Habermann-Horstmeier, Lotte, Horstmeier, Lukas M · Journal of translational medicine · 2026 · DOI
This cross-sectional study of 736 people with ME/CFS examined how muscle symptoms relate to other physiological symptoms and whether these patterns differ by sex and menopausal status. Researchers observed that muscle problems were associated with breathing difficulties, flu-like symptoms, temperature-regulation problems, and cardiovascular symptoms, and identified a shared underlying 'physiological dysregulation factor' that grouped these symptoms together. However, the study's exploratory analyses by sex and menopausal status produced descriptive patterns that were not statistically confirmed as true differences across groups, and the study cannot establish whether these associations reflect causation or mechanism.
Muscle symptoms are among the most disabling manifestations of ME/CFS, yet their relationship to other physiological symptoms remains poorly understood. This study's identification of a latent physiological dysregulation factor encompassing respiratory, cardiovascular, thermoregulatory, and viral-like symptoms may help clinicians recognise symptom clusters and could support future research into shared biological mechanisms. The exploratory findings by sex and menopausal status highlight the need for sex-stratified analyses in ME/CFS research, even though the statistical evidence for these differences remains preliminary.
This cross-sectional design does not establish causal relationships between symptoms or identify the mechanisms underlying the observed associations. The subgroup-specific findings by sex and menopausal status are explicitly descriptive and exploratory; the authors note that overall interaction tests were not statistically significant, so these patterns should not be interpreted as confirmed sex or menopause effects. The study does not validate biomarkers, does not measure PEM directly, and does not demonstrate that the latent factor reflects a specific biological process (autonomic, vascular, immunological, or metabolic).
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 →
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Primary citation
Habermann-Horstmeier, Lotte & Horstmeier, Lukas M (2026). Muscle symptoms and a latent physiological symptom-dysregulation factor in ME/CFS: exploratory analyses by sex and age-defined menopausal-status proxy group.. Journal of translational medicine. https://doi.org/10.1186/s12967-026-09018-9
BibTeX
@article{mecfsatlas-habermann-horstmeier-2026-muscle-symptoms,
author = {Habermann-Horstmeier, Lotte and Horstmeier, Lukas M},
title = {Muscle symptoms and a latent physiological symptom-dysregulation factor in ME/CFS: exploratory analyses by sex and age-defined menopausal-status proxy group.},
journal = {Journal of translational medicine},
year = {2026},
doi = {10.1186/s12967-026-09018-9},
note = {PubMed: 42806383},
url = {https://www.mecfsatlas.com/evidence/habermann-horstmeier-2026-muscle-symptoms},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-09-29. https://www.mecfsatlas.com/evidence/habermann-horstmeier-2026-muscle-symptoms
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