Derman, W, Schwellnus, M P, Lambert, M I et al. · Journal of sports sciences · 1997 · DOI
Doctors who treat athletes need to be able to tell the difference between normal tiredness from hard training and severe, long-lasting fatigue that signals a real medical problem. This article presents a framework to help doctors figure out what's causing persistent fatigue in athletes, including checking for treatable diseases, overtraining, and possible muscle disorders that might not show up on standard tests.
For ME/CFS research and patients, this study is relevant because it highlights that persistent fatigue can stem from underlying muscle pathology rather than purely psychological or training-related causes, and it emphasizes the importance of multidisciplinary evaluation. The proposed diagnostic framework and mention of muscle biopsy findings in fatigued athletes may inform approaches to understanding post-exertional malaise and muscular dysfunction in ME/CFS.
This review does not prove that muscle disorders are the primary cause of chronic fatigue syndrome in athletes or establish prevalence rates for the conditions described. It does not provide controlled comparisons between athlete populations and non-athlete populations with fatigue, nor does it definitively separate ME/CFS from 'fatigued athlete myopathic syndrome' through prospective data.
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
Derman, W, Schwellnus, M P, Lambert, M I, Emms, M, Sinclair-Smith, C, Kirby, P, et al. (1997). The 'worn-out athlete': a clinical approach to chronic fatigue in athletes.. Journal of sports sciences. https://doi.org/10.1080/026404197367353
BibTeX
@article{mecfsatlas-derman-1997-worn-out,
author = {Derman, W and Schwellnus, M P and Lambert, M I and Emms, M and Sinclair-Smith, C and Kirby, P and Noakes, T D},
title = {The 'worn-out athlete': a clinical approach to chronic fatigue in athletes.},
journal = {Journal of sports sciences},
year = {1997},
doi = {10.1080/026404197367353},
note = {PubMed: 9232560},
url = {https://www.mecfsatlas.com/evidence/derman-1997-worn-out},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/derman-1997-worn-out
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