Review article extracts:

Abstract: Post-exertional “malaise” is a hallmark symptom of Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Various abnormalities, including abnormal physiological responses to exertion, can account for post-exertional “malaise” and “exercise avoidance”. Since these abnormalities are not observed in sedentary healthy controls, the abnormalities and deviant responses cannot be explained by “exercise avoidance” and subsequent deconditioning, nor by  psychogenic factors.

Abnormalities relating to exercise and its effect:

  • Energetic abnormalities and reduced oxygen uptake amplified by exertion
  • Muscular abnormalities related to exercise
  • Long-lasting oxidative stress in response to exercise
  • Increased pain sensitivity and lower pain thresholds during and after exercise
  • Immunologic abnormalities in response to exertion
  • Cardiovascular dysfunction related to exertion and orthostasis
  • Autonomic abnormalities associated with exercise and orthostatic stress
  • Neurologic abnormalities in relation to physical and mental exertion

Conclusion: Post-exertional “malaise” and “exercise intolerance” are hallmark symptoms [80] of Myalgic Encephalomyelitis (ME) [1-3] and Chronic Fatigue Syndrome (CFS) [4].

This article reviews observations which support the position that post-exertional “malaise” in ME/CFS may be linked to a number of observable deviant physiological responses to exercise, including muscle weakness and myalgia, a substantial fall of oxygen uptake after exercise, an increase in metabolite-detecting (pain) receptors, increased acidosis, abnormal immune responses, and orthostatic intolerance.

Such findings go some way to explain why many ME/CFS sufferers either avoid exercise or report negative effects of exercised-based rehabilitation protocols, such as graded exercise therapy (GET). The physiological abnormalities induced by ME/CFS cannot be simply explained by a sedentary life style and deconditioning [81], or psychogenic factors
[82]. While we acknowledge the importance of physical activity in illness rehabilitation, our findings cast doubt on the efficacy of exercise protocols as a therapeutic approach.

More research into exercise-induced cellular and physiological abnormalities in ME/CFS is needed to better understanding the illness and its impact on patients, and to develop appropriate treatments.

Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome, by Frank N.M. Twisk, Keith J. Geraghty in Jacobs Journal of Physiology 11-07-2015

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