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Deconditioning
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== Evidence == In 2005 [[Peter White]], an influential proponent of the deconditioning hypothesis since the 1990s, stated that: {{Quote|We do not know whether this deconditioning maintains the illness or is a consequence.}} Despite the lack of evidence for the deconditioning hypothesis, White and other members of the [[Wessely school]] promoted this belief and developed treatments based on it, which were adopted in a number of countries including the [[United States]], [[United Kingdom]], and [[Netherlands]].<ref name="niceng206">{{Cite web | url = https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group|first = | authorlink = | publisher = [[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref> In their literature review, [[Lucy Clark|Clark]] and [[Peter White|White]] (2005) found that people with chronic fatigue syndrome were at least as deconditioned as healthy controls with a similar level of physical inactivity, but did not draw conclusions about whether they were more deconditioned.<ref name=":1">{{Cite journal | last = Clark|first = Lucy V | authorlink = Lucy Clark | last2 = White | first2 = Peter D | authorlink2 = Peter White | date = June 2005 | title = The role of deconditioning and therapeutic exercise in chronic fatigue syndrome (CFS) | url = https://www.tandfonline.com/doi/abs/10.1080/09638230500136308|journal=Journal of Mental Health|language=en|volume=14|issue=3 | pages = 237β252|doi=10.1080/09638230500136308|issn=0963-8237|via=}}</ref> Clarke and White later became authors of the highly controversial [[PACE trial]].<ref name="pace2011a">{{citation | last1 = White | first1 = PD | author-link1 = Peter White | last2 = Goldsmith | first2 = KA | authorlink2 = Kimberley Goldsmith | last3 = Johnson | first3 = AL | authorlink3 = Anthony Johnson | last4 =Potts | first4 = L | author-link4 = Laura Potts | last5 = Walwyn | first5 = R | author-link5 = Rebecca Walwyn | last6 = DeCesare | first6 = JC | author-link6 = Julia DeCesare | last7 = Baber | first7 = HL | author-link8 = Hannah Baber | last8 = Burgess | first8 = M | author-link8 = Mary Burgess | last9 = Clark | first9 = LV | author-link9 = Lucy Clark | last10 = Cox | first10 = DL | author-link10 = Diane Cox | last11 = Bavinton | first11 = J | author-link11 = Jessica Bavinton | last12 = Angus | first12 = BJ | author-link12 = BJ Angus | last13 = Murphy | first13 = G | author-link13 = Gabrielle Murphy | last14 = Murphy | first14 = M | author-link14 = Maurice Murphy | last15 = O'Dowd | first15 = H | author-link15 = Hazel O'Dowd | last16 = Wilks | first16 = D | author-link16 = David Wilks | last17 = McCrone | first17 = P | author-link17 = Paul McCrone | last18 = Chalder | first18 = T | author-link18 = Trudie Chalder | last19 = Sharpe | first19 = M | author-link19 = Michael Sharpe | last20 = on behalf of the PACE Trial Management Group| authorlink20 = PACE Trial Management Group | title = Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial| journal = The Lancet | volume = 377 | issue = 9768 | pages = 823β836 | date = March 5, 2011 | pmid = 21334061| doi = 10.1016/S0140-6736(11)60096-2 | url = http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/}}</ref> Results from [[Two-day cardiopulmonary exercise test|two-day cardiopulmonary exercise tests]] provide clear evidence that patients with ME/CFS have an abnormal response to exercise, which is not the result of deconditioning.<ref name="Snell2013">{{Cite journal | last = Snell|first = C.R. | authorlink = Christopher Snell | last2 = Stevens | first2 = S.R. | authorlink2 = Staci Stevens | last3 = Davenport | first3 = T.E. | author-link3 = Todd Davenport | last4 = Van Ness | first4 = J.M. | author-link4 = Mark VanNess | author-link5 = | date = 2013-06-27 | title = Discriminative Validity of Metabolic and Workload Measurements for Identifying People With Chronic Fatigue Syndrome | url = https://academic.oup.com/ptj/article/93/11/1484/2735315|journal=Physical Therapy|language=en|volume=93|issue=11 | pages = 1484β1492|doi=10.2522/ptj.20110368|issn=0031-9023|quote=|via=}}</ref> A large Dutch study by van Campen et al. (2018) found that deconditioning could not explain the cardiac index and stroke volume index changes in patients with ME/CFS that occurred during a normal tilt test.<ref name=":<ref name="vanCampen2018" /> Nakatomi and colleagues (2014) found widespread evidence of [[neuroinflammation]] in patients with [[ME/CFS]], and that neuroinflammation was correlated with the severity of neuropsychologic symptoms,<ref name="Nakatomi2014"/> while a review by Nijs and colleagues (2014) found evidence of an altered immune response to [[exercise]] in patients with ME/CFS.<ref name="Nijs2014"/>
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