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1/ The problem with Myalgic Encephalomyeltis/Chronic Fatigue Syndrome #MECFS is that it seems so ridiculous that exercise could actually make patients worse

How can exercise be so bad for #pwME but so good for almost every other serious illness?

2/ New study by @4WorkWell @sunsopeningband et al shows that #MECFS patients have metabolic defects that cannot be explained by exercise phobias, deconditioning or 'illness beliefs'

#pwME have reduced oxygen consumption during exercise tests
3/ #pwME have an impaired ability to increase their oxygen consumption during exercise

This is entirely different to every other disease we know including cardiovascular disease, lung disease, end-stage renal disease, hypertension & cystic fibrosis

4/ And #MECFS patients also show impaired oxygen consumption and reduced anaerobic threshold compared to Multiple Sclerosis

#MECFS are #SickNotDeconditioned, #SickNotTired, #SickNotWeak…
5/ Exercise testing provides an explanation for why #MECFS patients can crash even after modest exertion

The reduced aerobic capacity of #pwME results in a switch to anaerobic #metabolism that likely impacts their ability to do simple daily activities…
6/ And #MECFS patients can 'crash' if they over-exert resulting in a post-exertional malaise #PEM

Triggering #PEM reduces the threshold at which anaerobic #metabolism accelerates which impairs the ability of patients to do non-strenuous tasks

7/ And exercise that triggers #PEM in #MECFS patients leads to a sustained #immune inflammatory response that is distinct from that in sedentary or deconditioned people

@PLOSONE #MedEd #SickNotTired…
8/ Humans use aerobic metabolism for the majority of daily activities such as walking and seated tasks

But a reduced aerobic capacity of #MECFS patients likely forces a switch to less efficient anaerobic metabolism leading to premature fatigue and #PEM…
9/ Exercise studies also show that the increased reliance on anaerobic #metabolism in #MECFS patients results in increased metabolites such as lactic acid which likely leads to an inability to maintain work and a reduction in activity…
10/ Physical therapists should be aware that post-exertional malaise #PEM in #pwME is due to objectively measurable deficits in metabolism

So yes, exercise is beneficial for nearly every illness...

..but the science shows that #MECFS is the exception…
This @FrontiersIn review by @4WorkWell discusses how cardiopulmonary exercise testing #CPET can be used to help diagnose & research #MECFS

This table provides a helpful list definitions for patients and doctors to investigate #MECFS

#MedEd #MedTwitter…
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