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Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME / CFS) Post Treatment Lyme Disease Syndrome (PTLDS), Fibromyalgia Leading Research. Delivering Hope.Open Medicine Foundation® Canada

Blood Flow and Exercise in ME/CFS and Orthostatic Intolerance

Study Aim

The study aims to investigate the effects of supine vs upright exercise on cerebral blood flow, blood pressure, heart rate, and the presence of autoimmune antibodies in ME/CFS patients with orthostatic intolerance, compared to controls, to understand the underlying mechanisms and differences in symptom severity and post-exertional malaise.



  • Elena Christopoulos
  • Kegan Moneghetti, FRACP, PhD
  • Paul Gooley, PhD
  • Christopher Armstrong, PhD

Updates and Potential

  • IRB/Ethics approved for the design of at home positional detector in combination with hemodynamics tracking.
  • Activpal and CareTaker continuous BP devices in combination appear effective in monitoring BP at home.
  • IRB/Ethics approval for main project received.
  • Recruitment for main study occurs in June and we expect a 12-month recruitment period for this study. 8 visits a week is maximum capacity and 160 visits (20 weeks at max capacity) are needed.
  • Submitting systematic review paper to field interest.

Orthostatic intolerance (OI) is when people feel symptoms like light-headedness, dizziness, blurred vision, and sometimes fainting, especially when they stand up. This is because of instability in blood flow and pressure. Since 2003, recognizing these symptoms has been a key part of diagnosing ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome), a condition where OI is quite common. In some cases, these symptoms in ME/CFS patients are due to reduced blood flow to the brain rather than changes in how blood circulates upon standing.

We hypothesize that people with ME/CFS and OI will be impacted more by upright exercise versus supine exercise. This will be observed by reduced blood flow to the brain and/or reduced blood pressure and/or increased heart rate during and after exercise. We suspect this could lead to more severe post-exertional malaise (PEM), which is a worsening of symptoms following physical activity.

Additionally, the study predicts that there will be observable differences in metabolic processes in ME/CFS and OI patients before and after exercise, particularly during PEM, and these differences will be more pronounced in patients with both conditions.


The image is a visual representation of blood flow, depicting a stream of elements against a gradient background that suggests movement and fluidity.

  1. Determine if CBF is further reduced in patients with both ME/CFS and OI during exercise and its effect on OI and PEM symptoms.
  2. Observe any hemodynamic abnormalities post-exercise/during PEM in ME/CFS and OI patients.
  3. Determine metabolic, genomic, proteomic or transcriptomic differences between patients with ME/CFS and OI.
  4. Investigate the presence of autoantibodies against adrenoceptors and muscarinic acetylcholine receptors in ME/CFS and OI.