The influence of fear on anticipated symptoms following stairclimbing in chronic fatigue syndrome

In people with Chronic Fatigue Syndrome (CFS), too vigorous exercise or even a
30% increase in activity frequently triggers a relapse. Thus, it seems natural
for people with CFS to develop fear of performing physical demanding tasks
(kinesiophobia) and consequently an avoidance behaviour towards physical
activity. Kinesiophobia has been reported to be a common feature of people with
CFS , and evidence supportive of its clinical importance to CFS patients has
been provided. Others interpreted the lack of a difference in physical activity
in anticipation of an exercise test, both on the day of and the day before the
test, as a lack of *exercise phobia* in CFS patients without a comorbid
psychiatric disorder [11]. Thus, further studying of the exact role of
kinesiophobia in people with CFS is warranted.
Anticipated symptoms before physical activity might influence a patient*s
physical performance as well as beliefs. It is hypothesised that people with
CFS with high levels of kinesiophobia tend to overpredict their symptom
increase prior to a physical activity like stair climbing. Conversely, based on
our clinical experiences it is hypothesised that CFS patients without
kinesiophobia underpredict symptom increases prior to a physical demanding
task.
In people with CFS, fatigue severity is related to actual activity level and
high fatigue expectations are related to low activity levels [12], suggesting
that people with CFS try to prevent symptoms by avoiding physical activity.
This view is further supported by the observation that high levels of fear of
movement are related to low daily physical activity and high disability levels
[10]. Using actometers to assess daily activity, the heterogenous CFS
population can be divided into three subgroups: really inactive or passive
patients, patients having a fluctuating activity pattern or moderately active
patients, and rather active or pervasively active [13]. In line with the
previous observations addressing kinesiophobia in people with CFS, it seems
plausible that passive patients have more fear of movement compared to
pervasively active. Furthermore, it is hypothesised that better performance
during stair climbing (e.g. higher speed) is related with higher daily physical
activity levels in people with CFS, and that good performance during stair
climbing corresponds to low symptom expectancies and low kinesiophobia levels
in people with CFS.

The study aims at examining 1) whether the performance during stair climbing
(i.e. speed, heart rate increase) is associated with daily physical activity
levels in people with CFS; 2) whether the performance during stair climbing is
associated with symptom expectancies and kinesiophobia levels in people with
CFS; 3) whether high fearful persons with CFS (i.e. patients with high levels
of kinesiophobia) overpredict expected symptom intensity when exposed to a
physical demanding task like stair climbing, and conversely whether low fearful
people with CFS underpredict symptom increases prior to a physical demanding
task; and 4) whether anticipated symptom increases and kinesiophobia levels are
related to daily physical activity. In addition, the temporal stability of the
TSK-fatigue over a 1-week period is examined.

Op de eerste dag vullen proefpersonen acht korte vragenlijsten in. Hierna lopen
ze twee trappen op en neer, waarbij hartslag en tijd worden gemeten.
Onmiddelijk hierna worden ze weer gevraagd hun huidige vermoeidheid en pijn
weer te geven met een korte vragenlijst en twee VAS-schalen voor pijn en
vermoeidheid.
Hierna dragen ze een actometer tot en met dag acht van de studie. Om
vermoeidheid na inspanning te meten vullen proefpersonen 24 uur na het
traplopen een drietal korte vragenlijsten in. Op dag acht wordt de actometer
weer teruggebracht en worden vier korte vragenlijsten ingevuld.
On the first day participants fill-out eight short questionnaires. Afterwards,
patients will be asked to perform the physical demanding task (two floors stair
climbing and descending) with pre- and posttest heart rate monitoring and
immediate post-stair climbing symptom assessment. Exactly 24 hours after
stair-climbing participants fill-out another set of short questionaires. On day
eight of the study participants fill in a last set of short questionnaires. For
eight days following the stairclimbing participants wear an actometer, a small
device that detects movement and is worn around the ankle. But this is combined
with the standard pre-therapy assessment of daily activity.

Burden for participants is nihil. Climbing and descending stairs is somewhat
burdensome and fatigue- and painrelated symptoms can increase up to 48 hours.
Wearing the actometer is at most inconvenient and is combined with the standard
pre-therapy assessment. No risks are related with participating in this study.