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The mechanism by which exercise therapy relieves CFS is not fully understood but may include improving cardiopulmonary function and muscle endurance, reversing deconditioning adaptive changes in patients with CFS, improving autonomic dysfunction and reducing sympathetic nerve tone, increasing the levels of β-endorphins and monoamine neurotransmitters in the brain, improving pain and mood, regulating cytokines and immune function, decreasing chronic inflammatory responses and enhancing self-efficacy and sense of control (3,105,106)