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Multicenter Study
. 2020 Jan:147:202-212.
doi: 10.1016/j.ijpsycho.2019.11.008. Epub 2019 Nov 28.

Post-exertional malaise in veterans with gulf war illness

Jacob B Lindheimer  1 , Aaron J Stegner  1 , Glenn R Wylie  2 , Jacquelyn C Klein-Adams  3 , Neda E Almassi  1 , Jacob V Ninneman  1 , Stephanie M Van Riper  1 , Ryan J Dougherty  4 , Michael J Falvo  5 , Dane B Cook  6
Affiliations
Multicenter Study

Post-exertional malaise in veterans with gulf war illness

Jacob B Lindheimer et al. Int J Psychophysiol. 2020 Jan.

Abstract

Post-exertional malaise (PEM) is a potentially debilitating aspect of Gulf War Illness (GWI) that has received limited research attention. The purpose of the present investigation was to determine symptom severity changes following exercise in Veterans with GWI compared to control Veterans without GWI (CO). Sixty-seven Veterans (n = 39 GWI; n = 28 CO) underwent a 30-minute submaximal exercise challenge at 70% of heart rate reserve. Symptom measurements (e.g. fatigue, pain) occurred pre-, immediately post-, and 24-hour post-exercise. Self-reported physical and mental health, and physiological and perceptual responses to exercise were compared between groups using descriptive statistics, independent samples t-tests and repeated measures Analysis of Variance (RM-ANOVA). Post-exertional malaise was modeled using Group by Time (2 × 3) doubly-multivariate, RM-MANOVAs for (1) mood, (2) pain and (3) GWI-related symptoms, respectively (α = 0.05). Data were analyzed for the full sample of Veterans with GWI (n = 39) compared to CO (n = 28) and a subsample of Veterans (n = 18) who endorsed "feeling unwell after physical exercise or exertion" ("PEM endorsers") during screening. Veterans with GWI reported significantly lower physical and mental health. Groups exercised at similar relative exercise intensities, but GWI perceived exercise as more painful and fatiguing. Group-by-Time interactions were not significant for the entire sample for the three PEM models, however limiting the GWI sample to "PEM endorsers" resulted in significant interactions for Pain- and GWI-related PEM models. These results indicate that not all GVs with GWI experience PEM 24 h after exercise, and that more research is needed to determine the extent that exercise worsens symptoms in GWI.

Keywords: Chronic disease; Cognition; Exercise; Fatigue; Pain; Persian Gulf War.

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Conflict of interest statement

Disclosure statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Mean (SE) perceptual and lactate responses to exercise challenge in Veterans with Gulf War Illness (GWI), the GWI subgroup with PEM endorsement (GWI+PEM) subgroup, and control Veterans without GWI (CO) Note. Total participants with complete listwise data across all time-points for each outcome are listed as follows: Ratings of Perceived Exertion (GWI=32; GWI+PEM=15; CO=27); Leg Muscle Pain Intensity (GWI=33; GWI+PEM=15; CO=26); Fatigue (GWI=33; GWI+PEM=15; CO=27); Blood Lactate (GWI=32; GWI+PEM=16; CO=23)
Figure 2.
Figure 2.
Mean (SE) POMS-BF symptoms before, after, and 24 hours after exercise in Veterans with Gulf War Illness (GWI; n=39), GWI subgroup with PEM endorsement (GWI+PEM; n=18), and control Veterans without GWI (CO; n=28). Note. Total participants with complete listwise data across all time-points was: GWI=38; GWI+PEM=17; CO=28.
Figure 3.
Figure 3.
Mean (SE) SF-MPQ-2 symptoms before, after, and 24 hours after exercise in Veterans with Gulf War Illness (GWI; n=39), GWI subgroup with PEM endorsement (GWI+PEM; n=18), and control Veterans without GWI (CO; n=28). Note. Total participants with complete listwise data across all time-points was: GWI=38; GWI+PEM=17; CO=28.
Figure 4.
Figure 4.
Mean (SE) CDC VAS symptoms before, after, and 24 hours after exercise in Veterans with Gulf War Illness GWI (n=39), GWI subgroup with PEM endorsement (GWI+PEM; n=18), and control Veterans without GWI (CO; n=28). Note. Total participants with complete listwise data across all time-points was: GWI=36; GWI+PEM=16; CO=28.
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References

    1. Kang HK, Mahan CM, Lee KY, Magee CA & Murphy FM Illnesses among united states veterans of the gulf war: a population-based survey of 30,000 veterans. Journal of Occupational and Environmental Medicine 42, 491–501 (2000). - PubMed
    1. Research Advisory Committee on Gulf War Veterans’ Illnesses. Gulf war illness and the health of gulf war veterans: scientific findings and recommendations. (U.S. Government Printing Office, 2008).
    1. Committee on Gulf War and Health, Volume 10: Update of Health Effects of Serving in the Gulf War, Board on the Health of Select Populations, Institute of Medicine & National Academies of Sciences, Engineering, and Medicine Gulf War and Health: Volume 10: Update of Health Effects of Serving in the Gulf War, 2016. (National Academies Press, 2016). - PubMed
    1. Forman-Hoffman VL et al. Chronic Widespread Pain in Veterans of the First Gulf War: Impact of Deployment Status and Associated Health Effects. The Journal of Pain 8, 954–961 (2007). - PubMed
    1. Li B, Mahan CM, Kang HK, Eisen SA & Engel CC Longitudinal health study of US 1991 Gulf War Veterans: changes in health status at 10-year follow-up. American Journal of Epidemiology 174, 761–768 (2011). - PubMed

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