Hendrix, Jolien, Nijs, Jo, Ickmans, Kelly et al. · Antioxidants (Basel, Switzerland) · 2020 · DOI
This review examines how physical activity, pain, and a harmful process called oxidative stress (cellular damage from unstable molecules) interact in both healthy people and those with chronic pain conditions. The authors found that the relationships between these three factors are complicated and depend on the type of exercise and which person is being studied. They suggest that the nervous system's automatic functions and changes in how genes are expressed may help explain why these connections work differently in different people.
Understanding oxidative stress mechanisms in relation to exercise is critical for ME/CFS patients, as many experience post-exertional malaise (symptom worsening after activity). This review highlights that oxidative stress responses to exercise are not uniform and may differ fundamentally in disease states, potentially explaining why standard exercise recommendations can harm some patients while helping others.
This review does not prove causal mechanisms—it proposes hypotheses about autonomic and epigenetic involvement without empirical validation. It cannot establish whether oxidative stress is a primary driver of post-exertional malaise in ME/CFS or merely a correlate. The review also does not provide ME/CFS-specific data; generalizations from other chronic pain conditions may not apply to ME/CFS.
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
Hendrix, Jolien, Nijs, Jo, Ickmans, Kelly, Godderis, Lode, Ghosh, Manosij, & Polli, Andrea (2020). The Interplay between Oxidative Stress, Exercise, and Pain in Health and Disease: Potential Role of Autonomic Regulation and Epigenetic Mechanisms.. Antioxidants (Basel, Switzerland). https://doi.org/10.3390/antiox9111166
BibTeX
@article{mecfsatlas-hendrix-2020-interplay-between,
author = {Hendrix, Jolien and Nijs, Jo and Ickmans, Kelly and Godderis, Lode and Ghosh, Manosij and Polli, Andrea},
title = {The Interplay between Oxidative Stress, Exercise, and Pain in Health and Disease: Potential Role of Autonomic Regulation and Epigenetic Mechanisms.},
journal = {Antioxidants (Basel, Switzerland)},
year = {2020},
doi = {10.3390/antiox9111166},
note = {PubMed: 33238564},
url = {https://www.mecfsatlas.com/evidence/hendrix-2020-interplay-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/hendrix-2020-interplay-between
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