Qualitative Description of the Exertional Symptoms of Participants with Persistent Symptoms of Lyme Disease during a Low Intensity Resistance Training Intervention Original Research
Main Article Content
Keywords
Exercise log, Borrelia burgdorferi, RPE, Resistance exercise
Abstract
Introduction: Greater emphasis needs to be placed on approaches to improve the health-related quality of life of patients with persistent symptoms of Lyme disease (PSLD), but little information exists to inform an exercise professional’s expectations of their supervision of resistance training (RT) programs with PSLD patients. In order to build this knowledge base, a secondary qualitative analysis was performed to explore the RT exertional symptoms of PSLD patients that participated in a 4-week study investigating the feasibility of an RT intervention.
Methods: Comments regarding exertional symptoms that were recorded in a daily exercise log were the main source of data for this secondary analysis. A manifest content analysis was performed in order to identify recurrent themes of exertional symptoms experienced by this sample of PSLD patients during RT.
Results: The reported findings revealed that strain, discomfort, crepitus, tightness, shaking, and control loss were the major themes of exertional symptoms recorded during the RT intervention.
Conclusions: These results provide insights intended to inform the expectations of supervisors of exercise (personal trainers, physical therapists, exercise researchers, etc.) when directing RT programming with patients with PSLD.
References
2. Burgdorfer W. How the Discovery of Borrelia Burgdorferi Came About. Clin Dermatol. 1993;11(3):335-338. doi:10.1016/0738-081x(93)90087-s.
3. Sjöwall J, Ledel A, Ernerudh J, Ekerfelt C, Forsberg P. Doxycycline-Mediated Effects on Persistent Symptoms and Systemic Cytokine Responses Post-Neuroborreliosis: A Randomized, Prospective, Cross-over Study. BMC Infect Dis. 2012. doi:10.1186/1471-2334-12-186.
4. Hofmeester TR, Coipan EC, van Wieren SE, Prins HH, Takken W, Sprong H. Few Vertebrate Species Dominate the Borrelia Burgdorferi S.L. Life Cycle. Environ Res Lett. 2016;11(4). doi:10.1088/1748-9326/11/4/043001.
5. Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, Davis JP. Lyme Disease—a Tick-Borne Spirochetosis? Science. 1982;216(4552):1317-1319. doi:10.1126/science.7043737.
6. Hinckley AF, Connally NP, Meek JI, et al. Lyme Disease Testing by Large Commercial Laboratories in the United States. Clin Infect Dis. 2014;59(5):676-681. doi:10.1093/cid/ciu397.
7. Searing L. The Big Number: Lyme Disease Is Now in 100 Percent of the U.S. Washington Post. Published 2018.www.washingtonpost.com/national/health-science/the-big-number-lyme-disease-is-now-in-100-percent-of-the-us/2018/08/03/d35768ec-965e-11e8-810c-5fa705927d54story.html?noredirect=on&utmterm=.69c3d087cdb8.
8. Ogden NH, Radojevic´ M, Wu X, et al. Estimated Effects of Projected Climate Change on the Basic Reproductive Number of the Lyme Disease VectorIxodes Scapularis. Environ Health Perspect. 2014;122(6):631-638. doi:10.1289/ehp.1307799.
9. Randolph SE. Is Expert Opinion Enough? A Critical Assessment of the Evidence for Potential Impacts of Climate Change on Tick-Borne Diseases. Anim Health Res Rev. 2013;14(2):133-137. doi:10.1017/s1466252313000091.
10. Desmon S, Murrow S. Lyme Disease Costs Up to $1.3 Billion Per Year to Treat, Study Finds. Johns Hopkins Bloomberg Sch Public Health. Published 2015. www.jhsph.edu/news/news releases/2015/lyme-disease-costs-more-than-one-billion-dollars-per-year-to-treat-study-finds.html.
11. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-1134. doi:10.1086/508667.
12. Aucott JN, Crowder LA, Kortte KB. Development of a Foundation for a Case Definition of Post-Treatment Lyme Disease Syndrome. Int J Infect Dis. 2013;17(6). doi:10.1016/j.ijid.2013.01.008.
13. Di Domenico EG, Cavallo I, Bordignon V, et al. The Emerging Role of Microbial Biofilm in Lyme Neuroborreliosis. Front Neurol. 2018;9. doi:10.3389/fneur.2018.01048.
14. Nolen L. How Medical Education Is Missing the Bull’s-Eye. N Engl J Med. 2020;382(26):2489-2491. doi:10.1056/nejmp1915891.
15. Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK. Diagnostic Challenges of Early Lyme Disease: Lessons from a Community Case Series. BMC Infect Dis. 2009;9(1). doi:10.1186/1471-2334-9-79.
16. Adrion ER, Aucott J, Lemke KW, Weiner JP. Health Care Costs, Utilization and Patterns of Care Following Lyme Disease. PLoS One. 2015;10(2). doi:10.1371/journal.pone.0116767.
17. Steere AC, Gross D, Meyer AL, Huber BT. Autoimmune Mechanisms in Antibiotic Treatment-Resistant Lyme Arthritis. J Autoimmun. 2001;16(3):263-268. doi:10.1006/jaut.2000.0495.
18. Middelveen M, Sapi E, Burke J, et al. Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease. Healthcare. 2018;6(2):33. doi:10.3390/healthcare6020033.
19. Ali A, Vitulano L, Lee R, Weiss TR, Colson ER. Experiences of Patients Identifying with Chronic Lyme Disease in the Healthcare System: A Qualitative Study. BMC Fam Pract. 2014;15(1). doi:10.1186/1471-2296-15-79.
20. Arvikar SL, Crowley JT, Sulka KB, Steere AC. Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease. Arthritis Rheumatol. 2016;69(1):194-202. doi:10.1002/art.39866.
21. Burrascano J. Advanced Topics in Lyme Disease: Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick-Borne Illnesses. Bethesda; International Lyme and Associated Diseases Society; 2005.
22. National Institute of Allergy and Infectious Diseases. Chronic Lyme disease. National Institute of Allergy and Infectious Diseases. Published 2018. https://www.niaid.nih.gov/diseases-conditions/chronic-lyme-disease.
23. Rebman AW, Aucott JN. Post-Treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease. Front Med. 2020;7. doi:10.3389/fmed.2020.00057.
24. DeLong A, Hsu M, Kotsoris H. Estimation of Cumulative Number of Post-Treatment Lyme Disease Cases in the US, 2016 and 2020. BMC Public Health. 2019;19(1). doi:10.1186/s12889-019-6681-9.
25. Ranque-Garnier S, Eldin C, Sault C, Raoult D, Donnet A. Management of Patients Presenting with Generalized Musculoskeletal Pain and a Suspicion of Lyme Disease. Med Mal Infect. 2019;49(2):157-166. doi:10.1016/j.medmal.2019.01.008.
26. Macera CA, Hootman JM, Sniezek JE. Major Public Health Benefits of Physical Activity. Arthritis Rheum. 2003;49(1):122-128. doi:10.1002/art.10907
27. Roberts CK, Barnard RJ. Effects of Exercise and Diet on Chronic Disease. J Appl Physiol. 2005;98(1):3-30. doi:10.1152/japplphysiol.00852.2004.
28. Adamo CR, McMillin CR, Chen KW, Lucas EK, Berman BM. Supervised Resistance Exercise for Patients with Persistent Symptoms of Lyme Disease. Med Sci Sports Exerc. 2015;47(11):2291-2298. doi:10.1249/mss.0000000000000683.
29. Toth C, Brady S, Gagnon F, Wigglesworth K. A Randomized, Single-Blind, Controlled, Parallel Assignment Study of Exercise versus Education as Adjuvant in the Treatment of Peripheral Neuropathic Pain. Clin J Pain. 2014;30(2):111-118. doi:10.1097/ajp.0b013e31828ccd0f.
30. Corcos DM, Robichaud JA, David FJ, et al. A Two-Year Randomized Controlled Trial of Progressive Resistance Exercise for Parkinson's Disease. Mov Disord. 2013;28(9):1230-1240. doi:10.1002/mds.25380.
31. Durcan L, Wilson F, Cunnane G. The Effect of Exercise on Sleep and Fatigue in Rheumatoid Arthritis: A Randomized Controlled Study. J Rheumatol. 2014;41(10):1966-1973. doi:10.3899/jrheum.131282.
32. Feiereisen P, Delagardelle C, Vaillant M, Lasar Y, Beissel J. Is Strength Training the More Efficient Training Modality in Chronic Heart Failure? Med Sci Sports Exerc. 2007;39(11):1910-1917. doi:10.1249/mss.0b013e31814fb545.
33. Busch AJ, Webber SC, Richards RS, et al. Resistance Exercise Training for Fibromyalgia. Cochrane Database Syst Rev. 2013. doi:10.1002/14651858.cd010884.
34. Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P. Increased Rate of Force Development and Neural Drive of Human Skeletal Muscle Following Resistance Training. J Appl Physiol. 2002;93(4):1318-1326. doi:10.1152/japplphysiol.00283.2002.
35. Pedersen BK, Saltin B. Exercise as Medicine - Evidence for Prescribing Exercise as Therapy in 26 Different Chronic Diseases. Scand J Med Sci Sports. 2015;25. doi:10.1111/sms.12581.
36. Eijsvogels TM, Thompson PD. Exercise Is Medicine. JAMA. 2015;314(18):1915. doi:10.1001/jama.2015.10858.
37. McArt EW, McDougal LW. Secondary Data Analysis-a New Approach to Nursing Research. Image J Nurs Sch. 1985;17(2):54-57. doi:10.1111/j.1547-5069.1985.tb01418.x.
38. Sandelowski M. Whatever Happened to Qualitative Description? Res Nurs Health. 2000;23(4):334-340. doi:10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g.
39. Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
40. Purvis T. Skeletal-Neuromuscular Opportunity. Resistance Training Specialist Programs; 2011.
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This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright, 2025 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.
Charlie McMillin, PhD, Concordia University Chicago
Charlie McMillin is a personal trainer and a researcher investigating resistance training interventions with chronic disease populations. Currently he is splitting time between training clients and investigating the feasibility of a resistance training program with cancer patients undergoing proton treatment.
Dr. Bridget Melton, CSCS*D, TSAC-F*D, EP-C, Concordia University Chicago, Georgia Southern University
Bridget Melton is a Professor of Exercise Science and Coaching Education at Georgia Southern University and is an adjunct faculty member at Concordia University in Chicago. She teaches a variety of exercise science courses at the undergraduate, graduate, and doctoral levels, including Introduction to Exercise Science, Practical Applications of Human Movement, Principles of Personal Training, Sport Conditioning, Program Design in Physical Activity and Health, and Health Promotion and Disease Prevention, and Sport Nutrition. Dr. Melton’s research incorporated physical activity promotion, and the most recent research focuses on worksite wellness and tactical athletes.
Nicholas Murray, PhD, University of Nevada, Reno
Dr. Nicholas (Nic) Murray is an assistant professor in the School of Public Health and director of the Neuromechanics lab at the University of Nevada, Reno. In addition, he is the independent neurological assessor for the University of Nevada, Reno sports medicine, and Washoe County School Districts. His research focuses on the detection, treatment, and long-term effects of sport-related concussion and repetitive head trauma. His unique clinical and research expertise allows him to not only be an important part of a concussion management team but also study the underlying neurological impacts of head trauma.
Chris D'Adamo, PhD, University of Maryland School of Medicine
Dr. Chris D’Adamo is an epidemiologist with expertise in the impact of exercise, nutrition, dietary supplementation, and other modifiable lifestyle factors on human health. Dr. D’Adamo received his Ph.D. in Epidemiology in from the University of Maryland School of Medicine and is currently an Assistant Professor with dual appointments in the Departments of Family & Community Medicine and Epidemiology & Public Health. He is also the Director of the Center for Integrative Medicine.
Dr. D’Adamo has served as Principal Investigator on a wide variety of clinical trials and observational studies.
He has authored over 60 publications in numerous peer-reviewed scientific and medical journals including Nutrition, Clinical Nutrition, Nutrition Research, American Journal of Health Promotion, Journal of Nutrition, American Journal of Preventive Medicine, Nutrients, Journal of Nutrigenetics and Nutrigenomics, Journal of Nutrition, Aging, and Health,Journal of the American College of Nutrition, American Journal of Lifestyle Medicine, and Cochrane Database of Systematic Reviews, among many others.
Dr. D’Adamo has also contributed medical textbook chapters to the 6th and 7th editions of Rheumatology, the 5th and 6theditions of Practical Management of Pain, and gives invited lectures across the world topics in integrative, functional, and lifestyle medicine.