Fighting Fatigue

Fighting Fatigue is the fourth chapter in Jo Marchant’s “Cure:  A Journey Into the Science of Mind Over Body.” The key idea here is that the mind plays an important role in fighting fatigue.  It is worthwhile noting that many performance enhancing drugs, such as amphetamines, modafinil, and caffeine, work by influencing the central nervous system, not the muscles themselves.  A fairly recent healthy memory blog post, “Marathon Mind:  How Brain Training Could Smash World Records” obviously makes the same point.  However, what was missing from that blog post was the notion of a central governor.  The chapter documents extensive research showing that the no matter how hard we exercise, the body always takes the precaution to maintain a healthy reserve.  Presumably there is a central governor that controls this.  The question is whether this central governor can be persuaded, or fooled, to tap into some of this reserve.

Elite cyclists when given a pill or drink they believe is a performance enhancer can cycle on an average 2-3% faster.  Psychologist Chris Beedle suggests this is because the placebo increases their optimism and self-belief that persuades the central governor to free up more resources.  Another placebo expert  Fabrizio Benedetti concluded in a paper on fatigue that “a placebo may act as a cue signaling the central governor to inhibit its brake.”

This presence of a central governor might also explain why interval training, which consists of short bursts of high intensity exercise interspersed by recovery periods works so well.  According to sports physiologist Tim Noakes, who formulated the idea of a central governor, regular  sprints that push us close to our limit of maximum performance don’t just increase physical fitness, they also retrain the brain.  They teach the central governor that pushing ourselves that far was okay, so next time it’ll be safe to push ourselves a little bit further.

Chronic Fatigue Syndrome (CFS) is one of the most controversial conditions in medicine.  Its prognosis is extremely poor with trials that followed patients for up to five years concluding that the recovery rate is just 5%.  CFS is also known as myalgic encephalopathy (ME), although not everyone agrees that these are the same conditions.

To treat CFS and ME an approach was developed called graded exercise therapy (GET) that is intended to work as an ultra-gentle form of interval training.  Cognitive Behavioral Training (CBT) was combined with GET to bring the mind further into the treatment protocol.  This approach alarmed many patient groups who developed an alternative approach called adaptive pacing theory (APT).  The apparent belief of the APT group is that this was a real disease unaffected by the mind, and that people needed to learn to live with this illness.

A large five year study was conducted by Peter White of St. Barthlolomew’s Hospital and his colleagues that included 641 patients.  They were divided into four groups.  A control group that just received routine medical care.  The other groups received this standard care plus CBT, GET, or APT.  This study was published in he journal “Lancet” in 2011.  It reported the APT was completely ineffective. GET and CBT were both moderately helpful, reducing fatigue and disability scores more than the other two groups.  22% of the patients recovered after a year in the CBT and GET groups compared to just 7-8% in the other two groups.  Although this might not look impressive, it showed that GET and CBT were the best treatments available and that recovery from the condition is possible.

The  patient groups remained unimpressed and complained to the Journal.  the Journal answered with a strong endorsement of the research.  Patient groups remain unimpressed.  Apparently they like to believe what they believe and reject scientific evidence.


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