Postinfectious Fatigue in Adolescents: Does Physical Activity Make a Difference?

Huang Y, Katz BZ, Mears C, Kielhofner GW, Taylor R. Postinfectious fatigue in adolescents and physical activity.

Arch Pediatr Adolesc Med

. 2010;164(9):803-809. Copyright restrictions may apply

Introduction

• Chronic fatigue syndrome (CFS) may affect as many as 800 000 individuals (primarily adolescents and adults) in the United States.

– It is characterized by debilitating, persistent fatigue that lasts more than 6 months.

– Symptoms are typically exacerbated by physical and mental activity.

• In adolescents, CFS accounts for marked functional impairment and educational disruption.

• Recent study by these investigators: – 13% of adolescents presenting with acute mononucleosis infection failed to recover and met CFS criteria 6 months later.

– Questions: What leads to failure to recover? Could it be physical deconditioning?

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Methods

•

Study Design

– Prospective case-control cohort study.

– Involved retrospective measurement of activity in the year before mononucleosis.

– Also involved prospective measurement of activity and fatigue at baseline and at 6, 12, and 24 months after infection.

•

Sample/Participants

– 301 adolescents diagnosed with acute infectious mononucleosis.

– At 6 months: 39 patients were diagnosed as having CFS; 39 negative controls were randomly selected from the remaining sample.

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Methods

•

Data Collection

– CFS Screening Questionnaire.

– Fatigue Severity Scale.

– Modifiable Activity Questionnaire.

•

Data Analysis

– χ 2 and paired sample

t

tests were used to compare the CFS subjects with their matched controls; statistical significance was set at

P

≤ .01.

•

Limitations

– Follow-up was limited to 24 months; CFS duration may be 5 years on average.

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Results

• Adolescents with CFS reported higher fatigue severity than controls during mononucleosis and at all follow-ups.

• In the year before mononucleosis onset, adolescents who later developed CFS had the same level of physical activity as adolescents who did not develop CFS.

• During active infection with mononucleosis, adolescents who later developed CFS had the same level of physical activity as controls.

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Results

• At the 6-month follow-up, adolescents with CFS demonstrated increased sleep during the day compared with controls; in contrast, activity levels in these 2 groups were similar.

• By 24 months, there were no differences in sleep or activity between adolescents with CFS and matched controls.

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Results

Table. Physical Activities of 39 Adolescents With CFS and 39 Matched Controls at the 6-, 12-, and 24-Month Follow-ups Copyright restrictions may apply

Comment

• Trends toward reduced activity and increased napping in the CFS group suggest that adolescents with CFS may be struggling to keep up with their peers to maintain their usual activity levels.

• Recovery of some adolescents from CFS during the study increased the risk of type II error (failure to find a statistically significant difference).

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Comment

•

Implications

– It is possible that the CFS recovery period is marked by an increased need for sleep rather than decreased physical activity —this sleep dysfunction merits further investigation to understand how to support recovering patients more effectively.

– Optimal management during acute mononucleosis remains in question but does not appear to be related to preillness physical activity based on this study.

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Contact Information

• If you have questions, please contact the corresponding author: – Renée Taylor, PhD, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago ([email protected]).

Funding/Support

• Funding was provided by grant R01HD4330101A1 from the National Institute of Child Health and Human Development and grant M01 RR-00048 from the National Center for Research Resources.

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