Cook, Dane B, Stegner, Aaron J, Nagelkirk, Paul R et al. · Medicine and science in sports and exercise · 2012 · DOI
This study compared how the bodies of ME/CFS patients respond to moderate exercise on a stationary bike. Researchers found that patients who have both ME/CFS and fibromyalgia (a condition causing widespread pain) showed different heart and breathing responses during exercise compared to healthy people, including higher perceived effort and different blood pressure patterns.
This research demonstrates that ME/CFS patients are not a homogeneous group—those with fibromyalgia show distinctly different physiological responses to exercise. Understanding these differences is critical for developing safe, individualized exercise recommendations and for designing research studies that account for comorbidities that can mask or alter the true pathophysiology of ME/CFS.
This study does not prove that exercise is safe or beneficial for ME/CFS patients, nor does it establish causation for any observed differences. The submaximal steady-state exercise protocol may not reflect post-exertional malaise (delayed symptom worsening), which occurs after exertion and was not measured in this acute exercise session.
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, Stegner, Aaron J, Nagelkirk, Paul R, Meyer, Jacob D, Togo, Fumiharu, & Natelson, Benjamin H (2012). Responses to exercise differ for chronic fatigue syndrome patients with fibromyalgia.. Medicine and science in sports and exercise. https://doi.org/10.1249/MSS.0b013e3182417b9a
BibTeX
@article{mecfsatlas-cook-2012-responses-exercise,
author = {Cook, Dane B and Stegner, Aaron J and Nagelkirk, Paul R and Meyer, Jacob D and Togo, Fumiharu and Natelson, Benjamin H},
title = {Responses to exercise differ for chronic fatigue syndrome patients with fibromyalgia.},
journal = {Medicine and science in sports and exercise},
year = {2012},
doi = {10.1249/MSS.0b013e3182417b9a},
note = {PubMed: 22157881},
url = {https://www.mecfsatlas.com/evidence/cook-2012-responses-exercise},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-29. https://www.mecfsatlas.com/evidence/cook-2012-responses-exercise
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