntary isometric quadriceps contractions. Symptomatic measures included physical and mental fatigue, mood, sleep, somatic amplification, and functional incapacity. Results-Compared with sedentary controls, patients with CFS were physically weaker, had a significantly reduced exercise capacity, and perceived greater eVort during exercise, but were equally unfit. Compared with depressed controls, patients with CFS had significantly higher submaximal oxygen uptakes during exercise, were weaker, and perceived greater physical fatigue and incapacity. Multiple regression models suggested that exercise incapacity in CFS was related to quadriceps muscle weakness, increased cardiovascular response to exercise, and body mass index. The best model of the increased exercise capacity found after graded exercise therapy consisted of a reduction in submaximal heart rate response to exercise. Conclusions-Patients with CFS were weaker than sedentary and depressed controls and as unfit as sedentary controls. Low exercise capacity in patients with CFS was related to quadriceps muscle weakness, low physical fitness, and a high body mass ratio. Improved physical fitness after treatment was associated with increased exercise capacity. These data imply that physical deconditioning helps to maintain physical disability in CFS and that a treatment designed to reverse deconditioning helps to improve physical function. (J Neurol Neurosurg Psychiatry 2000;69:302-307)

Most studies of the triathlon have looked at male triathletes with respect to the longer distance events such as the Hawaii Ironman Triathlon. The purpose of this study was to investigate and compare the physiological characteristics and training protocols of elite and competitive (club) women triathletes who compete at Olympic distance (1.5 km swim, 40 km cycle, 10 km run) to examine the relationship between these factors and running performance in the triathlon. The elite triathletes (n = 10) had a lower body mass and BMI than club level triathletes (n = 9) as well as smaller girths at all measured sites although these differences were not significant. Sum of skinfold thickness measured at four sites was significantly smaller in the elite group (p = 0.05), yet, wide individual variations were found within each group. The amount of training undertaken by individuals in both groups varied markedly; however, overall the elite did more training in all disciplines. The VO2max measured on the treadmill was significantly higher (p = 0.03) in the elite women (65.6 +/- 6.0 ml.kg-1.min-1) as compared to the club level women (60.4 +/- 3.1 ml.kg-1.min-1). The elite triathletes were significantly more economical, showing a lowered relative oxygen consumption (% VO2max), (p = 0.008); lowered heart rate (p = 0.01) and lowered blood lactate values (p = 0.03) at 15 km.h-1. The elite group were also much more efficient runners at 15 km.h-1 when looking at VE/VO2 (p = 0.05). An association was found between run race time and %VO2max at 15 km.h-1 (p = 0.04). The results suggest that there is no ideal nor unique anthropometric profile that can be established for female triathletes especially with respect to running time and overall performance. The widespread differences in physiological variables found between the two groups confirms the important contribution factors such as these make to performance.

A pilot study was performed to assess the value of aerobic training as part of the rehabilitation programme for patients with a single incident brain injury requiring admission to an inpatient neurological rehabilitation unit. The cohort consisted of six patients with a combination of impairments including weakness, spasticity, taxia and cognitive problems. Each patient performed an exercise test at the beginning and end of the study to assess changes in aerobic fitness and performance. The aerobic training programme consisted of 20-30 minute sessions on an exercise bike three times a week for eight to 12 weeks. The post-training exercise test showed significant increases in duration ( p < 0.01) and in workload ( p < 0.025) compared to the pretraining test. There were no adverse effects from the training programme. Aerobic training should be considered in the rehabilitation programmes devised for patients with recent brain injury. Further research is needed to determine the best way to integrate this with other aspects of rehabilitation.

This study examined the effect of sodium citrate ingestion on high-intensity cycling performance in repeated 45-s bouts. Twelve subjects (9 male and 3 female) ingested either a sodium citrate solution (0.3 g ⋅ kg−1 body mass [BM]) or a placebo 90 min prior to exercise. Postingestion blood HCO3 concentrations were significantly higher in the citrate trial (p < .01), but there was no difference in blood pH between trials. Peak power and total work significantly decreased over the five bouts (p < .05) and postexercise blood lactate concentrations significantly increased over the five bouts (p < 0.01), but there were no differences between trials. We conclude that sodium citrate ingestion (0.3 g ⋅ kg−1 BM) is not an effective ergogenic aid for high-intensity, intermittent exercise as simulated in this protocol.