Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2: More in Common Than Not?
Joseph, Phillip, Singh, Inderjit, Oliveira, Rudolf et al. · Chest · 2023 · DOI
Quick Summary
This review compares how the body responds to exercise in people with long COVID (PASC) and ME/CFS, two conditions that share similar symptoms like extreme tiredness and worsening symptoms after activity. Researchers found that both conditions show similar abnormalities in heart function, blood flow, and breathing during exercise that go beyond simple deconditioning or being out of shape. These shared patterns suggest both conditions may involve similar underlying biological problems, which could help doctors develop better tests and treatments.
Why It Matters
This research validates that ME/CFS and long COVID share common biological problems during exercise, legitimizing the experiences of both patient populations and suggesting that treatments developed for one condition may be relevant to the other. Understanding these shared mechanisms could accelerate development of diagnostic tests and therapeutic strategies that benefit both communities. The comparison also highlights that ME/CFS research findings from decades of study may inform emerging PASC research.
Observed Findings
- Both PASC and ME/CFS show abnormalities in systemic blood flow distribution during exercise that differ from simple deconditioning
- Cardiopulmonary exercise testing reveals ventilatory control perturbations in both conditions
- Hemodynamic and gas exchange derangements substantially overlap between the two conditions
- Early attribution of PASC exertional intolerance to detraining alone is inconsistent with observed physiologic abnormalities
Inferred Conclusions
- PASC and ME/CFS likely share common underlying pathophysiologic mechanisms affecting exercise tolerance
- Simple deconditioning is insufficient to explain the exercise intolerance observed in either condition
- Shared mechanistic understanding between the two conditions should guide development of future diagnostics and treatments
- Exercise pathophysiology findings from ME/CFS research have relevance to understanding and managing PASC
Remaining Questions
- What are the specific cellular and molecular mechanisms causing the observed hemodynamic and ventilatory abnormalities in both conditions?
- Can exercise testing abnormalities serve as reliable diagnostic biomarkers to differentiate ME/CFS and PASC from other conditions?
- Do the shared exercise pathophysiologies respond to the same therapeutic interventions, and what treatments target the underlying mechanisms?
- What factors determine whether individuals progress to chronic illness following acute infection or exertion in either condition?
What This Study Does Not Prove
This systematic review does not prove that PASC and ME/CFS are caused by identical mechanisms, only that they share overlapping exercise-related abnormalities. The review cannot establish which specific biological pathways drive these abnormalities or definitively rule out multiple different mechanisms producing similar presentations. It also does not provide data on treatment efficacy or establish clear diagnostic criteria for either condition.
Topics
Tags
Metadata
- DOI
- 10.1016/j.chest.2023.03.049
- PMID
- 37054777
- Review status
- Editor reviewed
- Evidence level
- Established evidence from major reviews, guidelines, or evidence maps
- Last updated
- 7 April 2026