Joyner, Michael J, Masuki, Shizue · Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2008 · DOI
This review article compares POTS (a condition where heart rate and blood pressure drop abnormally when standing) with the physical deconditioning that happens after long bed rest or spaceflight. The authors suggest that both conditions may share similar causes and that carefully structured exercise training might help patients with POTS, ME/CFS, and fibromyalgia, while acknowledging the medical community must remain empathetic to patients with these complex conditions.
This study directly addresses a central debate in ME/CFS care: the role of deconditioning versus disease-specific dysfunction, and whether exercise is universally beneficial or potentially harmful. Understanding how POTS, ME/CFS, and fibromyalgia relate mechanistically is crucial for developing appropriate treatment strategies and avoiding harm from ill-fitting exercise prescriptions.
This review does not prove that deconditioning is the primary cause of ME/CFS or POTS—it only proposes parallels and raises hypotheses. It does not establish that exercise training is safe or effective for all ME/CFS patients, nor does it address potential harm from post-exertional malaise (PEM) in patients with ME/CFS. The article acknowledges its own incompleteness by noting what this model fails to explain.
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
Joyner, Michael J & Masuki, Shizue (2008). POTS versus deconditioning: the same or different?. Clinical autonomic research : official journal of the Clinical Autonomic Research Society. https://doi.org/10.1007/s10286-008-0487-7
BibTeX
@article{mecfsatlas-joyner-2008-pots-versus,
author = {Joyner, Michael J and Masuki, Shizue},
title = {POTS versus deconditioning: the same or different?},
journal = {Clinical autonomic research : official journal of the Clinical Autonomic Research Society},
year = {2008},
doi = {10.1007/s10286-008-0487-7},
note = {PubMed: 18704621},
url = {https://www.mecfsatlas.com/evidence/joyner-2008-pots-versus},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/joyner-2008-pots-versus
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