Nijs, Jo, Nees, Andrea, Paul, Lorna et al. · Exercise immunology review · 2014
When people with ME/CFS exercise, their immune system reacts differently than healthy people's immune systems do. This review looked at 23 studies comparing immune responses to exercise in ME/CFS patients versus healthy people. The key finding is that ME/CFS patients show stronger reactions in certain immune markers and more oxidative stress (damage from chemical imbalances), which may be connected to post-exertional malaise—the worsening of symptoms that happens after activity.
This systematic review synthesizes evidence that ME/CFS patients have fundamentally different immune responses to exercise compared to healthy people, suggesting the condition involves genuine biological alterations rather than deconditioning. Understanding these immune mechanisms may help explain post-exertional malaise and could guide development of better diagnostic tests and personalized exercise approaches for ME/CFS patients.
This review does not prove that the altered immune response causes ME/CFS or post-exertional malaise—only that they are associated. It cannot establish whether immune changes are a consequence of the disease or a contributing cause. The review synthesizes existing studies with varying methodologies, so individual studies may have had small sample sizes or other limitations that affect confidence in the overall conclusions.
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
Nijs, Jo, Nees, Andrea, Paul, Lorna, De Kooning, Margot, Ickmans, Kelly, Meeus, Mira, et al. (2014). Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic literature review.. Exercise immunology review. https://pubmed.ncbi.nlm.nih.gov/24974723/
BibTeX
@article{mecfsatlas-nijs-2014-altered-immune,
author = {Nijs, Jo and Nees, Andrea and Paul, Lorna and De Kooning, Margot and Ickmans, Kelly and Meeus, Mira and Van Oosterwijck, Jessica},
title = {Altered immune response to exercise in patients with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic literature review.},
journal = {Exercise immunology review},
year = {2014},
note = {PubMed: 24974723},
url = {https://www.mecfsatlas.com/evidence/nijs-2014-altered-immune},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/nijs-2014-altered-immune
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