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Billions of people use caffeine every day. Could it help a bit with one of the most problematic and difficult aspects of fibromyalgia, ME/CFS and long COVID – exercise?

Another exercise study! We have exercise on the brain – kind of literally (you’ll see :).  Exercise studies are just rolling in. Over the past 2 months, Health Rising has reported on:

THE GIST

  • We have exercise on the brain – kind of literally (you’ll see :)) This is the 7th Health Rising blog in the last couple of months to feature the effects of exercise and how one might improve it.
  • Given the veritable explosion of exercise studies in fibromyalgia, it’s not surprising to see caffeine – a known athletic performance enhancer – be featured in a fibromyalgia exercise study.
  • Caffeine is able to enhance exercise in several way that might be helpful in FM, ME/CFS and long COVID. It upregulates fatty acid metabolism and reduces “central fatigue” which occurs when the brain produces fatigue in order to stop us from exerting ourselves. The Nath Intramural study found evidence of central fatigue in ME/CFS.
  • This small Brazilian study found that FM patients given caffeine experienced more vigor, enjoyed the exercise more, had increased muscle oxygen, etc. These findings were tied to a reduction in central or brain induced fatigue.
  • They concluded, “Caffeine seems to be a promising bioactive to counteract the central mechanisms of fatigability and improve the exercise experience among FM women.”
  • The question – as Lawrence Oliver so inimitably put it to Dustin Hoffman in the Marathon Man – “Is it safe?“. Could a caffeine-induced improvement of central fatigue allow people with ME/CFS and long COVID, in particular, to push too hard, damage their muscles, and cause more post-exertional malaise (PEM)?
  • Or, since central fatigue and increased effort are present in both these diseases, might caffeine’s ability to reduce central fatigue and effort perception allow them to exercise a bit more and become a bit fitter and healthier?
  • We don’t know. In general, it appears that muscle fatigue is produced by the brain while muscle pain is produced more by the muscles – suggesting that caffeine might work best if fatigue is the main problem.
  • Caffeine’s ability to reduce “perception of effort” and improve performance might be able to help with the increased perception of effort the intramural study found was associated with exertion in ME/CFS.
  • Caffeine, of course, is a central nervous stimulant that can be helpful or not depending on your biological makeup, how often you use it, etc. Studies show wide variability in results from person to person.
  • Caffeine enhances alertness and motivation, can help keep you regular, and may protect against some brain conditions. On the other hand, it can produce heartburn and nausea, irritability, and jitteriness, and, when taken in large amounts (over 5 cups/day) can inhibit calcium absorption in the bones.
  • This study suggests that caffeine may be able to help some people with fibromyalgia, and perhaps similar conditions, exercise a bit more and get a bit more fit and that, of course, would be very helpful.
  • If you’ve tried to use caffeine to help you exercise, please tell us how it went.

 

 

Caffeine and Exercise

complicated

Exercise – the situation is not as simple as one might think.

That’s a lot! And now comes a fibromyalgia exercise study. The fibromyalgia (FM) field has gone gaga over exercise. Since the beginning of the year, I counted no less than 12 FM exercise studies.

While it’s clear that exercise can be helpful for many people with FM, studies also show that people with FM exhibit significant muscle issues and have problems with aerobic energy production; in other words, the issue is far from simple.

Given all the interest in exercise and FM, it’s not at all surprising to see caffeine show up in an FM exercise study. While caffeine is used by 90% of adults in the U.S. to sharpen their attention, athletes also commonly use caffeine to enhance their performance. It’s been shown to positively affect exercise in many ways including:

  • Increasing endurance via the enhanced mobilization of fatty acids, thus allowing one to stay in aerobic energy production mode longer.
  • Reduction of central fatigue; i.e. caffeine allows the brain to activate the muscles for longer periods of time than it would otherwise, thus improving endurance.
  • Increases the breakdown of fats in fat cells – providing an efficient energy source.

Studies suggest that all these factors may be deficient in chronic fatigue syndrome (ME/CFS).

The Fibromyalgia Caffeine Exercise Study

The small (10 FM / 10 healthy controls) Brazilian FM study, “Caffeine Attenuates Exacerbated Central Fatigue during Moderate Intensity Cycling Exercise in Women with Fibromyalgia“, attempted to figure out if caffeine helped people with FM exert themselves, and if so, how.

It gave half the group a caffeine tablet and the other a placebo, and monitored a bunch of things (maximal voluntary isometric contractions (MVIC), voluntary activation (VA), quadriceps potentiated twitch torque (Q tw-pot), heart rate, muscle oxygen saturation, perceptive responses, mood state, localized and widespread pain, and sleepiness) before, and then 15 and 30 minutes after, exercise. (I could not find the caffeine dose – the paper and an adjoining one were too expensive to purchase.)

The study found that caffeine increased the number of “maximal voluntary isometric contractions (MVIC)” and the “voluntary activation (VA)” in both groups.

Maximal voluntary isometric contractions refer to the maximal force generated during an isometric muscle exercise. As exercise continues, a reduction in the maximal force generated is caused by the brain pulling back. This study indicated that caffeine was able to keep the brain from doing that to some extent.

Voluntary activation also refers to the maximal amount of force which is voluntarily generated. Once again, caffeine allowed the participants to voluntarily generate more force at the muscle levels during exercise.

Women pushing big ball aka Sisyphus

Caffeine has been able to reduce “perception of effort”, thus enabling people to exercise longer. High levels of “perception of effort” have been found in ME/CFS.

No increase in the quadriceps potentiated twitch torque (Q tw-pot, though, suggested that caffeine did not improve “peripheral fatigue”; that is, fatigue generated by the muscles themselves).

The positive results weren’t limited to the brain, however. Caffeine also increased muscle oxygenation, perceived vigor, and energy, and decreased leg muscle pain, sleepiness, and perceived fatigue in both groups.

Caffeine only improved feelings of pleasure / reduced feelings of displeasure and exercise adherence likelihood, though, in the group that presumably needed it the most – the FM group. It made exercise more enjoyable for them – potentially a big deal in disease in which kinesiophobia – the fear of experiencing pain due to movement – is probably present.

The authors concluded:

“Caffeine seems to be a promising bioactive to counteract the central mechanisms of fatigability and improve the exercise experience among FM women.”

Other fibromyalgia caffeine studies have been done. One found that caffeine may help people with more severe fibromyalgia experience less pain during exercise.  A very large study also found that caffeine was associated with reduced pain, catastrophizing, and improved physical function in FM patients who were using opioid medications (but not for those who were not.) Finally, one study found that fibromyalgia patients ingesting high levels of caffeine (over 5 cups pf coffee a day) were in greater pain than those taking in lower levels.

Safe or Not?

The question – as Lawrence Oliver so inimitably put it to Dustin Hoffman in the Marathon Man – “Is it safe?“. Could a caffeine-induced improvement of central fatigue allow people with ME/CFS and long COVID, in particular, to push too hard, damage their muscles and cause more post-exertional malaise (PEM)? Or, since central fatigue and increased effort are present in both these diseases, might caffeine’s ability to reduce central fatigue and effort perception allow them to exercise a bit more and become a bit fitter and healthier?

Rob Wust’s study showed that intense exercise can damage the muscles in long COVID, but we’re not talking about intense exercise – this is more about how caffeine might help people with FM/ME/CFS and long COVID tolerate mild exercise.

Exercise Causes Muscle Damage and Energy Depletion in Long COVID

Central fatigue is produced by neurochemical changes in the brain and can reflect, in part, signals coming from the muscles indicating that they are losing strength. In central fatigue, the brain produces symptoms of fatigue to stop the exertion. The muscles also help stop exertion by sending pain signals to the brain.

It may be simplistic, but it may be that caffeine might help most in those who experience more fatigue. Fibromyalgia and ME/CFS, though, add an interesting twist with their central sensitization. Because pain signals sent by the muscles are probably amplified in the brain in both diseases (but particularly in FM), pain in the muscles may not indicate that any damage has occurred.

Note that a study using healthy people found that caffeine’s ability to reduce “perception of effort” resulted in improved performance. It’s possible, then, that caffeine might be able to help with the increased perception of effort the intramural study found associated with exertion in ME/CFS.

Exercise non athlete

Nobody thinks caffeine is going to turn someone with FM, ME/CFS or long COVID into Arnold Schwarzenegger – but could it help around the edges?

Caffeine, of course, is a central nervous stimulant that can be helpful or not depending on your biological makeup, how often you use it, etc. Studies show wide variability in results from person to person.

Caffeine enhances alertness and motivation, can help keep you regular, and may protect against some brain conditions. On the other hand, it can produce heartburn and nausea, irritability, and jitteriness, and, when taken in large amounts (over 5 cups/day), can inhibit calcium absorption in the bones.

Since the effects of caffeine can vary so much from person to person, it’s impossible to make any prescriptions but this study suggests that caffeine may be able to help some people with fibromyalgia, and perhaps similar conditions, exercise a bit more and get a bit more fit and that, of course, would be very helpful.

If you’ve tried to use caffeine to help you exercise, please tell us how it went.

Health Rising’s Quickie Summer Drive Gets Amped Up! 

Thanks to the 149 people who have given a nice jolt to Health Rising’s Summer Drive with their support over the past couple of days. We are almost halfway to our goal of $20,000!

Exercise piggy

As a former avid exerciser one of my overriding goals is to learn what’s gone wrong during exercise – and ultimately find a way to fix it.

This blog – and ones before it demonstrate a key focus of Health Rising’s: to explore what’s happening during exercise and find anyway possible to enable people with these chronic illnesses to “exercise” or exert themselves in a safe manner.

Being a formerly an avid exerciser, the subject of PEM and exercise intolerance has absorbed me since my first acquaintance with ME/CFS. If that focus resonates with you, as well, please support Health Rising in a way that works for you.

 

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