Journal of IiME Volume 5 Issue 1 (May 2011) Using Cardiopulmonary Exercise Testing to Evaluate Fatigue and Post-Exertional Malaise in ME/CFS continued relevant to research looking at immune function where individual fitness levels and exercise intensity can profoundly affect the immune response.[6] The availability of RER also gives CPET the capacity to objectively document PEM in ME/CFS patients. The reproducibility of both metabolic and work intensity measures obtained through CPET is well documented.[1] But research using CPET to examine functional capacity in CFS has found that a single test may be insufficient to identify abnormalities in work performance among CFS patients.[7, 8] By employing a dual test paradigm (i.e., 2 exercise tests, each separated by 24 hours) it is possible to compare data across tests. A significant change in exercise capacity during follow-up testing with similar peak RER values, it could be argued, is clear evidence of PEM. It should also be noted that RER is a critical arbiter when dealing with accusations of malingering or lack of effort! REFERENCES 1. Balady GJ, Arena R, Sietsema K, et al. Clinician's guide to cardiopulmonary exercise testing in adults: A scientific statement from the american heart association. Circulation. 2010;122:191-225. 2. Bitterman ME. Fatigue defined as reduced efficiency. American Journal of Psychology. 1944;57:569–73. 3. Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ. Principles of exercise testing and interpretation: Including pathophysiology and clinical applications, 2nd ed. Philadelphia, PA, USA, Lippincott Williams Wilkins, 2004. 4. Piepoli MF. Exercise tolerance measurements in pulmonary vascular diseases and CHF. Respiration. 2009;77:241–251 5. Maes M, Twisk FN. Why myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may kill you: disorders in the inflammatory and oxidative and nitrosative stress (IO&NS) pathways may explain cardiovascular Invest in ME (Charity Nr. 1114035) disorders in ME/CFS. Neuro Endocrinol Lett. 2009;30(6):677-93. 6. and the immune system: Regulation, integration, and adaptation. Physiol Rev. 2000;80:1055-81. 7. VanNess J.M., Snell, C.R., and Stevens, S.R. Diminished Cardiopulmonary Capacity During Post-Exertional Malaise in Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome. 2007;14(2): 77-85. 8. W, Scholte HR. Patients with chronic fatigue syndrome performed worse than controls in a controlled repeated exercise study despite a normal oxidative phosphorylation capacity. J Transl Med. 2010;8:93. ME FACTS From over 2,000 pages of information obtained under the Freedom of Information Act, much is already known about the design and progress of the PACE Trial, including the fact that its entry criteria were intentionally broad (“We chose these broad criteria in order to enhance generalisability and recruitment”; Trial Identifier 3.6). Despite the use of such broad entry criteria, there were serious recruitment difficulties, so the entry criteria were broadened even further when on 14th July 2006 Peter White sought approval from the West Midlands MREC to write to GPs imploring them to send anyone with “chronic fatigue (or synonym)” for entry into the PACE Trial, thereby opening the trial to anyone who was merely chronically tired. from Magical Medicine: How to Make a Disease Disappear - http://tinyurl.com/38yuj83 www.investinme.org Page 12/58 Pedersen BK, Hoffman-Goetz L. Exercise Vermeulen RC, Kurk RM, Visser FC, Sluiter

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