Patients who show the "effort syndrome" symptom complex often have a lessened muscular strength in addition to the neurosis that is generally present. This weakness may be limited to a few muscle groups, but it is usually general and may be very marked. This was true with the men who entered this hospital from the American camps during the summer of 1918 and, because of this picture of poor muscular development, graded exercises were among the first methods adopted for an intensive study of the effort syndrome condition. Lewis and his co-workers1 have used grouped exercises, requiring varying degrees of effort, in estimating the future military usefulness of these men, and, from the results, those men unfit for military service were listed earlier for discharge and the individuals retained in service were classified for duty by the grade of graduate work they could successfully carry through.
In the studies at
SMITH B. THE POSSIBILITIES OF PHYSICAL DEVELOPMENT IN CASES OF EFFORT SYNDROME BY MEANS OF GRADED EXERCISES. Arch Intern Med (Chic). 1919;24(3):321-331. doi:10.1001/archinte.1919.00090260076006