Journal of IiME Volume 2 Issue 2 www.investinme.org The Physiology of Exercise Intolerance in Patients with Myalgic Eencephalomyelitis (ME) and the Utility of Graded Exercise Therapy subtly different suites of symptoms. At best, graded exercise therapy has relieved symptoms for (but not cured) a tiny minority of patients, whilst the weight of empirical evidence indicates that exercise has direct and persistently negative impacts on the physiology and quality of life of a significant subgroup of ME patients. Any universally applied therapy is unlikely to address the heterogeneity of ME, and graded exercise is particularly unsuitable as it may worsen the condition, and should not be generally recommended without a high degree of confidence that it will not be applied to susceptible patients: it is difficult to conceive of a more inappropriate therapy for ME. By increasing the risk of relapse and overall health risks, rather than reducing them, graded exercise therapy also risks increasing the burden of illness on society at large. The present review suggests that an approach based on treatment of the underlying physiological dysfunction will be more fruitful. Abbreviations ATP = Adenosine triphosphate, RNase L = 2’,5’-oligoadenylate (2-5A) synthetase/Ribonuclease L Literature cited 1 De Becker PJ, Roeykens J, Reynders N, McGregor N & De Meirleir K. 2000. Exercise capacity in chronic fatigue syndrome. Archives of International Medicine 160: 32703277. 2 Fulcher KY & White PD. 2000. Strength and physiological response to exercise in patients with chronic fatigue syndrome. Journal of Neurology, Neurosurgery, and Psychiatry 69: 302-307. 3 4 Nus J, De Meirleir K, Wolfs S & Duquet W. 2004. Disability evaluation in chronic fatigue syndrome: associations between exercise capacity and activity limitations/participation restrictions. Clinical Rehabilitation 18: 139-148. 5 Sorensen B. Streib JE, Strand M, et al. 2003. Complement activation in a model of chronic fatique syndrome. Journal of Allergy and Clinical Immunology 112: 397-403. 6 Sargent C, Scroop GC, Nemeth PM, Burnet RB & Buckley JD. 2002. Maximal oxygen uptake and lactate metabolism are normal in chronic fatigue syndrome. Medicine & Science in Sports and Exercise 34: 51-56. 7 chronic fatigue syndrome. Journal of Clinical Pathology 58: 1126-1132. 8 National Institute for Health and Clinical Excellence (NICE). CFS/ME: full guideline DRAFT (September 2006). 9 Afari N & Buchwald D. 2003. Chronic fatigue syndrome: a review. American Journal of Psychiatry 160: 221-236. 10 Patarca-Montero R, Antoni M, Fletcher MA & Klimas NG. 2001. Cytokine and other immunologic markers in Chronic Fatigue Syndrome and their relation to neuropsychological factors. Applied Neuropsychology 8: 51-64. 11 Hooper M. 2006. Myalgic Wong R, Lopaschuk G, Zhu G, et al. 1992. Skeletal muscle metabolism in the chronic fatigue syndrome: in vivo assessment by 31P nuclear magnetic resonance spectroscopy. Chest 102: 1716-1722. Invest in ME (Charity Nr. 1114035) Encephalomyelitis (ME): a review with emphasis on key findings in biomedical research. Journal of Clinical Pathology (in press) published online 25 Aug. 2006 doi: 10.1136/jcp.2006.042408. 12 Lane RJM, Soteriou BA, Zhang H, & Archard LC. 2003. Enterovirus related metabolic myopathy: a postviral fatigue syndrome. Journal of Neurology, (continued on page 59) Page 58/74 Chia JKS. 2005. The role of enterovirus in

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