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. 1988 Oct 22;297(6655):1014–1017. doi: 10.1136/bmj.297.6655.1014

Normal muscle strength and fatigability in patients with effort syndromes.

M J Stokes 1, R G Cooper 1, R H Edwards 1
PMCID: PMC1834796  PMID: 3142592

Abstract

To examine fatigue mechanisms in an unselected series of patients with excess fatigue ("effort syndromes") their muscle function was compared with that of normal subjects. Voluntary performance was assessed with a cycle ergometer to exhaustion and by maximal isometric contractions of the quadriceps femoris. The mean maximal heart rate in patients during ergometry was 89% of the predicted rate, and quadriceps strength was either normal or was inappropriate for the available muscle, which suggested submaximal effort. Contractile performance was examined in the absence of volition with stimulated contractions of the adductor pollicis. During stimulated fatiguing activity patients were neither weaker nor more fatigable than controls; thus the excess fatigue experienced by the patients was not due to a defect of the contractile apparatus. The increased perception of effort must therefore be due to impairment of central rather than peripheral mechanisms. The optimal approach to treatment of effort syndromes combines physical and psychological techniques.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Basmajian J. V. Reeducation of vastus medialis: a misconception. Arch Phys Med Rehabil. 1970 Apr;51(4):245–247. [PubMed] [Google Scholar]
  2. Behan P. O., Behan W. M., Bell E. J. The postviral fatigue syndrome--an analysis of the findings in 50 cases. J Infect. 1985 May;10(3):211–222. doi: 10.1016/s0163-4453(85)92488-0. [DOI] [PubMed] [Google Scholar]
  3. Cooper R. G., Edwards R. H., Gibson H., Stokes M. J. Human muscle fatigue: frequency dependence of excitation and force generation. J Physiol. 1988 Mar;397:585–599. doi: 10.1113/jphysiol.1988.sp017020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cooper R. G., Stokes M. J., Edwards R. H., Stark R. D. Absence of excess peripheral muscle fatigue during beta-adrenoceptor blockade. Br J Clin Pharmacol. 1988 Apr;25(4):405–415. doi: 10.1111/j.1365-2125.1988.tb03323.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. David A. S., Wessely S., Pelosi A. J. Postviral fatigue syndrome: time for a new approach. Br Med J (Clin Res Ed) 1988 Mar 5;296(6623):696–699. doi: 10.1136/bmj.296.6623.696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. EDWARDS R. G., LIPPOLD O. C. The relation between force and integrated electrical activity in fatigued muscle. J Physiol. 1956 Jun 28;132(3):677–681. doi: 10.1113/jphysiol.1956.sp005558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Edwards R. H., Hill D. K., Jones D. A., Merton P. A. Fatigue of long duration in human skeletal muscle after exercise. J Physiol. 1977 Nov;272(3):769–778. doi: 10.1113/jphysiol.1977.sp012072. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Edwards R. H. Muscle fatigue and pain. Acta Med Scand Suppl. 1986;711:179–188. doi: 10.1111/j.0954-6820.1986.tb08948.x. [DOI] [PubMed] [Google Scholar]
  9. Edwards R. H. Physiological analysis of skeletal muscle weakness and fatigue. Clin Sci Mol Med. 1978 May;54(5):463–470. doi: 10.1042/cs0540463. [DOI] [PubMed] [Google Scholar]
  10. Edwards R. H., Young A., Hosking G. P., Jones D. A. Human skeletal muscle function: description of tests and normal values. Clin Sci Mol Med. 1977 Mar;52(3):283–290. doi: 10.1042/cs0520283. [DOI] [PubMed] [Google Scholar]
  11. Friman G. Effect of acute infectious disease on human isometric muscle endurance. Ups J Med Sci. 1978;83(2):105–108. doi: 10.3109/03009737809179121. [DOI] [PubMed] [Google Scholar]
  12. Friman G. Effect of acute infectious disease on isometric muscle strength. Scand J Clin Lab Invest. 1977 Jun;37(4):303–308. doi: 10.3109/00365517709092633. [DOI] [PubMed] [Google Scholar]
  13. Friman G., Schiller H. H., Schwartz M. Distubed neuromuscular transmission in viral infections. Scand J Infect Dis. 1977;9(2):99–103. doi: 10.3109/inf.1977.9.issue-2.08. [DOI] [PubMed] [Google Scholar]
  14. Gandevia S. C., McCloskey D. I. Interpretation of perceived motor commands by reference to afferent signals. J Physiol. 1978 Oct;283:493–499. [PMC free article] [PubMed] [Google Scholar]
  15. Ho-Yen D. O., Carrington D., Armstrong A. A. Myalgic encephalomyelitis and alpha-interferon. Lancet. 1988 Jan 16;1(8577):125–125. doi: 10.1016/s0140-6736(88)90329-7. [DOI] [PubMed] [Google Scholar]
  16. Jamal G. A., Hansen S. Electrophysiological studies in the post-viral fatigue syndrome. J Neurol Neurosurg Psychiatry. 1985 Jul;48(7):691–694. doi: 10.1136/jnnp.48.7.691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Komi P. V., Viitasalo J. T. Changes in motor unit activity and metabolism in human skeletal muscle during and after repeated eccentric and concentric contractions. Acta Physiol Scand. 1977 Jun;100(2):246–254. doi: 10.1111/j.1748-1716.1977.tb05943.x. [DOI] [PubMed] [Google Scholar]
  18. MERTON P. A. Voluntary strength and fatigue. J Physiol. 1954 Mar 29;123(3):553–564. doi: 10.1113/jphysiol.1954.sp005070. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Newham D., Edwards R. H. Effort syndromes. Physiotherapy. 1979 Feb;65(2):52–56. [PubMed] [Google Scholar]
  20. Stokes M., Young A. The contribution of reflex inhibition to arthrogenous muscle weakness. Clin Sci (Lond) 1984 Jul;67(1):7–14. doi: 10.1042/cs0670007. [DOI] [PubMed] [Google Scholar]
  21. Wiles C. M., Young A., Jones D. A., Edwards R. H. Relaxation rate of constituent muscle-fibre types in human quadriceps. Clin Sci (Lond) 1979 Jan;56(1):47–52. doi: 10.1042/cs0560047. [DOI] [PubMed] [Google Scholar]
  22. Woods J. J., Furbush F., Bigland-Ritchie B. Evidence for a fatigue-induced reflex inhibition of motoneuron firing rates. J Neurophysiol. 1987 Jul;58(1):125–137. doi: 10.1152/jn.1987.58.1.125. [DOI] [PubMed] [Google Scholar]
  23. Yousef G. E., Bell E. J., Mann G. F., Murugesan V., Smith D. G., McCartney R. A., Mowbray J. F. Chronic enterovirus infection in patients with postviral fatigue syndrome. Lancet. 1988 Jan 23;1(8578):146–150. doi: 10.1016/s0140-6736(88)92722-5. [DOI] [PubMed] [Google Scholar]

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