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Post-exertional malaise
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=== Sleep === A first study into the effects of exercise on sleep in ME/CFS found a beneficial effect: approximately half the patients slept better after exercise.<ref name="Togo2010">{{Cite journal | last = Togo | first = Fumiharu | last2 = Natelson | first2 = Benjamin H. | last3 = Cherniack | first3 = Neil S. | last4 = Klapholz | first4 = Marc | last5 = Rapoport | first5 = David M. | last6 = Cook | first6 = Dane B. | date = Jan 2010 | title = Sleep is not disrupted by exercise in patients with chronic fatigue syndromes|url=https://www.ncbi.nlm.nih.gov/pubmed/20010134|journal=Medicine and Science in Sports and Exercise|volume=42|issue=1|pages=16–22|doi=10.1249/MSS.0b013e3181b11bc7|issn=1530-0315|pmc=2796587|pmid=20010134}}</ref> A follow-up study by the same research team (under the guidance of Benjamin Natelson) found more post-exercise improvement (transitions to deeper sleep stages) of sleep in ME/CFS patients than in controls. The patients, however, reported more fatigue in the morning after exercise while healthy controls showed significant improvement in sleepiness and fatigue. The authors speculated this to be due to a disruption of the REM sleep: ME/CFS showed, both at baseline and post-exercise, an increased rate of transition from REM to wake compared to controls and this correlated with symptoms of fatigue, pain and sleepiness.<ref name="Kishi2013">{{Cite journal | last = Kishi | first = Akifumi | last2 = Togo | first2 = Fumiharu | last3 = Cook | first3 = Dane B | last4 = Klapholz | first4 = Marc | last5 = Yamamoto | first5 = Yoshiharu | last6 = Rapoport | first6 = David M | last7 = Natelson | first7 = Benjamin H | date = Nov 2013 | title = The effects of exercise on dynamic sleep morphology in healthy controls and patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3871467/|journal=Physiological Reports|volume=1|issue=6|doi=10.1002/phy2.152|issn=2051-817X|pmc=3871467|pmid=24400154}}</ref> An Australian study followed up on 35 ME/CFS patients after performing a physical (stationary cycling) or cognitive (stimulated driving) challenge. While patients spent a greater proportion of wakeful hours lying down, they did not report significant changes in sleep quality or sleep duration. The authors did however note that the expected increase in [[heart rate variability]] (HRV) between wake and sleep, was significantly reduced in ME/CFS patients after completing the challenges. These changes in HRV have been associated with the falling asleep, and might be related to the unfreshed sleep of ME/CFS patients.<ref name="Cvejic2017">{{Cite journal | last = Cvejic | first = Erin | last2 = Sandler | first2 = Carolina X. | last3 = Keech | first3 = Andrew | last4 = Barry | first4 = Benjamin K. | last5 = Lloyd | first5 = Andrew R. | last6 = Vollmer-Conna | first6 = Uté | date = Dec 2017 | title = Autonomic nervous system function, activity patterns, and sleep after physical or cognitive challenge in people with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/29167053|journal=Journal of Psychosomatic Research|volume=103 | pages = 91–94|doi=10.1016/j.jpsychores.2017.10.010|issn=1879-1360|pmid=29167053}}</ref> Finally, Ohashi et al. (2002) recorded physical activity for 6-days in 10 patients with ME/CFS and 6 controls before and after performing a maximal treadmill test. Their results indicate an increase in circadian rest-activity in ME/CFS patients after exercise as the activity pattern of patients shifted toward later hours in the day.<ref name="Ohashi2002">{{Cite journal | last = Ohashi | first = Kyoko | last2 = Yamamoto | first2 = Yoshiharu | last3 = Natelson | first3 = Benjamin H. | date = Sep 2002 | title = Activity rhythm degrades after strenuous exercise in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/12213500|journal=Physiology & Behavior|volume=77|issue=1|pages=39–44|issn=0031-9384|pmid=12213500}}</ref>
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