Van Houdenhove, B, Verheyen, L, Pardaens, K et al. · Clinical rehabilitation · 2007 · DOI
This paper proposes a new way to think about why people with ME/CFS have reduced physical ability. The authors suggest there may be two different problems: some patients may have low energy capacity (their bodies can't produce enough energy), while others may have reduced effort tolerance (their nervous system tells them to stop before their body actually reaches its limit). Understanding which problem a patient has could help doctors choose better treatments.
This framework is important because it challenges the assumption that all ME/CFS motor dysfunction stems from low energy availability, suggesting instead that nervous system dysfunction and perception may be equally or more important. If validated, this distinction could lead to personalized rehabilitation strategies—for example, energy management for capacity-limited patients versus pacing and nervous system retraining for tolerance-limited patients—potentially improving outcomes.
This is a theoretical proposal, not an empirical study, so it does not provide direct evidence that reduced effort tolerance is actually the primary problem in ME/CFS or that treating it differently improves outcomes. The paper does not test whether these proposed subgroups actually exist in patient populations or demonstrate that rehabilitation strategies based on this framework are more effective than current approaches.
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 Houdenhove, B, Verheyen, L, Pardaens, K, Luyten, P, & Van Wambeke, P (2007). Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?. Clinical rehabilitation. https://doi.org/10.1177/0269215507080769
BibTeX
@article{mecfsatlas-van-houdenhove-2007-rehabilitation-decreased,
author = {Van Houdenhove, B and Verheyen, L and Pardaens, K and Luyten, P and Van Wambeke, P},
title = {Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?},
journal = {Clinical rehabilitation},
year = {2007},
doi = {10.1177/0269215507080769},
note = {PubMed: 18042608},
url = {https://www.mecfsatlas.com/evidence/van-houdenhove-2007-rehabilitation-decreased},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/van-houdenhove-2007-rehabilitation-decreased
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