Cook, Dane B, Nagelkirk, Paul R, Poluri, Ashok et al. · Arthritis and rheumatism · 2006 · DOI
This study compared how people with ME/CFS respond to exercise on a stationary bike, looking at heart rate, breathing, and how hard the exercise felt. People with ME/CFS alone had similar physical responses to healthy controls, but those with ME/CFS and fibromyalgia showed different breathing patterns and found exercise much more painful and exhausting.
This study helps clarify conflicting research findings about whether ME/CFS involves abnormal metabolic responses to exercise. By carefully controlling for fitness level and examining fibromyalgia as a separate factor, it suggests that reduced fitness—rather than a fundamental disease mechanism—accounts for many observed differences, which has implications for rehabilitation approaches.
This cross-sectional study cannot determine causality or whether aerobic deconditioning is a cause or consequence of ME/CFS. It does not prove that post-exertional malaise (PEM) is purely deconditioning-based, nor does it establish the underlying mechanisms driving pain and effort perception in these patients. The findings may not generalize to the full spectrum of ME/CFS severity.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Cook, Dane B, Nagelkirk, Paul R, Poluri, Ashok, Mores, John, & Natelson, Benjamin H (2006). The influence of aerobic fitness and fibromyalgia on cardiorespiratory and perceptual responses to exercise in patients with chronic fatigue syndrome.. Arthritis and rheumatism. https://doi.org/10.1002/art.22124
BibTeX
@article{mecfsatlas-cook-2006-influence-aerobic,
author = {Cook, Dane B and Nagelkirk, Paul R and Poluri, Ashok and Mores, John and Natelson, Benjamin H},
title = {The influence of aerobic fitness and fibromyalgia on cardiorespiratory and perceptual responses to exercise in patients with chronic fatigue syndrome.},
journal = {Arthritis and rheumatism},
year = {2006},
doi = {10.1002/art.22124},
note = {PubMed: 17009309},
url = {https://www.mecfsatlas.com/evidence/cook-2006-influence-aerobic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/cook-2006-influence-aerobic
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