Frozen in Amber blog post, by Caroline Elisabeth: Energy systems and pacing in ME/CFS, 29 June 2020



  • The aerobic energy system is “broken” in ME/CFS and cannot be fixed with exercise (i.e., graded exercise therapy, also known as GET).
  • The anaerobic (glycolytic) system appears to be somewhat functional in ME/CFS (but see McGregor’s work) and, in theory, can be trained to be more efficient with a carefully-designed exercise protocol done under the guidance of an ME/CFS-literate physical therapist.
  • It is vitally important to avoid spending time above the anaerobic threshold, also known as “AT”.
  • It is also advisable to minimize the duration of aerobic activities, including cognitive tasks.
  • If the points above appear to contradict each other, in a sense they do! But a well-designed pacing program can minimize the negative effects of both aerobic and anaerobic metabolism while at the same time harness the benefits of each energy system.


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