{"id":21907,"date":"2019-08-02T08:16:38","date_gmt":"2019-08-02T08:16:38","guid":{"rendered":"https:\/\/wames.org.uk\/cms-english\/?p=21907"},"modified":"2019-08-02T08:16:38","modified_gmt":"2019-08-02T08:16:38","slug":"magenta-trial-comment-targeting-activity-levels-in-me-cfs","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/magenta-trial-comment-targeting-activity-levels-in-me-cfs\/","title":{"rendered":"MAGENTA trial comment: &#8216;Targeting activity levels in ME\/CFS"},"content":{"rendered":"<h3><strong>Michiel Tack queries some conclusions of the recently published MAGENTA trial paper.<\/strong><\/h3>\n<p style=\"text-align: left; padding-left: 40px;\"><a href=\"https:\/\/bmjpaedsopen.bmj.com\/content\/3\/1\/e000425\" target=\"_blank\" rel=\"noopener noreferrer\"><em>Physical activity patterns among children and adolescents with mild-to-moderate chronic fatigue syndrome\/myalgic encephalomyelitis<\/em><\/a>, by Emma Solomon-Moore, Russell Jago, Lucy Beasant, Amberly Brigden, Esther Crawley <span style=\"text-decoration: underline;\">in<\/span> <em>BMJ Paediatrics Open<\/em> Volume 3, Issue 1, 2019<\/p>\n<p><strong><a href=\"https:\/\/wames.org.uk\/cms-english\/magenta-trial-comment-targeting-activity-levels-in-me-cfs\/2-children-smaller-2\/\" rel=\"attachment wp-att-21926\"><img data-recalc-dims=\"1\" decoding=\"async\" class=\"alignright size-medium wp-image-21926 lazyload\" data-src=\"https:\/\/i0.wp.com\/wames.org.uk\/cms-english\/wp-content\/uploads\/2019\/08\/2-children-smaller-1.jpg?resize=300%2C200&#038;ssl=1\" alt=\"\" width=\"300\" height=\"200\" data-srcset=\"https:\/\/i0.wp.com\/wames.org.uk\/cms-english\/wp-content\/uploads\/2019\/08\/2-children-smaller-1.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/wames.org.uk\/cms-english\/wp-content\/uploads\/2019\/08\/2-children-smaller-1.jpg?resize=150%2C100&amp;ssl=1 150w, https:\/\/i0.wp.com\/wames.org.uk\/cms-english\/wp-content\/uploads\/2019\/08\/2-children-smaller-1.jpg?resize=768%2C511&amp;ssl=1 768w, https:\/\/i0.wp.com\/wames.org.uk\/cms-english\/wp-content\/uploads\/2019\/08\/2-children-smaller-1.jpg?w=800&amp;ssl=1 800w\" data-sizes=\"(max-width: 300px) 100vw, 300px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 300px; --smush-placeholder-aspect-ratio: 300\/200;\" \/><\/a>The study concludes:<\/strong><\/p>\n<ul>\n<li>Children and adolescents with chronic fatigue syndrome\/myalgic encephalomyelitis (CFS\/ME) are less active than the general child population, but not all are inactive. 9.4% of participants met physical activity recommendations.<\/li>\n<li>Compared with being \u2018inactive\u2019, \u2018active\u2019 children reported greater physical function but increased anxiety, while \u2018lightly\u2019 active children reported greater physical function and reduced fatigue.<\/li>\n<li>Paediatricians need to recognise that physical activity varies between patients with CFS\/ME when they recommend treatment.<\/li>\n<\/ul>\n<h3><strong>Comment:<\/strong> Targe<a href=\"https:\/\/bmjpaedsopen.bmj.com\/content\/3\/1\/e000425.responses\" target=\"_blank\" rel=\"noopener noreferrer\">ting activity levels in ME\/CFS<\/a>,\u00a0 by Michiel Tack <span style=\"text-decoration: underline;\">in<\/span> <em>BMJ Paediatrics Open<\/em> [Published on: 15 July 2019]<\/h3>\n<p>Contrary to what is claimed by Solomon-Moore et al., [1] the study by Van der Werf et al., (reference 17) [2] found little evidence of a boom and bust activity pattern in adult patients with myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS). The Dutch researchers measured physical activity using actimeters worn for 12 consecutive days. There was no significant difference in day-to-day fluctuations in physical activity between ME\/CFS patients and controls. The peak amplitude and peak duration of physical activity were larger in controls than in ME\/CFS patients while the latter had longer rest duration after an activity peak. Another actimeter study [3] found no supporting evidence of a more fluctuating activity pattern in patients with ME\/CFS compared to controls, during the day, nor during consecutive days.<\/p>\n<p>Now, Solomon-Moore et al. report that in children and adolescents with ME\/CFS, no fluctuating active or boom-bust physical activity pattern could be identified.<\/p>\n<p>It would be helpful if the authors could clarify how the actimeter data impacted the treatments in the MAGENTA trial. According to the trial protocol [4], one of the interventions aimed to \u201cconvert a boom\u2013bust pattern of activity (lots 1 day and little the next) to a baseline with the same daily amount\u201d. Was this aspect removed from the intervention now that participants showed little indication of a boom\u2013bust activity pattern? Or were young ME\/CFS patients instructed to correct illness behavior they did not display when tested objectively?<\/p>\n<p>Solomon-Moore et al., [1] also report that 9.4% of participants achieved government recommended levels of physical activity for children and adolescents, namely a minimum of 60 minutes of moderate to vigorous physical activity per day. This is of interest given that approximately half of healthy children and adolescents do not reach this target. [1] These results indicate that activity patterns are unlikely to be a key factor in perpetuating ME\/CFS symptoms, at least for this subgroup. Nonetheless, one of the interventions in the MAGENTA trial aims for a gradual increase in physical activity by prescribing exercise targets. Were ME\/CFS patients who already met government health recommendations for physical activity also instructed to increase their amount of exercise by 10-20% a week or were they exempted?<\/p>\n<p>I look forward to reading the authors\u2019 response to these questions.<\/p>\n<p>References<\/p>\n<p>[1] Solomon-Moore E, Jago R, Beasant L, Brigden A, Crawley E. Physical activity patterns among children and adolescents with mild-to-moderate chronic fatigue syndrome\/myalgic encephalomyelitis. BMJ Paediatr Open. 2019 May 2;3(1):e000425. 2019.<\/p>\n<p>[2] van der Werf SP, Prins JB, Vercoulen JH, et al. Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment. J Psychosom Res 2000;49:373\u20139.<\/p>\n<p>[3] Meeus M, van Eupen I, van Baarle E, De Boeck V, Luyckx A, Kos D, et al. Symptom fluctuations and daily physical activity in patients with chronic fatigue syndrome: a case-control study. Arch Phys Med Rehabil. 2011 Nov;92(11):1820-6.<\/p>\n<p>[4] Brigden A, Beasant L, Hollingworth W, et al. Managed activity graded exercise iN teenagers and pre-Adolescents (magenta) feasibility randomised controlled trial: study protocol. BMJ Open 2016;6:e011255.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Michiel Tack queries some conclusions of the recently published MAGENTA trial paper. Physical activity patterns among children and adolescents with mild-to-moderate chronic fatigue syndrome\/myalgic encephalomyelitis, by Emma Solomon-Moore, Russell Jago, Lucy Beasant, Amberly Brigden, Esther Crawley in BMJ Paediatrics Open &hellip; <a href=\"https:\/\/wames.org.uk\/cms-english\/magenta-trial-comment-targeting-activity-levels-in-me-cfs\/\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[625,4000,5175,257,416,5219,4611,2470,5172,1449,5218,427],"class_list":["post-21907","post","type-post","status-publish","format-standard","hentry","category-news","tag-adolescents","tag-amberly-brigden","tag-boom-and-bust-behaviour","tag-children","tag-dr-esther-crawley","tag-emma-solomon-moore","tag-lucy-beasant","tag-magenta-trial","tag-michiel-tack","tag-physical-activity","tag-russell-jago","tag-teenagers"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-5Hl","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/21907","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=21907"}],"version-history":[{"count":5,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/21907\/revisions"}],"predecessor-version":[{"id":21929,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/21907\/revisions\/21929"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=21907"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=21907"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=21907"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}