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Published in: Journal of Translational Medicine 1/2021

Open Access 01-12-2021 | Cancer Fatigue | Research

Hand grip strength and fatigability: correlation with clinical parameters and diagnostic suitability in ME/CFS

Authors: Bianka Jäkel, Claudia Kedor, Patricia Grabowski, Kirsten Wittke, Silvia Thiel, Nadja Scherbakov, Wolfram Doehner, Carmen Scheibenbogen, Helma Freitag

Published in: Journal of Translational Medicine | Issue 1/2021

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Abstract

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex and debilitating disease accompanied by muscular fatigue and pain. A functional measure to assess muscle fatigability of ME/CFS patients is, however, not established in clinical routine. The aim of this study is to evaluate by assessing repeat maximum handgrip strength (HGS), muscle fatigability as a diagnostic tool and its correlation with clinical parameters.

Methods

We assessed the HGS of 105 patients with ME/CFS, 18 patients with Cancer related fatigue (CRF) and 66 healthy controls (HC) using an electric dynamometer assessing maximal (Fmax) and mean force (Fmean) of ten repetitive measurements. Results were correlated with clinical parameters, creatinine kinase (CK) and lactate dehydrogenase (LDH). Further, maximum isometric quadriceps strength measurement was conducted in eight ME/CFS patients and eight HC.

Results

ME/CFS patients have a significantly lower Fmax and Fmean HGS compared to HC (p < 0.0001). Further, Fatigue Ratio assessing decline in strength during repeat maximal HGS measurement (Fmax/Fmean) was higher (p ≤ 0.0012). The Recovery Ratio after an identical second testing 60 min later was significantly lower in ME/CFS compared to HC (Fmean2/Fmean1; p ≤ 0.0020). Lower HGS parameters correlated with severity of disease, post-exertional malaise and muscle pain and with higher CK and LDH levels after exertion.

Conclusion

Repeat HGS assessment is a sensitive diagnostic test to assess muscular fatigue and fatigability and an objective measure to assess disease severity in ME/CFS.
Appendix
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Literature
1.
go back to reference Grabowski P, Scheibenbogen C. 464e Chronisches Fatigue Syndrom. In: Suttorp N, Möckel M, Siegmund B, al e, editors. Harrisons Innere Medizin. 19. Berlin: ABW Wissenschaftsverlag GmbH; 2016. Grabowski P, Scheibenbogen C. 464e Chronisches Fatigue Syndrom. In: Suttorp N, Möckel M, Siegmund B, al e, editors. Harrisons Innere Medizin. 19. Berlin: ABW Wissenschaftsverlag GmbH; 2016.
2.
go back to reference Grabowski P, Scheibenbogen C. Das Chronische Fatigue Syndrom - eine unterschätzte Erkrankung. Forum Sanitas. 2018;3:36–8. Grabowski P, Scheibenbogen C. Das Chronische Fatigue Syndrom - eine unterschätzte Erkrankung. Forum Sanitas. 2018;3:36–8.
3.
go back to reference Mateo LJ, Chu L, Stevens S, Stevens J, Snell CR, Davenport T, et al. Post-exertional symptoms distinguish myalgic encephalomyelitis/chronic fatigue syndrome subjects from healthy controls. Work (Reading, Mass). 2020. Mateo LJ, Chu L, Stevens S, Stevens J, Snell CR, Davenport T, et al. Post-exertional symptoms distinguish myalgic encephalomyelitis/chronic fatigue syndrome subjects from healthy controls. Work (Reading, Mass). 2020.
4.
go back to reference Wirth K, Scheibenbogen C. A Unifying Hypothesis of the Pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Recognitions from the finding of autoantibodies against ß2-adrenergic receptors. (1873–0183 (Electronic)). Wirth K, Scheibenbogen C. A Unifying Hypothesis of the Pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Recognitions from the finding of autoantibodies against ß2-adrenergic receptors. (1873–0183 (Electronic)).
5.
go back to reference Carruthers B, Jain A, De Meirleir K, al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J Chronic Fatig Syndr. 2003;11:178. Carruthers B, Jain A, De Meirleir K, al. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. J Chronic Fatig Syndr. 2003;11:178.
6.
go back to reference Speight N. Myalgic encephalomyelitis/chronic fatigue syndrome: Review of history, clinical features, and controversies. Saudi J Med Med Sci. 2013;1(1):11–3.CrossRef Speight N. Myalgic encephalomyelitis/chronic fatigue syndrome: Review of history, clinical features, and controversies. Saudi J Med Med Sci. 2013;1(1):11–3.CrossRef
7.
go back to reference Nelson MJ, Buckley JD, Thomson RL, Clark D, Kwiatek R, Davison K. Diagnostic sensitivity of 2-day cardiopulmonary exercise testing in myalgic encephalomyelitis/chronic fatigue syndrome. J Transl Med. 2019;17(1):80.CrossRef Nelson MJ, Buckley JD, Thomson RL, Clark D, Kwiatek R, Davison K. Diagnostic sensitivity of 2-day cardiopulmonary exercise testing in myalgic encephalomyelitis/chronic fatigue syndrome. J Transl Med. 2019;17(1):80.CrossRef
8.
go back to reference Hodges LD, Nielsen T, Baken D. Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study. Clin Physiol Funct Imaging. 2018;38(4):639–44.CrossRef Hodges LD, Nielsen T, Baken D. Physiological measures in participants with chronic fatigue syndrome, multiple sclerosis and healthy controls following repeated exercise: a pilot study. Clin Physiol Funct Imaging. 2018;38(4):639–44.CrossRef
9.
go back to reference Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18(5):465–70.CrossRef Bohannon RW. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Curr Opin Clin Nutr Metab Care. 2015;18(5):465–70.CrossRef
10.
go back to reference Meeus M, Ickmans K, Struyf F, Kos D, Lambrecht L, Willekens B, et al. What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia. Clin Rheumatol. 2016;35(1):191–203.CrossRef Meeus M, Ickmans K, Struyf F, Kos D, Lambrecht L, Willekens B, et al. What is in a name? Comparing diagnostic criteria for chronic fatigue syndrome with or without fibromyalgia. Clin Rheumatol. 2016;35(1):191–203.CrossRef
11.
go back to reference Nacul LC, Mudie K, Kingdon CC, Clark TG, Lacerda EM. Hand grip strength as a clinical biomarker for ME/CFS and disease severity. Front Neurol. 2018;9:992.CrossRef Nacul LC, Mudie K, Kingdon CC, Clark TG, Lacerda EM. Hand grip strength as a clinical biomarker for ME/CFS and disease severity. Front Neurol. 2018;9:992.CrossRef
12.
go back to reference Neu D, Mairesse O, Montana X, Gilson M, Corazza F, Lefevre N, et al. Dimensions of pure chronic fatigue: psychophysical, cognitive and biological correlates in the chronic fatigue syndrome. Eur J Appl Physiol. 2014;114(9):1841–51.CrossRef Neu D, Mairesse O, Montana X, Gilson M, Corazza F, Lefevre N, et al. Dimensions of pure chronic fatigue: psychophysical, cognitive and biological correlates in the chronic fatigue syndrome. Eur J Appl Physiol. 2014;114(9):1841–51.CrossRef
13.
go back to reference Jammes Y, Stavris C, Charpin C, Rebaudet S, Lagrange G, Retornaz F. Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue. Clin Biomech (Bristol, Avon). 2020;73:162–5.CrossRef Jammes Y, Stavris C, Charpin C, Rebaudet S, Lagrange G, Retornaz F. Maximal handgrip strength can predict maximal physical performance in patients with chronic fatigue. Clin Biomech (Bristol, Avon). 2020;73:162–5.CrossRef
14.
go back to reference Paul L, Wood L, Behan WM, Maclaren WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. Eur J Neurol. 1999;6(1):63–9.CrossRef Paul L, Wood L, Behan WM, Maclaren WM. Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome. Eur J Neurol. 1999;6(1):63–9.CrossRef
15.
go back to reference Gibson H, Carroll N, Clague JE, Edwards RH. Exercise performance and fatiguability in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1993;56(9):993–8.CrossRef Gibson H, Carroll N, Clague JE, Edwards RH. Exercise performance and fatiguability in patients with chronic fatigue syndrome. J Neurol Neurosurg Psychiatry. 1993;56(9):993–8.CrossRef
16.
go back to reference Cella D, Davis K, Breitbart W, Curt G, Coalition F. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a united states sample of cancer survivors. J Clin Oncol. 2001;19(14):3385–91.CrossRef Cella D, Davis K, Breitbart W, Curt G, Coalition F. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a united states sample of cancer survivors. J Clin Oncol. 2001;19(14):3385–91.CrossRef
17.
go back to reference Doehner W, Turhan G, Leyva F, Rauchhaus M, Sandek A, Jankowska EA, et al. Skeletal muscle weakness is related to insulin resistance in patients with chronic heart failure. ESC Heart Failure. 2015;2(2):85–9.CrossRef Doehner W, Turhan G, Leyva F, Rauchhaus M, Sandek A, Jankowska EA, et al. Skeletal muscle weakness is related to insulin resistance in patients with chronic heart failure. ESC Heart Failure. 2015;2(2):85–9.CrossRef
18.
go back to reference Cicoira M, Bolger AP, Doehner W, Rauchhaus M, Davos C, Sharma R, et al. High tumour necrosis factor-alpha levels are associated with exercise intolerance and neurohormonal activation in chronic heart failure patients. Cytokine. 2001;15(2):80–6.CrossRef Cicoira M, Bolger AP, Doehner W, Rauchhaus M, Davos C, Sharma R, et al. High tumour necrosis factor-alpha levels are associated with exercise intolerance and neurohormonal activation in chronic heart failure patients. Cytokine. 2001;15(2):80–6.CrossRef
19.
go back to reference Bell DS. The doctor’s guide to chronic fatigue syndrome. Berlin: Addison-Wesley Publishing Company Reading; 1995. Bell DS. The doctor’s guide to chronic fatigue syndrome. Berlin: Addison-Wesley Publishing Company Reading; 1995.
20.
21.
go back to reference Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, et al. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–53.CrossRef Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, et al. Development of a fatigue scale. J Psychosom Res. 1993;37(2):147–53.CrossRef
22.
go back to reference Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012;87(12):1196–201.CrossRef Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012;87(12):1196–201.CrossRef
23.
go back to reference Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DE. Symptoms of autonomic dysfunction in chronic fatigue syndrome. QJM. 2007;100(8):519–26.CrossRef Newton JL, Okonkwo O, Sutcliffe K, Seth A, Shin J, Jones DE. Symptoms of autonomic dysfunction in chronic fatigue syndrome. QJM. 2007;100(8):519–26.CrossRef
24.
go back to reference Cotler J, Holtzman C, Dudun C, Jason LA. A brief questionnaire to assess post-exertional malaise. Diagnostics (Basel, Switzerland). 2018;8:3. Cotler J, Holtzman C, Dudun C, Jason LA. A brief questionnaire to assess post-exertional malaise. Diagnostics (Basel, Switzerland). 2018;8:3.
25.
go back to reference Fluge O, Risa K, Lunde S, Alme K, Rekeland IG, Sapkota D, et al. B-lymphocyte depletion in myalgic encephalopathy/chronic fatigue syndrome. An open-label phase II study with rituximab maintenance treatment. PloS one. 2015;10(7):e0129898.CrossRef Fluge O, Risa K, Lunde S, Alme K, Rekeland IG, Sapkota D, et al. B-lymphocyte depletion in myalgic encephalopathy/chronic fatigue syndrome. An open-label phase II study with rituximab maintenance treatment. PloS one. 2015;10(7):e0129898.CrossRef
26.
go back to reference Scheibenbogen C, Loebel M, Freitag H, Krueger A, Bauer S, Antelmann M, et al. Immunoadsorption to remove ss2 adrenergic receptor antibodies in chronic fatigue syndrome CFS/ME. PLoS ONE. 2018;13(3):e0193672.CrossRef Scheibenbogen C, Loebel M, Freitag H, Krueger A, Bauer S, Antelmann M, et al. Immunoadsorption to remove ss2 adrenergic receptor antibodies in chronic fatigue syndrome CFS/ME. PLoS ONE. 2018;13(3):e0193672.CrossRef
27.
go back to reference Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121(12):953–9.CrossRef Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994;121(12):953–9.CrossRef
28.
go back to reference Ickmans K, Meeus M, De Kooning M, Lambrecht L, Nijs J. Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia. Eur J Clin Invest. 2014;44(2):153–9.CrossRef Ickmans K, Meeus M, De Kooning M, Lambrecht L, Nijs J. Recovery of upper limb muscle function in chronic fatigue syndrome with and without fibromyalgia. Eur J Clin Invest. 2014;44(2):153–9.CrossRef
29.
go back to reference Goudsmit EM, Nijs J, Jason LA, Wallman KE. Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document. Disabil Rehabil. 2012;34(13):1140–7.CrossRef Goudsmit EM, Nijs J, Jason LA, Wallman KE. Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document. Disabil Rehabil. 2012;34(13):1140–7.CrossRef
30.
go back to reference Fluge O, Mella O, Bruland O, Risa K, Dyrstad SE, Alme K, et al. Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome. JCI Insight. 2016;1(21):e89376.CrossRef Fluge O, Mella O, Bruland O, Risa K, Dyrstad SE, Alme K, et al. Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome. JCI Insight. 2016;1(21):e89376.CrossRef
31.
go back to reference Kindermann W. Creatine Kinase Levels After Exercise. (1866–0452 (Electronic)). Kindermann W. Creatine Kinase Levels After Exercise. (1866–0452 (Electronic)).
32.
go back to reference Nacul L, de Barros B, Kingdon CC, Cliff JM, Clark TG, Mudie K, et al. Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study. LID - https://doi.org/10.3390/diagnostics9020041 [doi] LID - 41. 2019(2075–4418 (Print)). Nacul L, de Barros B, Kingdon CC, Cliff JM, Clark TG, Mudie K, et al. Evidence of Clinical Pathology Abnormalities in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) from an Analytic Cross-Sectional Study. LID - https://​doi.​org/​10.​3390/​diagnostics90200​41 [doi] LID - 41. 2019(2075–4418 (Print)).
33.
go back to reference Almenar-Pérez E, Sarría L, Nathanson L, Oltra EA-O. Assessing diagnostic value of microRNAs from peripheral blood mononuclear cells and extracellular vesicles in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. (2045–2322 (Electronic)). Almenar-Pérez E, Sarría L, Nathanson L, Oltra EA-O. Assessing diagnostic value of microRNAs from peripheral blood mononuclear cells and extracellular vesicles in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. (2045–2322 (Electronic)).
34.
go back to reference Pietrangelo T, Toniolo L, Paoli A, Fulle S, Puglielli C, Fanò G, et al. Functional characterization of muscle fibres from patients with chronic fatigue syndrome: case-control study. Int J Immunopathol Pharmacol. 2009;22(2):427–36.CrossRef Pietrangelo T, Toniolo L, Paoli A, Fulle S, Puglielli C, Fanò G, et al. Functional characterization of muscle fibres from patients with chronic fatigue syndrome: case-control study. Int J Immunopathol Pharmacol. 2009;22(2):427–36.CrossRef
35.
go back to reference Pietrangelo T, Mancinelli R, Toniolo L, Montanari G, Vecchiet J, Fanò G, et al. Transcription profile analysis of vastus lateralis muscle from patients with chronic fatigue syndrome. Int J Immunopathol Pharmacol. 2009;22(3):795–807.CrossRef Pietrangelo T, Mancinelli R, Toniolo L, Montanari G, Vecchiet J, Fanò G, et al. Transcription profile analysis of vastus lateralis muscle from patients with chronic fatigue syndrome. Int J Immunopathol Pharmacol. 2009;22(3):795–807.CrossRef
36.
go back to reference Brown AE, Dibnah B, Fisher E, Newton JL, Walker M. Pharmacological activation of AMPK and glucose uptake in cultured human skeletal muscle cells from patients with ME/CFS. Bioscience reports. 2018;38:3.CrossRef Brown AE, Dibnah B, Fisher E, Newton JL, Walker M. Pharmacological activation of AMPK and glucose uptake in cultured human skeletal muscle cells from patients with ME/CFS. Bioscience reports. 2018;38:3.CrossRef
37.
go back to reference McCully KK, Smith S, Rajaei S, Leigh JS, Natelson BH. Muscle metabolism with blood flow restriction in chronic fatigue syndrome. J Appl Physiol. 2004;96(3):871–8.CrossRef McCully KK, Smith S, Rajaei S, Leigh JS, Natelson BH. Muscle metabolism with blood flow restriction in chronic fatigue syndrome. J Appl Physiol. 2004;96(3):871–8.CrossRef
38.
go back to reference van Campen C, Rowe PC, Visser FC. Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing. Healthcare (Basel, Switzerland). 2020;8:2. van Campen C, Rowe PC, Visser FC. Cerebral Blood Flow Is Reduced in Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients During Mild Orthostatic Stress Testing: An Exploratory Study at 20 Degrees of Head-Up Tilt Testing. Healthcare (Basel, Switzerland). 2020;8:2.
39.
go back to reference Jones DE, Hollingsworth KG, Taylor R, Blamire AM, Newton JL. Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome. J Intern Med. 2010;267(4):394–401.CrossRef Jones DE, Hollingsworth KG, Taylor R, Blamire AM, Newton JL. Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome. J Intern Med. 2010;267(4):394–401.CrossRef
40.
go back to reference Scherbakov N, Szklarski M, Hartwig J, Sotzny F, Lorenz S, Meyer A, et al. Peripheral endothelial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome. ESC Heart Failure. 2020;7(3):1064–71.CrossRef Scherbakov N, Szklarski M, Hartwig J, Sotzny F, Lorenz S, Meyer A, et al. Peripheral endothelial dysfunction in myalgic encephalomyelitis/chronic fatigue syndrome. ESC Heart Failure. 2020;7(3):1064–71.CrossRef
41.
go back to reference Leblanc A, Pescatello LS, Taylor BA, Capizzi JA, Clarkson PM, Michael White C, et al. Relationships between physical activity and muscular strength among healthy adults across the lifespan. SpringerPlus. 2015;4:557.CrossRef Leblanc A, Pescatello LS, Taylor BA, Capizzi JA, Clarkson PM, Michael White C, et al. Relationships between physical activity and muscular strength among healthy adults across the lifespan. SpringerPlus. 2015;4:557.CrossRef
Metadata
Title
Hand grip strength and fatigability: correlation with clinical parameters and diagnostic suitability in ME/CFS
Authors
Bianka Jäkel
Claudia Kedor
Patricia Grabowski
Kirsten Wittke
Silvia Thiel
Nadja Scherbakov
Wolfram Doehner
Carmen Scheibenbogen
Helma Freitag
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Journal of Translational Medicine / Issue 1/2021
Electronic ISSN: 1479-5876
DOI
https://doi.org/10.1186/s12967-021-02774-w

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