Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2: More in Common Than Not?

Phillip Joseph; Inderjit Singh; Rudolf Oliveira; Christine A Capone; Mary P Mullen; Dane B Cook; Mary Catherine Stovall; Johanna Squires; Kristine Madsen; Aaron B Waxman; David M Systrom

doi:10.1016/j.chest.2023.03.049

Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2: More in Common Than Not?

Chest. 2023 Sep;164(3):717-726. doi: 10.1016/j.chest.2023.03.049. Epub 2023 Apr 11.

Authors

Affiliations

¹ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Yale-New Haven Hospital, Yale University, New Haven, CT.
² Division of Respiratory Disease, Department of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
³ Division of Pediatric Cardiology Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra, Manhasset, NY.
⁴ Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
⁵ Research Service, William S. Middleton Memorial Veterans Hospital & Department of Kinesiology, University of Wisconsin-Madison, Madison, WI.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: dsystrom@bwh.harvard.edu.

PMID: 37054777
PMCID: PMC10088277 (available on 2024-09-01)
DOI: 10.1016/j.chest.2023.03.049

Abstract

Topic importance: Postacute sequelae of SARS-CoV-2 (PASC) is a long-term consequence of acute infection from COVID-19. Clinical overlap between PASC and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has been observed, with shared symptoms including intractable fatigue, postexertional malaise, and orthostatic intolerance. The mechanistic underpinnings of such symptoms are poorly understood.

Review findings: Early studies suggest deconditioning as the primary explanation for exertional intolerance in PASC. Cardiopulmonary exercise testing reveals perturbations related to systemic blood flow and ventilatory control associated with acute exercise intolerance in PASC, which are not typical of simple detraining. Hemodynamic and gas exchange derangements in PASC have substantial overlap with those observed with ME/CFS, suggestive of shared mechanisms.

Summary: This review illustrates exercise pathophysiologic commonalities between PASC and ME/CFS that will help guide future diagnostics and treatment.

Keywords: CPET; ME/CFS; PASC; hyperventilation; neurovascular dysregulation.

Publication types

Review
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Exercise / physiology
Exercise Test
Fatigue Syndrome, Chronic* / etiology
Humans
SARS-CoV-2

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States