Petracek, Lindsay S, Eastin, Ella F, Rowe, Ian R et al. · BMC sports science, medicine & rehabilitation · 2022 · DOI
This study looked at five elite swimmers who experienced severe fatigue and couldn't perform at their usual level. The researchers tested whether orthostatic intolerance—a condition where the body struggles to maintain proper blood pressure when standing—might explain their symptoms. When the swimmers were tested with standing or tilt table tests, they all felt fatigued and other symptoms appeared. After receiving treatment with extra salt and fluids, all five swimmers felt significantly better and returned to normal performance.
Many ME/CFS patients experience orthostatic intolerance and profound fatigue, similar to the swimmers in this study. This research demonstrates that orthostatic intolerance is measurable through accessible clinical tests and can be effectively treated with simple interventions. Identifying and addressing orthostatic intolerance may help ME/CFS patients and other fatigued patients improve their functioning and quality of life.
This small case series (n=5) cannot establish that orthostatic intolerance is the primary cause of athlete underperformance, only that it was present and treatable in these specific individuals. The lack of a control group means we cannot determine how common orthostatic intolerance is in underperforming athletes generally. Results in elite swimmers may not generalize to other populations or to the broader ME/CFS patient population.
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 →
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