utc um well absence of research isn't research evidence of absence there's no severely affected patients in that lot and they were only exercised modestly with regard to their illness status the more sufferers push themselves the more aggravated symptoms and weakness should be the sort of people who apply for exercise testing are not likely to be already on the verge of a relapse or struggling to cope at work or even at home if some of them have practical help or accomodating family they would do worse in the same tests without it gosh no mention of exertional insomnia even most of these studies aren't looking into a variety of somatic symptoms or even pain only fatigue and functional strength though the latter's good enough a demonstration of worsening after exercise for me at the end of the day it's objective measures are most helpful if good evidence is totally lacking you have to use next best evidence with caveats you miss out a major notable source of good evidence in all the me studies and synonymous diagnoses before c or the 's for instance papers by acheson gilliam galpine innes compston wallis et al this is after all where exercise intolerance and severe multi system symptoms were first described and recognised as a cardinal feature in non remitting cases there should also be some orthostasis studies there's also peckerman's heart studies les simpson's trigger finger study the da costa study and so on though they might not be focussing on symptoms the sort and extent of findings likely gives indirect suppport to the extend and breadth of symptoms february