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Adrienne Dellwo

Exercise & Oxygen Shortage in Chronic Fatigue Syndrome

By February 7, 2014

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Research Brief

New research underscores the fact of exercise intolerance in chronic fatigue syndrome (ME/CFS) and helps us understand why it exists.

When you exercise, your muscle cells need more oxygen than they do when you're at rest. However, previous studies have shown that the bodies of people with ME/CFS don't distribute oxygen like they should, leaving muscles exhausted and unable to perform.

This new study measured oxygen extraction (the amount of oxygen taken from the blood as it flows through your capillaries) in 440 people with ME/CFS to figure out why extraction is low in this condition. They found irregularities that suggest the problem is in the mitochondria - tiny structures inside your cells that produce energy.

What's more, researchers say the participants did not show signs of deconditioning, which some have suggested could be behind low exercise tolerance and poor performance in ME/CFS.

In addition to low oxygen extraction, researchers noted a higher cardiac output than in healthy controls.

Researchers concluded that exercise intolerance in ME/CFS is due to abnormal metabolism at the mitochondrial level.

What this means for you is that, essentially, it's as if your exercising at a higher altitude than what your body is used to. Ask any athlete who's had to compete under those circumstances - it's tough! Your muscles are deprived of oxygen and can't function. Your cells simply don't have the proper ingredients to make energy.

You already know what over-exertion means for your body and how important it is to stay within your limits. You don't need studies to tell you that. However, as we get more evidence of mitochondrial dysfunction, it'll become a bigger target for research on how to correct it. This study, and those that came before it, could lead the way to treatments that target the cause of exercise intolerance, which is considered by many researchers to be the hallmark symptom of ME/CFS.

Learn more about mitochondrial dysfunction and how it's treated:

What does exercise do to you? How much exertion can you handle? Have you been treated for mitochondrial dysfunction? If so, how did it work? Leave your comments below!


Photo Michael Greenberg/Getty Images

February 7, 2014 at 10:31 am
(1) Rachael says:

Some of us, probably were genetically never meant to be long distance (endurance) runners. I developed ME/CFS, while doing strenuous (aerobic) exercise. I just kept pushing myself beyond my (genetically, inborn) mitochondrial limit, even though I knew, that my body was telling me to stop.

As a child, I never had the endurance it took to be a long distance runner. I enjoyed track and field events, but the activities I excelled at were the ones that required short bursts of energy (anaerobic), the 100 yard dash, standing long jump, or running long jump. I always won the red ribbons in these events. But, as much as I tried I never had the stamina to run long distance. I was always curious, as to why?

I’ve come to understand that slow-twitch muscle fibers like those of the long-distance runner have abundant mitochondria and use large amounts of energy slowly so that you can work out for a long time without getting tired. Slow fibers use oxygen-using (aerobic) pathways for activities that require endurance.

Fast-twitch muscle fibers found in sprinters have less mitochondria and use small amounts of energy quickly. Fast fibers use sugars for fuel (anaerobic) and do not require oxygen. It gives you the ability to run fast, but for short distances. The byproduct of this (anaerobic) energy production is heat and lactic acid. Lactic acid accumulation in the muscle causes fatigue and soreness. The (anaerobic energy) system is a limited system for energy production.

The organization of muscle fibers in each or us is determined by our genes. I now understand, that the endurance of the long-distance runner (aerobic) and the short-burst of energy experienced by the sprinter (anaerobic) are both genetic in nature. If I had known this almost thirty years ago, I may have been able to save myself from developing ME/CFS.

February 7, 2014 at 12:34 pm
(2) Tara says:

Thank you for sharing your insights. I track my initial illness to starting a rather strenuous (for me) work out program. It began ss fatigue that left me motionless on the couch pretty much any time I was not at work. Doctors kept telling me it was just depression so I followed conventional advice, hired a trainer and got to work. It wasn’t a very strenuous program but it only took a couple of weeks and I collapsed. After that I became very ill with all of the familiar symptoms and gradually I have had to quit my job and have become disabled and pretty much housebound.

February 7, 2014 at 3:38 pm
(3) Donna L says:

Rachel, I was exactly the same, I maxed out sprinting for the 400 meter dash, my coach put me in the 800m and it was impossible for me. I couldn’t figure it out why I couldn’t develop better endurance. That was over 30 years ago. Before my diagnosis of fibromyalgia, I got a trainer who simply would not consider yhe concept of exercise fatigue – I had no proof of it except my own experience. I listened to myself and quit, if I hadn’t I would have missed a lot of work.

I am having a lot of success with pain reduction by going gluten free, but it hasn’t changed energy levels. Hopefully researchers will help us understand all this more and more.

February 7, 2014 at 4:07 pm
(4) Foggy in MN says:

Thanks for the new info, Adrienne!!

This explains why the can of Boost brand Oxygen I bought on Amazon helps the pain in my legs feel better for a little while.

Very interesting!!!

February 7, 2014 at 4:09 pm
(5) dana says:

My husband and I went to Utah where he really struggled walking around. I didn’t notice much difference.

February 7, 2014 at 7:10 pm
(6) Helen says:

This is not related to exercise but to supplements. I have FMS and started taking Life Extension Foundation’s Mitochondrial Energy Optimizer two years ago and found it improved my energy levels – now I am rarely suffering fatigue or brain fog. Fatigue or fog days are now mostly on clearly identifiable days such as low air pressure days or when under very high stress. However I do watch the amount of exercise I do and don’t push it.

Supplement includes: Vitamin B6, Calcium, Sodium, Carnosine, Acetyl-L-carnitine, Benfotiamine, R-Lipoic Acid, BioPQQ, Luteolin.

Maybe supplements are worth tryng along with measured exercise.

February 7, 2014 at 8:33 pm
(7) Bonie says:

I did it the old fashion way. At the height of my illness my resting pulse was 123bpm, exercise was lying down, sitting up. Over the course of a year using my resting pulse as my guide it is now 63bpm I swim a little, walk a little and potter a little. Obviously everyone wants a “quick fix” but this illness is a slow but steady approach to getting your life back. I did it and I thought I had no hope, you can too.

February 7, 2014 at 8:43 pm
(8) Julie says:

it feels like when you try and workout that you have been working out for 10 days straight

February 7, 2014 at 9:16 pm
(9) prema says:

where and who do you go to for mitochondria testing?
I know my dr would not even believe in such a thing. how is one tested any info would be appreciated

February 8, 2014 at 1:41 am
(10) Coloradosue says:

SO THAT’S WHY I CAN’T FRIGGING BREATH VERY WELL!! And it’s only getting worse as the years go by. I’m lucky if I can get the lawn mowed in 3 days, assuming of course I have ANY energy at all after doing the laundry, vacuuming, cooking, etc., etc., etc.!!!!!!
Seriously, I do really feel more and more breathless sometimes for nothing at all I and I hope and pray that it doesn’t get any worse!!!!!!
Peace and Strength to All!!!!!

February 8, 2014 at 1:58 am
(11) Esther Siebert says:

Maybe now we’ll stop hearing about graded exercise as a cure for ME! Wouldn’t that be nice…

February 8, 2014 at 3:25 am
(12) Andrew Porter says:

Through extensive autonomic tests, my CFS was revealed as being caused by a lack of carbon dioxide wash out from cells, leading to less oxygen uptake, reducing mitochondrial function. Further tests showed low levels of noradrenaline (norepinephrine) release as a neurotransmitter, so that peripheral blood vessels failed to constrict upon standing, my heart rate is too slow, blood pressure too low, and my pulse pressure, also too low. This limits blood deliver to where needed when exercising, forces muscle cells into anaerobic instead of aerobic energy transfer, leading to rapid onset, fatigue and, for many, pain. Use graded exercise, and you force the muscle cells deeper into anaerobic debt, causing more fatigue and delayed recovery. However, by artificially stimulating the muscle cells to operate in aerobic mode after using an anaesthetic to remove normal neural control, and correct aerobic function is restored, all pointing towards a neural problem, in my case believed to have been caused by hit and run viral damage. It is analogous to an automotive petrol engine with one ignition that has failed, the fuel is delivered, the air is delivered, but the spark is either missing, or too weak to ignite the fuel. Using better fuel, better delivery of air, fails to cure the problem, as the cylinder still cannot process the fuel and air mixture.

February 8, 2014 at 11:50 pm
(13) Mary Beth says:

I’ve been exercizing in a 90* pool with physical therapists for over a year. 3-4 days a week, every week. I had to stop for the last two months. I no longer have knee pain and ankle pain. The swelling in my ankles has stopped. Even my shoulder pain is improved. These results are surprising to me. Can it be explained?

February 9, 2014 at 8:33 pm
(14) C says:

I’m not surprised one bit by this study. I’ve suspected something of this sort. I’ve fairly in tune with my body and even when I was younger and more fit I was fatigued. Motivation isn’t my problem. Every time I have thought oh what’s the big deal just push through and grin and bear… I end up so sick and twice as tired. My conditions are fairly extensive and I notice the littler things…they aren’t so little. Takes effort to make bread or use a stationary bike for 5 minutes…yes folks, my conditions if fairly severe and I notice. *sigh* so frustrating…

February 9, 2014 at 8:36 pm
(15) C says:

Just one more comment. I really hope this study makes pain clinics sit up and take note because in my experience they understand the pain a lot more than they understand the fatigue. I’m tired of being patronized. *sigh*

February 12, 2014 at 11:32 pm
(16) chrysoula holtzhauer says:

I’ve had fibro for 2 decades but only diagnosed 7 years ago. I’ve tried lots of meds, done PT, xrays, sleep study, special diets, and mental health therapy but up until now I had never experienced the oxygen shortage until 2 weeks ago…

Went back to doctor and got B12 shot and D3 (2,000 iu). I’ve been told thatmy anxiety level is too high which would explain the elephant standingon my chest. Was given some klonopin to take the edge off.

Was encouraged to walk around the neighborhood or at the mall because their interpretation of “my legs won’t hold me up”, means my muscles atrophy from lack of exercise.

What they don’t seem to get is that I need to lay down after going just 20 paces to the mailbox in front of my house!

I almost instantly feel like I’m suffocating AND like a ran a marathon. I can barely talk without gasping for air and my entire body feels like collapsing.

This is a new symptom and the only way to control it is to stay in bed, which only makes the muscles hurt more. It’s so exhausting to start the day feeling weak & winded but i don’t know how to cope with it.

Started taking Fibro Complete with Malic Acid but honestly I don’t think anything can help.

Will i need an oxygen tank from now on?

February 14, 2014 at 3:56 pm
(17) Jim says:

After living at 9300 feet for years I developed CFS (?).. Went to sea level in Maine 2 summers ago for two weeks and no change in my fatigue
and instability in walking. I am still at 9200 feet and fatigue and instab-
ility is still here so I am moving back to Maine May 1 for the summer and
see if the extended period assists. Some of this is coming from old
age. I will be taking tests also up here in the mountains next week by
experienced persons. I was short on B9 but that did not help when I
took supplements mailed down from Bangor, ME..2 doctors say this
may help but a doctor who lived in Nepal for years says if the 2 weeks
in Maine did not assist something else is wrong.. Jim

February 14, 2014 at 4:33 pm
(18) Dianne Bunn says:

I’ve chosen Tai Chi as my form of exercise. It’s gentle and it good for your circulation and for stretching. It’s not just for old folks. There are people of all ages in my class. My pain doctor says it’s the best possible thing I can do. I love it! It make feels good great that I am doing something. Once you’re a member of the International Taoist Society you can do Tai Chi with any club in the world. Some of the people in my class have t-shirts from all over the world. I hope one day when I travel to have time to be able to visit another club.

February 14, 2014 at 8:29 pm
(19) Liz Ho says:

I was the very high energy type, endurance swimming, gym, yoga, squash, netball – both aerobic and anaerobic energy being in abundance until age 28. Exercise and movement was (and still would be) my passion. Onset of ME from reactivated viral infection and travel vaccinations (cholera/thyphoid). When all symptoms are improved, my energy production remains too low for my daily needs. Some days I can climb 9 stairs, others, I can barely climb 9 stairs and arrive puffing and need to pause before continuing, and am in pain. I have been ill with ME/CFS over 30 years. I have tried many treatments incl long-term antibiotics and anti-virals and HGH. My large major crash 2 years ago was from overusing my brain. I have tried oxygen, and it didn’t make much difference. Graded exercise makes me worse, it has to be tailored to how I am on the day. Currently I do gentle pilates under instruction of a physio. I carry injuries from Ehlers Danlos syndrome. I believe my mitochondria are permanently damaged – the “hit-and-run” viral incident as mentioned earlier, in my case EBV/CMV, the herpes cirus family.

February 14, 2014 at 8:56 pm
(20) Karen says:

I have felt for a number of years that my brain and my muscles are not getting enough oxygen. I am thinking about trying a hyperbaric chamber. Any thoughts?

February 15, 2014 at 12:17 am
(21) Kimberly Ann Collier says:

Ive met an inventor that has developed a personal use hyperbaric tent-like unit you use at home.ive been using it 2to3 times a day for 3 weeks now and it has made positive changes in the quality of my life….sleep andbreathe better, mind clearer, less pain and a bit more energy, too.theres a website http://www.therejuv.com if you want more info.please use me as a referral if you get in touch with them.thanks. kim c.

February 15, 2014 at 9:34 pm
(22) Tommy says:

I think every age of a person has a special function like learning, growing up reproducing and so on. When you enter a new phase of life you have to let go of the old things, e.g. when you are 90, you do not reproduce any more, usually you even do not try to ;)
So when it was the right age I did a lot of exercise as 40,000km pushbike, running, swimming, scuba, sailing, skiing, fencing and then I realized it was enough – even go to work by pushbike was to much so I let go of it. The funny thing is that after 15years of lazyness I am still very strong and with 66 have rather good muscles.
What I do?
1.) I snore and because of that I have a snoring mashine (CEPAP) which over night supplies me with a higher air pressure (+12 cm H20) and gives me a lot more oxygen over night. So perhaps the CEPAP is also useful for fibro sufferers (like me).
Perhaps this news letter could encourage a research about this, a least it is logic.
2.) Warm air contains less oxygen then cold air, so when it gets cold, I use a pullover and not a heater!
3.) High humidity makes air difficult to breath, that is so bad that because of it I moved from Brisbane Australia (tropical climate) To Adelaide (desert or Southpole influenced)
4.) There was research that THINKING you are doing exercise is close in its rewards than doing the real thing.
5.) You can tell your body/mind in the stage of falling asleep to exercise through the night and there is a very high liklyhood that you will harvest the rewards.

Summerization: Go to sleep with a CEPAP in a cold dry room receiving lots of oxygen and tell your body to exercise while you are slepping, Do not use the air humidifyer and heater of the CEPAP if it has one.

Never bother about exercises again and that means less stress for your fibro, more time to rest and less pain during the day.

Don’t bother to exercise, be happy, Tommy

February 16, 2014 at 6:16 pm
(23) tersa says:

So glad this exercise problem has come to site with the experts. My doctors are upset with me for not going to physical therapy..I have tried all the physical therapes for over 20 years, only to find myself now unable to walk…recently I have been put on a breathing machine for chronic athsma, and copd. My oxygen level in my lungs was low for a long while, and after two months of breathing treatments, my blood oxygen has improved greatly..I still have copd problems along with the pain levels, and I am house bound, but I can now not feel guilty about not getting the physical therapy done as requested. I do light stretching and some houe work, not much, as two days of house work and three days of bed rest! I feel I must do something, as is my personality, a hard habit to break. take care everyone.

February 16, 2014 at 9:01 pm
(24) Tommy says:

Hi Teresa,
The caring Doctor has disappeared, today they only follow their rules and one of their rules is that you have to execise.
Doctors completley have ecome foreighn to the idea that we all are individuals and we ALL are different.
If your Doc want’s you to do things you think is bad for you tell him:
“This is my body and only I am responsible for what I am doing with it!
I ask you for FRIENDLY advise, but it is ALLWAYS MY decision if I follow it.”

Whenever you act in Your own way instedt of folowing rules (like you must execise, drink 3l water a day – I would drown if I did) you become a bit more grown up and that is the most important thing in life.

Come to the grown up table to teresa, you are welcome, Tommy

February 19, 2014 at 6:40 am
(25) Blake says:

This is quite the interesting piece of information. Aside from all other symptoms, I’ve always complained that I can’t seem to breathe as well as I’d like to. On rare occasions I can take a deep breath that clears my head momentarily so I can still sometimes distinguish the difference between breathing well and not so much. The majority of the time my head feels very congested, especially my sinuses and my chest is often tight. It feels as if a lot of energy is exerted just breathing.

The lack of oxygen I feel is what usually contributes to all my nausea and usually going to the gym, if I go with a partner, I’ll attempt to push myself which ends in wanting to vomit and almost passing out because of my heart rate going off at a ridiculous rate and not being able to produce as much oxygen as I’d prefer.

I’ve spoken to my doctor many times about it and I was just always convinced it may have had something to do with my bronchitis as a teenager, she usually prescribes me a puffer to alleviate my breathing but it never really worked to begin with.

I live in Perth, Australia, myself. Usually in hot climates it becomes increasingly more difficult to breathe. My gym isn’t air conditioned and it makes a massive difference taking in air in front of a fan as opposed to the ambience around me. No one else seems fazed by it.

February 19, 2014 at 11:45 am
(26) c says:

In regards to treatment I find certain types of massage, moist heat, and careful trigger point therapy help to some degree. Part in keeping the muscles relaxed and working and part in helping blood flow.

February 25, 2014 at 12:36 am
(27) Valetudinarian says:

I think what a few people described above is what my Fibro doc calls “air hunger”. I don’t think this is the same as oxygen problems with excercise.

I have had this “air hunger” feeling. Like u need to take another deep breath that just isn’t satisfying.

From my experience this could mean my fibrinogen blood levels were increased. I think this indicates a thicker blood. Sometimes it was indeed increased. I took a product called co ag clear. It seemed to help with the air hunger/need a satisfying breath issue but not excercise intolerance.

April 8, 2014 at 3:36 pm
(28) Cece says:

I’ve had CFS for 5 years and have been through the trials and tribulations of not being able to get out of bed, being highly stressed and anxious, being exercise intolerant, leaving my job, spending a lot of money on private doctors, supplements and low dose hydrcortisone etc and have major depression as a result of it all !!!

So having done lots of research, the things which have helped me have been – a diet of predominantly raw fruits and veg (eg. Green smoothie in morning, big salad for lunch and various for dinner) which provides basic nutrients for my malnourished body, Low dose Naltrexone, which raises endorphine levels and therefore boosts the immune system.

The new thing I’m about to try is EWOT (exercise with oxygen therapy) its a specialised treatment which involves breathing in oxygen with a special mask while doing exercise so the oxygen penetrates at a deeper cellular level rather then just passive oxygen inhalation. Because oxygen it being inhaled at the sametime, it should offset the exercise ntolerance as the musles are being provided for.

Anyway, It’s sounds really promising from what I’ve read and seems to tie in with the thrust of the new research highlighted in the article – some kind of hypoxia, which make sense as a lot of us CFS sufferers are shallow breathers.

Far infra red light is also supposed to help the mitochondria produce ATP and therefore energy! I have access to a far infrared therapy bed, so I’m going to try that!!

If I can get consistent enough to implement everything at the same time, then this might all work to improve my condition!!

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