Objective Evidence of Post-exertional “Malaise” in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome: Twisk, 2015

Abstract

Essential elements of Myalgic Encephalomyelitis (ME) are muscle (weakness) and tenderness, cognitive deficits, neurological impairments, especially of cognitive, autonomic and sensory functions, but above all, post-exertional “malaise”: a prolonged increase of symptoms after a minor physical and mental exertion.

Chronic fatigue Syndrome (CFS) is defined as clinically evaluated, unexplained (persistent or relapsing) chronic fatigue, accompanied by at least four out of eight specific symptoms, e.g., sore throat, unrefreshing sleep, and headaches.

Since cognitive deficits and post-exertional “malaise” are not mandatory for the diagnosis CFS, only part of the CFS patient group meets the diagnostic criteria for ME.

So, post-exertional “malaise” is considered to be the distinctive feature of ME. However, “malaise” is an ambiguous and subjective notion. In order to assess post-exertional malaise objectively, several studies have employed widely used methods to quantify the deviant effects of exertion in ME (CFS). This review focuses on the long-lasting (negative) effects of exercise on the performance indicators of the physical exercise capacity, the cognitive deficits and the muscle power.


Introduction

ME and CFS are often qualified as enigmatic disorders [1], partly due to the fact that typical symptoms, e.g. fatigue and post-exertional “malaise”, are subjective notions. A substantial part of the confusion and controversy with regard to the diagnosis, the nature and the treatment of ME and CFS originates from these subjective notions. To end this debate and to move forward it is essential to use objective methods to assess the characteristic symptoms of ME and CFS objectively, as far as possible [2]. This review aims to discuss observations with regard to the impact of exercise on the physical exercise capacity, cognitive functioning and muscle power in ME (CFS).

Post-exertional “malaise” in this article is defined as ‘a pathological inability to produce sufficient energy on demand’ [3], resulting into a (delayed) increase of typical symptoms, e.g. weakness, muscular and/or joint pain, cognitive deficits, after a minor physical or mental exertion, with prolonged “recovery” times [4,5].


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