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Key changes they discovered were differences in the body's abilty to generate energy compared to healthy patients. This included lower levels of oxidative phosphorylation—a biocheical process that yields ATP, a molecule that the body uses for energy. They also observed that after exercise there was a decrease in the activity of mitochondria, cellular power stations that manufacture the ATP molecules “Their mitochondrial function s impaired rapidly upon exercise,” Wst says. “This can make them go into a vicious cycle, because every time they overexert themselves, they get a crash in their mitochondrial function and their metabolism.” The impact on the body’s ability to manufacture energy are also echoed by the results from experiments where patients with post-exertional malaise performed two exercise tests—24 hours apart—in which they were asked to exercise until exhausted During the exercise test on the second day, patients with post-exertional malaise showed an impaired ability to manufacture energy and reached a point of exhaustion much sooner and with far less exercise than on the first day. For people without post-exertional malaise, they can do very similar amounts of exercise on both days before they reach exhaustion The point at which the body shifts from using oxygen for energy to anaerobic metabolism—a biochemical process in the cell that produces less energy and is less efficient—