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Post-exertional malaise
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=== Gulf war illness === [[James Baraniuk|Baraniuk]] and Shivapurkar (2017) looked at MicroRNAs (miRNA) in the [[cerebrospinal fluid]] of ME/CFS patients, healthy controls and patients with [[Gulf War Illness]] before and after an exercise challenge (a submaximal bicycle exercise). While there were no differences in miRNA between the groups at baseline, a distinct signature appeared after exercise. According to the authors, "exercise caused distinct patterns of miRNA changes in CFS and […] [[Gulf War Illness|GWI]] indicating significant pathophysiological differences between conditions."<ref name="Baraniuk2017">{{Cite journal | last = Baraniuk | first = James N. | last2 = Shivapurkar | first2 = Narayan | date = 2017-11-10 | title = Exercise – induced changes in cerebrospinal fluid miRNAs in Gulf War Illness, Chronic Fatigue Syndrome and sedentary control subjects|url=https://www.nature.com/articles/s41598-017-15383-9|journal=Scientific Reports|language=en|volume=7|issue=1|doi=10.1038/s41598-017-15383-9|issn=2045-2322}}</ref> A 2013 study under the guidance of [[Nancy Klimas]] compared the immune signature in 30 Gulf war patients, 22 ME/CFS patients and 30 controls, after an graded exercise test. Results indicated the importance of physical exercise for differentiating these different groups: <blockquote>"Common to both GWI and CFS illness signatures were the direct or indirect contributions of IL-10 and IL-23 expression though these occurred at very different times. While levels measured at rest supported an illness signature in GWI, their impact in CFS was only observable during and after exercise, again emphasizing the importance of a challenge and response timeline in distinguishing these illnesses."<ref name="Smylie2013">{{Cite journal | last = Smylie | first = Anne Liese | last2 = Broderick | first2 = Gordon | last3 = Fernandes | first3 = Henrique | last4 = Razdan | first4 = Shirin | last5 = Barnes | first5 = Zachary | last6 = Collado | first6 = Fanny | last7 = Sol | first7 = Connie | last8 = Fletcher | first8 = Mary Ann | last9 = Klimas | first9 = Nancy | authorlink9 = Nancy Klimas | date = 2013-06-25 | title = A comparison of sex-specific immune signatures in Gulf War illness and chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/23800166|journal=BMC immunology|volume=14|pages=29|doi=10.1186/1471-2172-14-29|issn=1471-2172|pmc=3698072|pmid=23800166}}</ref></blockquote> A study by Washington et al. (2020) found different brain activation patterns after exercise in patients with Gulf War Illness compared to ME/CFS, including the opposite response in some areas, despite both illnesses causing post-exertional malaise.<ref name="Washington2020">{{Cite journal | last = Washington | first = Stuart D. | authorlink = | last2 = Rayhan | first2 = Rakib U. | authorlink2 = Rakib Rayhan | last3 = Garner | first3 = Richard | author-link3 = | last4 = Provenzano | first4 = Destie | author-link4 = | last5 = Zajur | first5 = Kristina | authorlink5 = | last6 = Addiego | first6 = Florencia Martinez | authorlink6 = | last7 = VanMeter | first7 = John W. | last8 = Baraniuk | first8 = James N. | authorlink8 = James Baraniuk | date = 2020-07-01 | title = Exercise alters brain activation in Gulf War Illness and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://academic.oup.com/braincomms/article/2/2/fcaa070/5885074|journal=Brain Communications|language=en|volume=2|issue=2|pages=|doi=10.1093/braincomms/fcaa070|pmc=|pmid=|access-date=|quote=|via=}}</ref> The same study found that brain activation patterns did not change after exercise in healthy controls.<ref name="Washington2020" />
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