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Post-exertional malaise
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=== Autonomic response === Several research teams have noted post-exertional abnormalities in the [[Autonomic nervous system|autonomic]] function of ME/CFS patients, though the exact meaning of these results is not yet clear. A Canadian team under the guidance of Terrence Montague noted that during a maximal exercise test, ME/CFS patients have a lower maximal heart rate than controls. The authors noted that: <blockquote>"...patients with chronic fatigue syndrome have normal resting cardiac function but a markedly abbreviated exercise capacity characterized by slow acceleration of heart rate and fatigue of exercising muscles long before peak heart rate is achieved."<ref name="Montague1979">{{Cite journal | last = Montague | first = T.J. | last2 = Marrie | first2 = T.J. | last3 = Klassen | first3 = G.A. | last4 = Bewick | first4 = D.J. | last5 = Horacek | first5 = B.M. | date = Apr 1989 | title = Cardiac function at rest and with exercise in the chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/2924607|journal=Chest|volume=95|issue=4 | pages = 779–784|issn=0012-3692|pmid=2924607}}</ref> </blockquote>A significantly lower peak heart rate has been repeatedly observed in CPET-studies with ME/CFS patients.<ref name="Gibson1993">{{Cite journal | last = Gibson | first=H | last2 = Carroll | first2 = N | last3 = Clague | first3 = J E | last4 = Edwards | first4 = R H | date = Sep 1993 | title = Exercise performance and fatiguability in patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC489735/|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=56|issue=9 | pages = 993–998|issn=0022-3050|pmid=8410041}}</ref><ref name="LaManca1996">{{Cite journal | last = Sisto | first = Sue Ann | last2 = LaManca | first2 = John | last3 = Cordero | first3 = Douglas L. | last4 = Bergen | first4 = Michael T. | last5 = Ellis | first5 = Steven P. | last6 = Drastal | first6 = Susan | last7 = Boda | first7 = Wanda L. | last8 = Tapp | first8 = Walter N. | last9 = Natelson | first9 = Benjamin H. | date = Jun 1996 | title = Metabolic and cardiovascular effects of a progressive exercise test in patients with chronic fatigue syndrome|url=https://www.amjmed.com/article/S0002-9343(96)00041-1/pdf|journal=The American Journal of Medicine|language=English|volume=100|issue=6 | pages = 634–640|doi=10.1016/S0002-9343(96)00041-1|issn=0002-9343}}</ref><ref name="Rowbottom1998">{{Cite journal | last = Rowbottom | first = David | last2 = Keast | first2 = David | last3 = Pervan | first3 = Zhukov | last4 = Morton | first4 = Alan | date = Jan 1998 | title = The Physiological Response to Exercise in Chronic Fatigue Syndrome|url=https://www.tandfonline.com/doi/abs/10.1300/J092v04n02_04|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=4|issue=2|pages=33–49|doi=10.1300/j092v04n02_04|issn=1057-3321}}</ref> In one of the largest of these into exercise performance, the authors noted the same phenomenon as Montague et al. <blockquote>“The resting heart rate of the patient group was higher, but the maximal heart rate at exhaustion was lower, relative to the control subjects.”<ref name="deBecker2000">{{Cite journal | last = De Becker | first=P. | last2 = Roeykens | first2 = J. | last3 = Reynders | first3 = M. | last4 = McGregor | first4 = N. | last5 = De Meirleir | first5 = K. | date = 2000-11-27 | title = Exercise capacity in chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/11088089|journal=Archives of Internal Medicine|volume=160|issue=21|pages=3270–3277|issn=0003-9926|pmid=11088089}}</ref></blockquote>The Belgium team Van Oosterwijck et al. (2015) reported an impaired heart rate recovery in 20 female ME/CFS patients following exercise.<ref name="VanOosterwijck2015">{{Cite journal | last = Van Oosterwijck | first = J. | author-link = Jessica Van Oosterwijck | last2 = Marusic | first2 = U. | last3 = De Wandele | first3 = I. | last4 = Meeus | first4 = M. | last5 = Paul | first5 = L. | last6 = Lambrecht | first6 = L. | last7 = Moorkens | first7 = G. | last8 = Nijs | first8 = J. | authorlink8 = Jo Nijs | date = May 2015 | title = Reduced parasympathetic reactivation during recovery from exercise in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS)|url=https://www.physiotherapyjournal.com/article/S0031-9406(15)02014-3/fulltext|journal=Physiotherapy|language=English|volume=101| pages = e1091–e1092|doi=10.1016/j.physio.2015.03.1984|issn=0031-9406|issue=|quote=|via=}}</ref> In other disease groups this is associated with risk for cardiac events and sudden death. Cordero et al. (1986) did not find a significant difference in mean heart rate between 11 ME/CFS patients and six healthy controls after walking on a treadmill, but they did find patients to have significantly less 'vagal power', a measure for respiratory-related parasympathetic contributions to heart rate.<ref name="Cordero1996">{{Cite journal | last = Cordero | first = D. L. | last2 = Sisto | first2 = S.A. | last3 = Tapp | first3 = W.N. | last4 = LaManca | first4 = J.J. | last5 = Pareja | first5 = J.G. |last6 = Natelson | first6 = B.H. | date = Dec 1996 | title = Decreased vagal power during treadmill walking in patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/8985621|journal=Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society|volume=6|issue=6|pages=329–333|issn=0959-9851|pmid=8985621}}</ref> Soetekouw et al. (1999) noted that during a handgrip exercise, the hemodynamics response was lower in the ME/CFS group than in the control group, although this could be attributed to the lower level of muscle exertion in the ME/CFS group.<ref name="Soetekouw1999">{{Cite journal | last = Soetekouw | first = P. M. | last2 = Lenders | first2 = J.W. | last3 = Bleijenberg | first3 = G. | last4 = Thien | first4 = T. | last5 = van der Meer | first5 = J.W. | date = Dec 1999 | title = Autonomic function in patients with chronic fatigue syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/10638807|journal=Clinical Autonomic Research: Official Journal of the Clinical Autonomic Research Society|volume=9|issue=6|pages=334–340|issn=0959-9851|pmid=10638807}}</ref> LaManca et al. studied 19 ME/CFS (Holmes criteria) and found that they had a diminished heart rate and blood pressure in response to a cognitive test compared to healthy controls, though exercise did not magnify this effect.<ref name="LaManca2001">{{Cite journal | last = LaManca | first=J.J. | last2 = Peckerman | first2 = A. | last3 = Sisto | first3 = S.A. | last4 = DeLuca | first4 = J. | last5 = Cook | first5 = S. | last6 = Natelson | first6 = B.H. | date = Sep 2001 | title = Cardiovascular responses of women with chronic fatigue syndrome to stressful cognitive testing before and after strenuous exercise|url=https://www.ncbi.nlm.nih.gov/pubmed/11573024|journal=Psychosomatic Medicine|volume=63|issue=5 | pages = 756–764|issn=0033-3174|pmid=11573024}}</ref> Similar results were found by a Norwegian research group. They studied 13 adolescents with ME/CFS and 53 age-matched controls after a mental stress test (arithmetic questions). Though heart rate was significantly higher in patients at baseline, there were no meaningful differences during the arithmetic challenge.<ref name="Egge2010">{{Cite journal | last = Egge | first = Caroline | last2 = Wyller | first2 = Vegard Bruun | date = 2010-12-14 | title = No differences in cardiovascular autonomic responses to mental stress in chronic fatigue syndrome adolescents as compared to healthy controls|url=https://www.ncbi.nlm.nih.gov/pubmed/21156045|journal=BioPsychoSocial Medicine|volume=4|pages=22|doi=10.1186/1751-0759-4-22|issn=1751-0759|pmc=3012010|pmid=21156045}}</ref> Finally, Ocon et al. (2012) studied 16 patients with both the diagnosis of ME/CFS and POTS after increased orthostatic stress and a cognitive challenge. An impairment of the neurocognitive abilities was noted, that was not seen in healthy controls.<ref name="Ocon2012">{{Cite journal | last = Ocon | first=Anthony J. | last2 = Messer | first2 = Zachary R. | last3 = Medow | first3 = Marvin S. | last4 = Stewart | first4 = Julian M. | date = Mar 2012 | title = Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome|url=https://www.ncbi.nlm.nih.gov/pubmed/21919887|journal=Clinical Science (London, England: 1979)|volume=122|issue=5|pages=227–238|doi=10.1042/CS20110241|issn=1470-8736|pmc=3368269|pmid=21919887}}</ref>
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