Nakamura, Toru, Schwander, Stephan, Donnelly, Robert et al. · Clinical and vaccine immunology : CVI · 2013 · DOI
Researchers tested whether exercise and sleep loss could trigger increased inflammatory markers in the blood of ME/CFS patients, since many people report that physical activity and poor sleep make their symptoms worse. They found that neither exercise nor sleep deprivation caused the expected increases in inflammatory proteins in people with ME/CFS compared to healthy controls. This suggests that immune activation from these stressors may not be the main reason symptoms worsen with exertion or sleep loss.
This study directly addresses a leading biological theory about ME/CFS by testing whether the symptom flares patients experience with exertion and sleep loss are driven by inflammatory immune responses. The findings refocus research attention on alternative mechanisms and suggest that symptom worsening may involve non-inflammatory pathways, which could influence future treatment development.
This study does not prove that immune dysregulation plays no role in ME/CFS generally—only that exercise and sleep deprivation do not trigger observable cytokine upregulation in blood. It does not examine other immune markers, tissue-specific responses, or longer-term immune activation patterns. The failure to detect increased cytokines does not identify what actually causes symptom exacerbation.
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
Nakamura, Toru, Schwander, Stephan, Donnelly, Robert, Cook, Dane B, Ortega, Felix, Togo, Fumiharu, et al. (2013). Exercise and sleep deprivation do not change cytokine expression levels in patients with chronic fatigue syndrome.. Clinical and vaccine immunology : CVI. https://doi.org/10.1128/CVI.00527-13
BibTeX
@article{mecfsatlas-nakamura-2013-exercise-sleep,
author = {Nakamura, Toru and Schwander, Stephan and Donnelly, Robert and Cook, Dane B and Ortega, Felix and Togo, Fumiharu and Yamamoto, Yoshiharu and Cherniack, Neil S and Klapholz, Marc and Rapoport, David and Natelson, Benjamin H},
title = {Exercise and sleep deprivation do not change cytokine expression levels in patients with chronic fatigue syndrome.},
journal = {Clinical and vaccine immunology : CVI},
year = {2013},
doi = {10.1128/CVI.00527-13},
note = {PubMed: 24027260},
url = {https://www.mecfsatlas.com/evidence/nakamura-2013-exercise-sleep},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/nakamura-2013-exercise-sleep
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