PubMed · 13285352
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A SCHEIMBERG. 1955-12-12. [Problems posed by abnormal fatigue].. https://pubmed.ncbi.nlm.nih.gov/13285352/
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Chronic fatigue is a typical symptom of neurological diseases, and is most disabling in multiple sclerosis, postpoliomyelitis, poststroke, and in chronic fatigue syndrome. Disorders of neuromuscular junction transmission and metabolic diseases cause muscle fatigability, which is characterised by failure to sustain the force of muscle contraction (peripheral fatigue). Fatigue is also seen in diseases that affect the central, peripheral, and autonomic nervous systems (central fatigue). Enhanced perception of effort and limited endurance of sustained physical and mental activities are the main characteristics of central fatigue. Metabolic and structural lesions that disrupt the usual process of activation in pathways interconnecting the basal ganglia, thalamus, limbic system, and higher cortical centre are implicated in the pathophysiological process of central fatigue. A state of pre-existing relative hypocortisolaemia might sensitise the hypothalamic-pituitary-adrenal axis to development of persistent central fatigue after stress. The contributions of physiological, cognitive, and affective changes underlying fatigue are variable, and treatment is largely symptomatic and rehabilitative.
The aim of this study was to assess the tasks and activities that make physical demands on Dutch fire-fighters and to compare them with a guideline related to the development of excessive fatigue. The occupational physical demands on Dutch fire-fighters were assessed by conducting a task analysis during 85 24-h shifts. While workplace observations on the duration and frequency of physical tasks and activities were recorded, the heart rate was measured. This was then used to calculate the heart rate reserve percentage (%HRR) for predefined working periods, tasks and activities during 24-h shifts. The findings indicate that actual fire-fighting during 24-h shifts is characterised by a low frequency of incidents, a short 'turn-out' time, short tasks, and activities with a moderate to occasionally high energetic workload. Two tasks which sometimes occur in actual fire-fighting exceeded the guideline on energetic workload. The conclusion was that, though the number of incidents and the occupational demands are low during 24-h shifts, the peak loads for these two tasks are energetically high and could lead to excessive fatigue. Consequently, attention may need to be paid to health surveillance for persons exposed to such energetic peak loads, the development of physical and medical selection procedures, training, and workplace adjustments.