American College of Sports Medicine’s Guidelines for Exercise Testing

John Mac

Senior Member (Voting Rights)

New CPET Guidelines: What They Mean for People with ME/CFS

The American College of Sports Medicine’s Guidelines for Exercise Testing and Prescription, for the first time, includes a section on ME/CFS. ACSM is a leading authority on exercise science, and these guidelines serve as a foundational text for exercise professionals to guide safe and effective exercise testing and programming. The guidelines were released on the use of cardiopulmonary exercise testing (CPET) in research and clinical practice for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). These guidelines are important because CPET has long been one of the few tools that objectively capture the hallmark feature of ME/CFS: post-exertional malaise (PEM).

What is CPET?
CPET measures how the heart, lungs, and metabolism respond to exercise. For both healthy individuals and those with chronic diseases, results show predictable and repeatable patterns. However, for people with post-exertional malaise, CPET can reveal an abnormal response: reduced capacity and impaired recovery on the second day of testing. The two-day CPET pattern provides objective evidence of PEM, a symptom patients describe as a worsening of fatigue, pain, and cognitive issues after even small amounts of activity.


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