Friedberg, Fred, Adamowicz, Jenna L, Bruckenthal, Patricia et al. · Psychosomatic medicine · 2022 · DOI
Researchers followed 148 people with ME/CFS for 6 months to understand why some patients improve while others don't. They tracked activity patterns, daily stressors and positive experiences, and measured heart rate variability (a sign of nervous system health). Patients who didn't improve had less heart rate variability and reported fewer positive daily experiences, but surprisingly, activity patterns like "push-crash" cycles didn't differ between improving and non-improving groups.
This study provides objective biological evidence linking patient outcomes to autonomic nervous system dysfunction, potentially validating a mechanism of persistent illness in ME/CFS. Understanding factors associated with nonimprovement may help identify patients at risk and inform future therapeutic interventions targeting autonomic regulation and psychological well-being.
This study cannot establish causation—lower heart rate variability and reduced uplifts may be consequences of nonimprovement rather than causes. The findings do not explain why "push-crash" cycles did not differ between groups, and do not validate any specific activity-management approach (pacing, energy envelope) as beneficial or harmful.
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
Friedberg, Fred, Adamowicz, Jenna L, Bruckenthal, Patricia, Milazzo, Maria, Ramjan, Sameera, & Quintana, Daniel (2022). Nonimprovement in Chronic Fatigue Syndrome: Relation to Activity Patterns, Uplifts and Hassles, and Autonomic Dysfunction.. Psychosomatic medicine. https://doi.org/10.1097/PSY.0000000000001082
BibTeX
@article{mecfsatlas-friedberg-2022-nonimprovement-chronic,
author = {Friedberg, Fred and Adamowicz, Jenna L and Bruckenthal, Patricia and Milazzo, Maria and Ramjan, Sameera and Quintana, Daniel},
title = {Nonimprovement in Chronic Fatigue Syndrome: Relation to Activity Patterns, Uplifts and Hassles, and Autonomic Dysfunction.},
journal = {Psychosomatic medicine},
year = {2022},
doi = {10.1097/PSY.0000000000001082},
note = {PubMed: 35420586},
url = {https://www.mecfsatlas.com/evidence/friedberg-2022-nonimprovement-chronic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/friedberg-2022-nonimprovement-chronic
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