Kujawski, Sławomir, Cossington, Jo, Słomko, Joanna et al. · Journal of clinical medicine · 2021 · DOI
This study tested whether a personalized activity program could help ME/CFS patients feel less tired and function better. Thirty-four patients followed a 16-week program tailored to their individual abilities. After the program, patients reported significant improvements in fatigue, and blood tests showed improvements in mitochondrial markers (Mfn1 and Mfn2)—the energy-producing components of cells. However, about half of the patients found exercise difficult to tolerate.
This study addresses growing concerns about exercise-based interventions in ME/CFS by examining whether individualized programs can improve fatigue without harm. The finding that mitochondrial markers improve alongside fatigue reduction provides biological support for activity-based approaches. Understanding which patients tolerate activity well and which do not is critical for developing safer, more personalized treatment strategies.
This study does not prove that exercise is universally safe or effective for ME/CFS patients, since 51% did not tolerate it well. The study cannot determine whether improvements in mitochondrial markers directly cause fatigue reduction or are simply correlated with activity participation. Without a control group receiving no intervention, the study cannot rule out placebo effects or natural disease fluctuation as contributing factors.
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
Kujawski, Sławomir, Cossington, Jo, Słomko, Joanna, Zawadka-Kunikowska, Monika, Tafil-Klawe, Małgorzata, Klawe, Jacek J, et al. (2021). Relationship between Cardiopulmonary, Mitochondrial and Autonomic Nervous System Function Improvement after an Individualised Activity Programme upon Chronic Fatigue Syndrome Patients.. Journal of clinical medicine. https://doi.org/10.3390/jcm10071542
BibTeX
@article{mecfsatlas-kujawski-2021-relationship-between,
author = {Kujawski, Sławomir and Cossington, Jo and Słomko, Joanna and Zawadka-Kunikowska, Monika and Tafil-Klawe, Małgorzata and Klawe, Jacek J and Buszko, Katarzyna and Jakovljevic, Djordje G and Kozakiewicz, Mariusz and Morten, Karl J and Dawes, Helen and Strong, James W L and Murovska, Modra and Van Oosterwijck, Jessica and Estevez-Lopez, Fernando and Newton, Julia L and Hodges, Lynette and Zalewski, Paweł and On Behalf Of The European Network On Me/Cfs Euromene},
title = {Relationship between Cardiopulmonary, Mitochondrial and Autonomic Nervous System Function Improvement after an Individualised Activity Programme upon Chronic Fatigue Syndrome Patients.},
journal = {Journal of clinical medicine},
year = {2021},
doi = {10.3390/jcm10071542},
note = {PubMed: 33917586},
url = {https://www.mecfsatlas.com/evidence/kujawski-2021-relationship-between},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/kujawski-2021-relationship-between
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