2. Objective Evidence of Post-Exertional Malaise and Exercise Impairment in ME/CFS
The provocation of symptoms and signs in ME/CFS in response to exertion suggests the presence of measurable physiological deficits in the post-exertional state. A 2-day maximal cardiopulmonary exercise test (CPET) paradigm was devised, which has revealed a whole host of cardiac, pulmonary, metabolic, and symptomatic differences between people with ME/CFS and sedentary people after an initial bout of exertion. The purposes of this chapter are to acquaint the learner with the 2-day maximal CPET paradigm and to describe the scientific research it has generated regarding the physiological basis of post-exertional malaise.