Exercise

Effects of exercise in Chronic Fatigue Syndrome
Exercise has also been found to induce both early and excessive lactic acid formation in the muscles with reduced intraceullar concentrations of ATP and acceleration of glycolysis. Several studies have found abnormal increases in plasma lactate following short period of moderate exercise that cannot be explained by deconditioning.

Examples of Clinical Recommendations
While there has been no research on physical therapy alternatives to graded exercise, many clinicians recommend some exercise or strength training for patients who are able. Dr. Sarah Myhill recommends patients who are well enough engage in strength training, specifically Body by Science created by Dr Doug McGuff and John Little. "If muscle strength is correctly developed, this automatically translates into cardiovascular fitness and increased numbers of mitochondria". Dr Myhill has a page on her web site detailing her recommendations.

Dr. Lucinda Bateman encourages her patients to find a way to exercise: "we try to focus on maintaining or improving muscle strength, flexibility and also bit of cardiovascular exercise". She discusses exercise and gene expression in an interview. Dr. Nancy Klimas recommends patients engage in exercise or movement without exceeding a certain heart rate, a proxy for an individual's anaerobic threshold, as established by a VO2 max test.