Cook, Dane B, VanRiper, Stephanie, Dougherty, Ryan J et al. · PloS one · 2022 · DOI
Researchers tested 214 people with ME/CFS and 189 healthy controls using exercise bikes to see how their bodies responded to physical activity. They found that people with ME/CFS had unusual patterns during exercise: they breathed inefficiently, their hearts didn't speed up as much as expected, but they felt the exercise was harder than controls thought it was. These differences remained even when comparing people with similar fitness levels.
This study provides objective, reproducible exercise testing evidence that ME/CFS involves physiological abnormalities beyond simple deconditioning—specifically inefficient breathing patterns and exaggerated effort perception that persist even in fitness-matched individuals. These findings validate the clinical use of cardiopulmonary exercise testing as a diagnostic tool and support the biological basis of ME/CFS, potentially reducing diagnostic uncertainty and improving acceptance of the illness.
This study does not establish the cause of abnormal exercise responses or prove they are specific to ME/CFS (they may occur in other conditions). Being cross-sectional, it cannot determine whether these responses develop from ME/CFS or contribute to its pathophysiology. It also does not establish whether these exercise patterns predict symptom severity, post-exertional malaise, or treatment response.
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, VanRiper, Stephanie, Dougherty, Ryan J, Lindheimer, Jacob B, Falvo, Michael J, Chen, Yang, et al. (2022). Cardiopulmonary, metabolic, and perceptual responses during exercise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Multi-site Clinical Assessment of ME/CFS (MCAM) sub-study.. PloS one. https://doi.org/10.1371/journal.pone.0265315
BibTeX
@article{mecfsatlas-cook-2022-cardiopulmonary-metabolic,
author = {Cook, Dane B and VanRiper, Stephanie and Dougherty, Ryan J and Lindheimer, Jacob B and Falvo, Michael J and Chen, Yang and Lin, Jin-Mann S and Unger, Elizabeth R and MCAM Study Group},
title = {Cardiopulmonary, metabolic, and perceptual responses during exercise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A Multi-site Clinical Assessment of ME/CFS (MCAM) sub-study.},
journal = {PloS one},
year = {2022},
doi = {10.1371/journal.pone.0265315},
note = {PubMed: 35290404},
url = {https://www.mecfsatlas.com/evidence/cook-2022-cardiopulmonary-metabolic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/cook-2022-cardiopulmonary-metabolic
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