Exercise Pathophysiology in ME/CFS and PASC


This review finds the mechanisms of systemic blood flow, ventilatory control, hemodynamic and gas exchange derangements to be involved in exercise intolerance in both conditions.

Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-Acute Sequelae of SARS-CoV-2: More in Common Than Not? by Phillip Joseph, Inderjit Singh, Rudolf Oliveira, Christine A Capone, Mary P Mullen, Dane B Cook, Mary Catherine Stovall, Johanna Squires, Kristine Madsen, Aaron B Waxman, David M Systrom in Chest. 2023 Apr 11;S0012-3692(23)00502-0 [10.1016/j.chest.2023.03.049]


This review aims to illustrate exercise pathophysiologic commonalities between PASC and ME/CFS that will help guide future diagnostics and treatment.

Research abstract:

Topic importance:

Post-Acute Sequelae of SARS-CoV-2 (PASC) is a long-term consequence of acute infection from coronavirus disease 2019 (COVID-19). Clinical overlap between PASC and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has been observed, with shared symptoms including intractable fatigue, post-exertional malaise, and orthostatic intolerance. The mechanistic underpinnings of such symptoms are poorly understood.

Review findings: 

Early studies suggest deconditioning as the primary explanation for exertional intolerance in PASC. Cardiopulmonary exercise testing (CPET) reveals perturbations related to systemic blood flow and ventilatory control associated with acute exercise intolerance in PASC, which are not typical of simple detraining.

Hemodynamic and gas exchange derangements in PASC have substantial overlap with those observed with ME/CFS, suggestive of shared mechanisms.


See also: Video – Dr David Systrom speaks about the pathophysiology of exercise intolerance in chronic fatigue syndrome, including a clinical case with a patient perspective.

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