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In practical terms, that shows up as fatigue that seems disproportionate to your effort, shortness of breath during workouts that used to feel manageable, and a general sense that your body isn't performing the way it should

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It has also been suggested that in patients with ME/CFS exercise may trigger or aggravate mitochondrial dysfunction leading to increased lactate production, reduced ATP availability in the muscles (Lien et al., 2019), abnormal levels of metabolites (Germain et al., 2022), abnormal redox balance (Paul et al., 2021) and/or nitrosative stress (Morris et al., 2017)