Exercise

Exercise and the immune system
In healthy people, exercise induces a variety of temporary changes to immune markers. Immediately after exercise, natural killer cell activity is decreased and Leukotriene B4 (LTB4) increase, along with the LTB4/PGE2 ratio. Exercise elevates levels of prostaglandin E2 (PGE2) for up to five days.

Post Exertional Malaise
ME/CFS patients who exercise are likely to experience Post-exertional malaise.

Microbiome
A small study of ten CFS patients found significant changes in the composition of the microbiome and increased bacterial translocation (movement from the intestine into the bloodstream following exercise. In the blood, the study found increased Clostridium fifteen minutes after exercise and increased Bacilli 48 hours later.

Musculature
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.

There is evidence of loss of capacity to recover from acidosis on repeat exercise.

There is evidence of abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.

There is evidence of Abnormalities in pH handling by peripheral muscle.

Possible evidence of an increased acidosis and lactate accumulation.

Gene expression
There is evidence of increased gene expression following muscular exertion.

Second day exercise test
The seminal study on the response by CFS patients to a 2-day cardiopulmonary exercise test was published by J. Mark Van Ness, Christopher R. Snell & Staci R. Stevens in 2007: "Diminished Cardiopulmonary Capacity During Post-Exertional Malaise." A repeat study in 2013 confirmed these results. 

In a confirmation study, Doctor Betsy Keller found that patients could not repeat their performance on a second cardiopulmonary exercise test performed a day after the first.

Examples of clinical recommendations
While there has been no research on physical therapy alternatives to graded exercise, and many patients find it harmful, many clinicians recommend some exercise or strength training for patients who are able.

Dr Sarah Myhill
Dr 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
Dr 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
Dr 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.

Workwell Foundation
Staci Stevens and colleagues at the Workwell Foundation provide exercise advice. They have published a paper in 2010 for physical therapists, "Conceptual model for physical therapist management of chronic fatigue syndrome/myalgic encephalomyelitis." 

UK NICE Guidelines
British patient Sally Burch has written about the The UK National Institute for Health and Care Excellence (NICE) guidelines on maintaining a lower heart rate.

Talks & Interviews

 * 2014, Mark VanNess 'Exercise and ME/CFS' at Bristol Watershed. Part One

Learn more

 * 2016, Review Article: Understanding Muscle Dysfunction in Chronic Fatigue Syndrome
 * 2016, Dr VanNess on recent press reports (Mark VanNess, January)
 * 2016, Lost in Translation - The ME-Polio Connection and the Dangers of Exercise
 * 2015, Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome
 * 2014, Sufferers of chronic fatigue, fibromyalgia have hope in new diagnostic tool