I'm pretty sure that in some cases a MitoD crash from over-exertion can be far worse (in terms of clear objective abnormalities) than an ME crash.
What I imagine going on is that GET in MitoD is prescribed with a lot more care and an understanding that more is not better. It is not prescribed in the perverted ME/CFS sense of pushing through symptoms to cure your false illness beliefs.
One interesting thing that came out of the Mito Conference was the idea that every Mito Doctor speaking at the conference agreed that every MitoD patient should exercise, but never to the point of changing over from aerobic to anaerobic. One doctor said while most MitoD patients switch over to anaerobic way too early in exercise (or even just with an easy daily activity), some switch so quickly that they can't even catch the switch over during exercise testing. Just getting on the bike or standing on the treadmill sends some into anaerobic.
The idea was to do something every day. One doctor gave the example of a patient that doesn't get out of bed, but lifts a can of corn every day. Some days it's more lifts, some days it's less. But overall the trajectory after 3 years is this person can do more than the patient previously could. More reps, more weight, more.....
At the same time the doctors also agreed, listen to one's body. If you are more fatigued than yesterday, then don't push it to equal yesterday's exercises. You might be coming down with a cold or energy is being used for something else. It was agreed that patients listening to their own bodies and doctors listening to their patients is critical with regards to exercise.
One study that came up three times by three different Mito doctors at the conference was the study on mice. A researcher had done a study on regular mice and also mice with a genetic mitochondrial mutation. Generally the normal mice (not MitoD mutation) have brown fur and are running around the cage at a certain age. The mice with the MitoD mutation have grey fur, aren't running around, and are much smaller at the same age. Then they had a batch of the MitoD mutation mice that they had workout on the treadmill everyday for 45 minutes. These mice almost looked like the mice without the mutation. They had brown fur and they were running around and over the mice with the mutation who hadn't exercised.
When they looked in the lab at the mice, they found the mice with MitoD who exercised had a lot more mitochondria within their cells than the mice who didn't exercise. So therefore, while mice with MitoD produced less energy per mitochondria, if they exercised they produced more mitochondria which therefore increased the total energy production for each cell. Maybe not to the level of mice without MitoD, but it was more energy production. For people with fatigue, even a 10% boost in energy would be nice.
I'll try to find the study or at least a slide from the conference.
The take away of the MitoD doctors was:
1) their patients should be encouraged to do exercise (they prefer switching up weights one day and walking or biking or dancing). A doctor did mention that weights combined with something else is the best they know of today, but could always be overruled by new studies tomorrow.
2) their patients should be taught to do something they enjoy doing and will be willing to do. If the patient gets bored, then keep changing the exercise routine so it doesn't grow to be a chore.
3) their patients should be encouraged to listen to their own bodies and to never push it when fatigued.
4) their patients should feel and know that their doctor is listening to them (because each unique mutation and environment will impact what can be done and how often). Each patient is unique.
5) their patients should be told about the switch from aerobic to anaerobic and how to recognize it and avoid it. Exercise by a MitoD patient into the anaerobic zone causes more harm than good. Laying up a mito patient all afternoon, or the next day, or a few weeks from one physical therapy session is not good. Exercise must be stopped before this point (before anaerobic) and it needs to be recognized in order to be avoided.
6) Family members and physical therapists should be educated in order to know how important exercise is to MitoD patients, while realizing how quickly well intended pushes can lead to more harm to mitochondria (fewer mitochondria or mitochondria producing even less energy than they did before the exercise program).