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=== Musculature === Exercise has also been found to induce both early and excessive lactic acid formation in the [[muscle fatigability|muscles]]<ref name="Plioplys1995">{{citation | last1 = Plioplys | first1 = AV | author-link1 = | last2 =Plioplys | first2 = S | authorlink2 = | title = Serum levels of carnitine in chronic fatigue syndrome: clinical correlates| journal = Neuropsychobiology | date = 1995 | volume = 32 | issue = 3 | page = 132-138 | pmid = 8544970| url = http://www.ncbi.nlm.nih.gov/pubmed/8544970 }}</ref> with reduced intracellular concentrations of [[ATP]] and acceleration of [[glycolysis]].<ref name="McCully1996">{{citation | last1 = McCully | first1 = KK | author-link1 = | last2 =Natelson | first2 = BH | authorlink2 = Benjamin Natelson | last3 = Iotti | first3 = S | authorlink3 = | last4 = Sisto | first4 = S | authorlink4 = | last5 = Leigh | first5 = JS Jr. | authorlink5 = | title = Reduced oxidative muscle metabolism in chronic fatigue syndrome | journal = Muscle Nerve | volume = 19 | issue = 5 | page = 621-625 | date = May 1996 | pmid = 8618560 | doi =| url = http://www.ncbi.nlm.nih.gov/pubmed/8618560 }}</ref> Several studies have found abnormal increases in plasma [[lactate]] following short period of moderate exercise that cannot be explained by [[deconditioning]].<ref name="LaneRJ1998">{{citation | last1 = Lane | first1 = R J | author-link1 = Russell Lane | last2 =Barrett | first2 = M C | authorlink2 = Michael Barrett | last3 = Taylor | first3 = D J | authorlink3 = Doris Taylor | last4 = Kemp | first4 = G J | authorlink4 = Graham Kemp | last5 = Lodi | first5 = R | authorlink5 = Raffaele Lodi | title = Heterogeneity in chronic fatigue syndrome: evidence from magnetic resonance spectroscopy of muscle| journal = Neuromuscul Disord | volume = 8 | issue = 3-4 | page = 204-9 | date = May 1998 | pmid = 9631403 | url = http://www.ncbi.nlm.nih.gov/pubmed/9631403 }}</ref> There are abnormalities in pH handling by peripheral muscle, and possible evidence of an increased acidosis and lactate accumulation.<ref name="JonesDE2010">{{citation | last1 = Jones | first1 = David EJ | author-link1 = David Jones | last2 =Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Taylor | first3 = Renee R | authorlink3 = Renee Taylor | last4 = Blamire | first4 = Andrew M | authorlink4 = Andrew Blamire | last5 = Newton | first5 = Julia L | authorlink5 = Julia Newton | title = Abnormalities in pH handling by peripheral muscle and potential regulation by the autonomic nervous system in chronic fatigue syndrome| journal = J Intern Med | volume = 267 | issue = 4 | page = 394-401 | date = Apr 2010 | pmid = 20433583 | doi = 10.1111/j.1365-2796.2009.02160.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2009.02160.x/abstract }}</ref> <ref name="JonesDE2012">{{citation | last1 = Jones | first1 = David EJ | author-link1 = David Jones | last2 =Hollingsworth | first2 = Kieren G | authorlink2 = Kieren Hollingsworth | last3 = Jakovljevic | first3 = Djordje G | authorlink3 = Djordje Jakovljevic | last4 =Fattakhova | first4 = Gulnar | authorlink4 = Gulnar Fattakhova | last5 = Pairman | first5 = Jessie | authorlink5 = Jessie Pairman | last6 = Blamire | first6 = Andrew M | authorlink6 = Andrew Blamire | last7 =Trenell | first7 = Michael I | author-link8 = Michael Trenell | last8 = Newton | first8 = Julia L | author-link8 = Julia Newton| display-authors = | title = Loss of capacity to recover from acidosis on repeat exercise in chronic fatigue syndrome | journal = Eur J Clin Invest | volume = 42 | issue = 2 | page = 186-94 | date = Jul 12, 2011 | pmid = 21749371 | doi = 10.1111/j.1365-2362.2011.02567.x | url = http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.2011.02567.x/abstract }}</ref><ref name="LengertN2015">{{citation | last1 = Lengert | first1 = Nicor | author-link1 = Nicor Lengert | last2 =Drossel | first2 = Barbara| authorlink2 = Barbara Drossel | title = In silico analysis of exercise intolerance in myalgic encephalomyelitis/chronic fatigue syndrome| journal = Biophysical Chemistry | volume = 202 | page = 21β31 | date = Jul 2015 | pmid = 25899994 | doi = 10.1016/j.bpc.2015.03.009| url = http://www.sciencedirect.com/science/article/pii/S0301462215000630 }}</ref> There is also evidence of loss of capacity to recover from acidosis on repeat exercise, as demonstrated by the [[two-day cardiopulmonary exercise test|Two-Day Cardiopulmonary Exercise Test]].<ref name="JonesDE2012" /> Finally, there is evidence of abnormalities of [[AMPK]] activation and glucose uptake in cultured skeletal muscle cells in ME/CFS patients.<ref name="BrownAE2015">{{Citation | last1 = Brown | first1 = Audrey E | author-link1 = Audrey Brown | last2 =Jones | first2 = David E | authorlink2 = David Jones | last3 = Walker | first3 = Mark | authorlink3 = Mark Walker | last4 = Newton | first4 = Julia L | authorlink4 = Julia Newton | title = Abnormalities of AMPK activation and glucose uptake in cultured skeletal muscle cells | journal = PLoS One | volume = 10 | issue = 4 | date = Apr 2, 2015 | pmid = 25836975 | doi = 10.1371/journal.pone.0122982 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122982 }}</ref> [[File:Light2011-geneexpression-figure3.jpg|right|frame|Gene expression changes following moderate exercise (Light et al, 2011)|516x516px]]
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