van der Schaaf, Marieke E, Roelofs, Karin, de Lange, Floris P et al. · Biological psychiatry. Cognitive neuroscience and neuroimaging · 2018 · DOI
This study used brain imaging to understand why people with ME/CFS feel so fatigued and struggle with physical effort. Researchers asked patients and healthy people to squeeze a hand device at different force levels and give them feedback on their performance. People with ME/CFS were more likely to use less effort after feedback, especially at higher effort levels, and this related to lower activity in a brain region involved in decision-making and planning.
This study provides neurobiological evidence that ME/CFS fatigue involves measurable changes in brain function during effort decisions and motor preparation, not just psychological factors. Understanding these mechanisms could inform more targeted interventions and validate the physiological basis of symptom severity, potentially improving how clinicians and researchers conceptualize the condition.
This study does not establish causation—it shows that altered brain activity is associated with fatigue, but does not prove whether these brain changes cause fatigue or result from it. The findings are correlational and based on a single effort task; they may not generalize to other types of exertion or daily life. The study also does not address whether these neural differences are primary pathology or secondary to deconditioning or other 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
van der Schaaf, Marieke E, Roelofs, Karin, de Lange, Floris P, Geurts, Dirk E M, van der Meer, Jos W M, Knoop, Hans, et al. (2018). Fatigue Is Associated With Altered Monitoring and Preparation of Physical Effort in Patients With Chronic Fatigue Syndrome.. Biological psychiatry. Cognitive neuroscience and neuroimaging. https://doi.org/10.1016/j.bpsc.2018.01.015
BibTeX
@article{mecfsatlas-van-der-schaaf-2018-fatigue-associated,
author = {van der Schaaf, Marieke E and Roelofs, Karin and de Lange, Floris P and Geurts, Dirk E M and van der Meer, Jos W M and Knoop, Hans and Toni, Ivan},
title = {Fatigue Is Associated With Altered Monitoring and Preparation of Physical Effort in Patients With Chronic Fatigue Syndrome.},
journal = {Biological psychiatry. Cognitive neuroscience and neuroimaging},
year = {2018},
doi = {10.1016/j.bpsc.2018.01.015},
note = {PubMed: 29628071},
url = {https://www.mecfsatlas.com/evidence/van-der-schaaf-2018-fatigue-associated},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/van-der-schaaf-2018-fatigue-associated
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