Not in the mind, but in the immune system! Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis   January 1st, 2014

Chronic Fatigue Syndrome (CFS), or myalgic encephalomyeltitis (ME), is a severe and underestimated illness. The presence of symptoms like a sore throat, tender lymph nodes, and low-grade fever, as well as flu-like symptoms including widespread muscle pain and severe fatigue, has inspired researchers to search for immune abnormalities in patients with ME/CFS. Importantly, symptoms are often exacerbated during and after physical activities. The severe exacerbation of symptoms following exercise (‘post-exertional malaise’), as seen in ME/CFS patients, is one of the core features of the illness, and it differentiates people with ME/CFS from other chronic illnesses like rheumatoid arthritis, depression or multiple sclerosis. 

An increasing number of studies have examined how the immune system of patients with ME/CFS responds to exercise, and whether such immune responses to exercise explain post-exertional malaise. Pain in Motion, together with Lorna Paul from the University of Glasgow (Scotland, UK), has now reviewed all those studies, assessed their scientific quality, and summarized the main findings. Here are the main findings:

  • Compared to the normal response of the immune system to exercise as seen in healthy subjects, patients with ME/CFS have a more pronounced response in the complement system (i.e. C4a split product levels), oxidative stress system (i.e. enhanced oxidative stress combined with a delayed and reduced anti-oxidant response), and an alteration in the immune cells’ gene expression profile (increases in post-exercise interleukin-10 and toll-like receptor 4 gene expression).
  • Many of these immune changes relate to post-exertional malaise in ME/CFS.
  • Contrary to what is often advocated, exercise does not result in abnormally higher levels of pro- or anti-inflammatory cytokines in patients with ME/CFS. There is moderate evidence that CFS patients have a normal circulating cytokine (e.g. interleukin-1ß, interleukin-6, interleukin-10, tumor necrosis factor-a) response to exercise.
  • Taken together, the literature review provides level B evidence for an altered immune response to exercise in patients with ME/CFS. Not in the mind, but in the body!


“Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyeltitis: A systematic literature review”
Nijs J, Nees A, Paul L, De Kooning M, Ickmans K, Meeus M, Van Oosterwijck J. 
Exercise Immunology Review 2014;20:94-116.
SCI2013=9.929 - Q1 Sport sciences (1/81) & Q1 Immunology (9/144)

Further reading (full text available for free): 

Jo Nijs