Some of these links refer to ME/CFS as per the IOM which is a broad criteria encompassing many patients who may not have ME as defined by the ICC. For choosing proper research candidates, the IC Primer states on page ii: "...the ICC [International Consensus Criteria] select patients who exhibit explicit multi-systemic neuropathology, and have a pathological low threshold of physical and mental fatigability in response to exertion."
ME patients who exceed the safe activity threshold have post-exertional neuroimmune exhaustion (PENE) which can lead to serious deterioration.
Graded Exercise Therapy (GET) is contraindicated** in anyone with ME. **something (such as a symptom or condition) that makes a particular treatment or procedure inadvisable
HANDOUTS 25% ME Group Stance on Exercise from the 25% ME Group Charity - "We are extremely concerned that some medical/care professionals and sports/exercise specialists are still recommending exercise programmes and/or graded exercise therapy (GET) to people who suffer from ME without even adding very prominent warnings about the harm that exercise can cause to ME sufferers - especially those with severe ME." (U.K.) - August 2020
LETTER from the National Centre for Neuroimmunology and Emerging Diseases (Griffith University) describing the harm GET and CBT can impose on ME patients. Permission received for posting. NOTE: A typo labeling the ICC as the International Case Consensus has been recognized by the authors. (U.K.) - 31 January 2019
Coxsackie viruses are characteristically myotropic and enteroviral genomic sequences have been detected in muscle biopsies from patients with ME. Exercise related abnormalities of function have been demonstrated by nuclear magnetic resonance  and single fibre electro-myography including a failure to coordinate oxidative metabolism with anaerobic glycolysis causing abnormally early intracellular acidosis, consistent with the early fatiguability and the slow recovery from exercise in ME.
Coxsackie viruses can initiate non-cytolytic persistent infection in human cells. Animal models demonstrate similar enteroviral persistence in neurological disease, myopericarditis and the deleterious effect of forced exercise on persistently infected muscles. These studies elucidate the exercise-related morbidity and the chronic relapsing nature of ME.
[From the Conclusions section:]
ME predominantly affects the most socially and economically active section of society. Misinterpretation of this common illness as psychogenic delays the early recognition mandatory for modification of life style which may avoid progression to chronic disability.
"The medical management of ME differs greatly from that of other comparatively short-lived post infectious debility, such as may follow influenza, in that the patient with ME has a 30% chance of cardiac and other systemic complications and must modify their lifestyle to a reduced capacity for as long as it takes the illness to stablize.Early recognition and sensible advice to avoid mental or physical over-exertion, can do much to avert a prolonged chronic illness."
ME and CFS Exercise Intolerance from The Paradigm Change - "A list (in reverse chronological order) of peer-reviewed articles from medical journals on the phenomenon of exercise intolerance in myalgic encephalomyelitis and the broader condition of chronic fatigue syndrome." (U.S.)
Exercise Intolerance Quotes from The Paradigm Change - "... more than two dozen comments from experts in M.E. on this topic. Except where indicated otherwise, the quotes were supplied directly by the named individuals for this collection (in some cases a few years ago)." (U.S.)
VIDEOS Voices from the Shadows - Video one covers the danger of exercise (2018 - 8:49). The second video covers the inappropriateness and inaccuracies of the PACE trial (2019 - 8:59). (U.K.)
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