Miwa, Kunihisa, Inoue, Yukichi · Journal of cardiology · 2018 · DOI
This study looked at 44 ME/CFS patients to understand why they struggle to stay upright (orthostatic intolerance). Researchers found that balance problems—difficulty staying steady when standing with eyes closed—were common and seemed to make orthostatic intolerance worse. Patients with balance problems were more likely to have trouble completing a 10-minute standing test than those with only heart rate changes, suggesting balance issues may be just as important as blood pressure and heart rate problems in ME/CFS.
This study identifies balance/disequilibrium as an underrecognized but clinically important factor in ME/CFS-related orthostatic intolerance, potentially explaining why some patients struggle more than others despite similar blood pressure or heart rate patterns. Understanding multiple contributing mechanisms to orthostatic intolerance could lead to more targeted, personalized treatment approaches and better patient stratification in future research and clinical practice.
This study does not prove that disequilibrium causes orthostatic intolerance—it only shows they frequently occur together. The cross-sectional design cannot establish temporal relationships or determine whether balance problems are primary drivers of OI or secondary consequences of other ME/CFS pathology. The small sample and high female predominance limit generalizability to diverse ME/CFS populations.
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
Miwa, Kunihisa & Inoue, Yukichi (2018). The etiologic relation between disequilibrium and orthostatic intolerance in patients with myalgic encephalomyelitis (chronic fatigue syndrome).. Journal of cardiology. https://doi.org/10.1016/j.jjcc.2018.02.010
BibTeX
@article{mecfsatlas-miwa-2018-etiologic-relation,
author = {Miwa, Kunihisa and Inoue, Yukichi},
title = {The etiologic relation between disequilibrium and orthostatic intolerance in patients with myalgic encephalomyelitis (chronic fatigue syndrome).},
journal = {Journal of cardiology},
year = {2018},
doi = {10.1016/j.jjcc.2018.02.010},
note = {PubMed: 29588088},
url = {https://www.mecfsatlas.com/evidence/miwa-2018-etiologic-relation},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/miwa-2018-etiologic-relation
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