181:
189:
57:
133:. PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Typically, it begins 12–48 hours after the activity that triggers it, and lasts for days, but this is highly variable and may persist much longer. Management of PEM is symptom-based, and patients are recommended to
223:
The course of a crash is highly variable. Symptoms typically begin 12–48 hours after the triggering activity, but may be immediate, or delayed up to 7 days. PEM lasts "usually a day or longer", but can span hours, days, weeks, or months. The level of activity that triggers PEM, as well as the
224:
symptoms, vary from person to person, and within individuals over time. Due to this variability, affected people may be unable to predict what will trigger it. This variable, relapsing-remitting pattern can cause one's abilities to fluctuate from one day to the next.
220:, infections, and spending too long standing or sitting up are other potential triggers. The resulting symptoms are disproportionate to the triggering activity and are often debilitating, potentially rendering someone housebound or bedbound until they recover.
1262:
There is an inappropriate loss of physical and mental stamina, rapid muscular and cognitive fatigability, post exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms within the patient's cluster of symptoms to
215:
PEM is triggered by "minimal" physical or mental activities that were previously tolerated, and that healthy people tolerate, like attending a social event, grocery shopping, or even taking a shower. Sensory overload, emotional distress, injury,
239:
However, its presence can be difficult to assess because patients and doctors may be unfamiliar with it. Hence, the WHO recommends that clinicians explicitly ask long COVID patients whether symptoms worsen with activity.
1619:
212:. Though typically cast as a worsening of existing symptoms, patients may experience some symptoms exclusively during PEM. Patients often describe PEM as a "crash", "relapse", or "setback".
1323:
1486:
1477:
425:"Pain-Related Post-Exertional Malaise in Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: A Systematic Review and Three-Level Meta-Analysis"
122:
82:
1123:
276:
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268:
264:
260:
165:
158:
150:
196:
Post-exertional malaise involves an exacerbation of symptoms, or the appearance of new symptoms, which are often severe enough to impact a person's functioning. While
1322:. Nancy Klimas, A. Martin Lerner, Cynthia Mulrow, Benjamin Natelson, Peter Rowe, Michael Shelanski. National Academy of Medicine (Institutes of Medicine). p. 7.
247:(CPET) may aid in documenting PEM, showing apparent abnormalities in the body's response to exercise. Still, more research on developing a diagnostic test is needed.
530:
921:
1405:
149:
but describes prolonged fatigue after exercise as a symptom. The term was later used in a 1991 review summarizing the symptoms of ME/CFS. Afterwards, the
753:
Identifying and diagnosing ME/CFS: Myalgic encephalomyelitis (or encephalopathy) / chronic fatigue syndrome: diagnosis and management: Evidence review D
580:
1039:
1470:
764:
454:
168:
committe stated they consider the term PEM outdated, as it may give the impression of just a "vague discomfort", and argued that the term
1153:
495:
1437:
1312:
1246:
951:
342:
291:
1116:"IOM 2015 Diagnostic Criteria | Diagnosis | Healthcare Providers | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | CDC"
1463:
1286:
154:
1552:
1500:
1115:
300:, a management strategy in which someone plans their activities to stay within their limits, may help avoid triggering PEM.
778:
1598:
655:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols"
1236:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners"
522:
1209:
863:
297:
134:
1400:. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management – Recommendations.
916:. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management – Recommendations.
525:. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management - Recommendations.
1557:
279:
consider it optional. Depending on the definition of ME/CFS used, PEM is present in 60 to 100% of ME/CFS patients.
913:
1433:
338:
256:
1397:
857:
Carruthers BM, van de Sande MI, De
Meirleir KL, Klimas NG, Broderick G, Mitchell T, et al. (October 2011).
693:
Carruthers BM, van de Sande MI, De
Meirleir KL, Klimas NG, Broderick G, Mitchell T, et al. (October 2011).
1588:
1313:"Beyond Myalgic Encephalomyelits/Chronic Fatigue Syndrome: Redefining an Illness (Report Guide for Clinicians)"
188:
172:
better captures the symptom. Nonetheless, they decided to continue using PEM as it is the more familiar term.
1593:
180:
751:
573:
1035:
56:
1063:"The Prospects of the Two-Day Cardiopulmonary Exercise Test (CPET) in ME/CFS Patients: A Meta-Analysis"
652:
Carruthers BM, Jain AK, De
Meirleir KL, Peterson DL, Klimas NG, Lerner AM, et al. (January 2003).
759:. NICE Evidence Reviews Collection. London: National Institute for Health and Care Excellence (NICE).
17:
1455:
145:
One of the first definitions of ME/CFS, the Holmes
Criteria published in 1988, does not use the term
1629:
424:
834:
606:
69:
121:, is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of
1624:
1547:
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826:
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634:
626:
487:
446:
405:
387:
217:
205:
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943:
332:
306:
for people with long COVID must be modified to avoid triggering PEM in susceptible patients.
1505:
1369:
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1191:
1084:
1074:
1007:
991:
882:
872:
816:
722:
706:
667:
654:
618:
436:
395:
377:
303:
1311:
Wright
Clayton E, Alegria M, Bateman L, Chu L, Cleeland C, Davis R, et al. (2015).
1275:
271:
require "post exertional malaise and/or fatigue" instead. On the other hand, the older
1583:
1578:
1374:
1349:
1196:
1089:
1062:
1012:
979:
887:
858:
727:
694:
400:
365:
1613:
1573:
877:
838:
710:
130:
1146:"Symptoms of ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)"
574:"Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness"
821:
804:
282:
A majority of people with long COVID experience post-exertional malaise as well.
184:
Typical timeframes of post-exertional malaise after normal daily activities, 2020
805:"Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"
622:
1365:
995:
382:
1515:
244:
233:
126:
86:
1176:
1003:
718:
679:
630:
391:
1205:
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1021:
896:
830:
774:
736:
450:
409:
64:
Chart of physical, cognitive, and emotional activities that may trigger PEM
1383:
671:
638:
1531:
441:
366:"Myalgic Encephalomyelitis or What? The International Consensus Criteria"
209:
201:
1276:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Key Facts"
1079:
488:"Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Symptoms"
197:
192:
Severe symptoms triggered by a 2-day CPET in people with ME/CFS, 2023
187:
179:
1038:. Centers for Disease Control and Prevention. September 1, 2022.
494:. U.S. Department of Health & Human Services. July 14, 2017.
1459:
978:
Davis HE, McCorkell L, Vogel JM, Topol EJ (January 13, 2023).
1350:"A report--chronic fatigue syndrome: guidelines for research"
859:"Myalgic encephalomyelitis: International Consensus Criteria"
695:"Myalgic encephalomyelitis: International Consensus Criteria"
980:"Long COVID: major findings, mechanisms and recommendations"
200:
is often prominent, it is "more than fatigue following a
1177:"Chronic fatigue syndrome and mitochondrial dysfunction"
803:
Grach SL, Seltzer J, Chon TY, Ganesh R (October 2023).
423:
Barhorst EE, Boruch AE, Cook DB, Lindheimer JB (2022).
579:. National Academy of Medicine. 2015. pp. 78–86.
267:, and NICE's definition of ME/CFS all require it. The
944:"Information for Healthcare Providers | ME/CFS | CDC"
607:"Chronic Fatigue Syndrome: A Working Case Definition"
232:
PEM is a hallmark symptom of ME/CFS and is common in
1061:
Eun-Jin L, Eun-Bum K, Eun-Su J, Chang-Gue S (2020).
204:". Other symptoms that may occur during PEM include
1566:
1540:
1524:
1493:
92:
78:
68:
42:
37:
1620:Myalgic encephalomyelitis/chronic fatigue syndrome
1487:Myalgic encephalomyelitis/chronic fatigue syndrome
1404:(Report). October 29, 2021. NICE guideline NG206.
920:(Report). October 29, 2021. NICE guideline NG206.
653:
529:(Report). October 29, 2021. NICE guideline NG206.
123:myalgic encephalomyelitis/chronic fatigue syndrome
83:Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
1429:Clinical management of COVID-19 Living Guideline
334:Clinical management of COVID-19 Living Guideline
908:
906:
1471:
1175:Myhill S, Booth NE, McLaren-Howard J (2009).
259:of ME/CFS by modern diagnostic criteria: the
119:post-exertional neuroimmune exhaustion (PENE)
74:Worsening of symptoms after ordinary activity
50:Post-exertional neuroimmune exhaustion (PENE)
8:
46:Post-exertional symptom exacerbation (PESE)
1478:
1464:
1456:
517:
515:
513:
492:Centers for Disease Control and Prevention
55:
34:
1373:
1195:
1088:
1078:
1011:
886:
876:
820:
726:
440:
399:
381:
208:, flu-like symptoms, pain, weakness, and
1354:Journal of the Royal Society of Medicine
1329:from the original on September 29, 2018
1234:Carruthers BM, van de Sande MI (2005).
750:National Guideline Centre (UK) (2021).
315:
296:There is no treatment or cure for PEM.
1408:from the original on December 29, 2021
924:from the original on December 29, 2021
781:from the original on February 19, 2024
533:from the original on December 29, 2021
18:Post-exertional neuroimmune exhaustion
1110:
1108:
1042:from the original on January 14, 2022
1036:"Long COVID or Post-COVID Conditions"
973:
971:
969:
852:
850:
848:
798:
796:
586:from the original on January 20, 2017
568:
265:National Academy of Medicine criteria
7:
1156:from the original on August 22, 2020
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564:
562:
560:
558:
556:
554:
552:
550:
548:
498:from the original on August 22, 2020
482:
480:
478:
476:
474:
472:
341:. January 13, 2023. pp. 113–4.
327:
325:
323:
321:
319:
170:post-exertional symptom exacerbation
157:from 2011 used the term, as well as
111:post-exertional symptom exacerbation
1292:from the original on March 27, 2019
954:from the original on August 9, 2020
660:Journal of Chronic Fatigue Syndrome
245:2-day Cardiopulmonary Exercise Test
27:Worsening of symptoms with activity
1252:from the original on March 4, 2019
1215:from the original on July 11, 2019
1126:from the original on March 8, 2019
292:Chronic fatigue syndrome treatment
25:
1440:from the original on May 22, 2023
1436:. January 13, 2023. p. 109.
457:from the original on May 21, 2023
345:from the original on May 22, 2023
275:lack any mention of PEM, and the
878:10.1111/j.1365-2796.2011.02428.x
711:10.1111/j.1365-2796.2011.02428.x
523:"Terms: Post-exertional malaise"
261:International Consensus Criteria
155:International Consensus Criteria
1:
1599:Whittemore Peterson Institute
364:Twisk F (December 20, 2018).
1067:Journal of Clinical Medicine
864:Journal of Internal Medicine
822:10.1016/j.mayocp.2023.07.032
699:Journal of Internal Medicine
109:), sometimes referred to as
48:Postexertional malaise (PEM)
984:Nature Reviews Microbiology
623:10.7326/0003-4819-108-3-387
611:Annals of Internal Medicine
605:Holmes GP (March 1, 1988).
269:Canadian Consensus Criteria
151:Canadian Consensus Criteria
1646:
1366:10.1177/014107689108400224
1348:Sharpe M (February 1991).
996:10.1038/s41579-022-00846-2
383:10.3390/diagnostics9010001
289:
1434:World Health Organization
1073:(12). J Clin Med.: 4040.
339:World Health Organization
137:to avoid triggering PEM.
63:
54:
1589:Open Medicine Foundation
1594:Solve ME/CFS Initiative
1511:Post-exertional malaise
914:"1.2 Suspecting ME/CFS"
809:Mayo Clinic Proceedings
147:post-exertional malaise
141:History and terminology
125:(ME/CFS) and common in
103:Post-exertional malaise
38:Post-exertional malaise
1398:"1.11 Managing ME/CFS"
193:
185:
1501:Clinical descriptions
1320:nationalacademies.org
950:. November 11, 2022.
672:10.1300/J092v11n01_02
191:
183:
135:pace their activities
1152:. January 27, 2021.
1122:. November 8, 2018.
255:PEM is considered a
206:cognitive impairment
1541:Society and history
1285:. 2015. p. 2.
1184:Int J Clin Exp Med
1080:10.3390/jcm9124040
442:10.1093/pm/pnab308
194:
186:
153:from 2003 and the
1607:
1606:
815:(10): 1544–1551.
766:978-1-4731-4221-3
218:sleep deprivation
159:later definitions
100:
99:
32:Medical condition
16:(Redirected from
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1558:Notable patients
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435:(6): 1144–1157.
420:
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350:
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304:Physical therapy
257:cardinal symptom
210:trouble sleeping
59:
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277:Fukuda Criteria
273:Oxford Criteria
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85:
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47:
33:
28:
23:
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15:
12:
11:
5:
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1584:ME Research UK
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1579:ME Association
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1494:Medical issues
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1360:(2): 118–121.
1340:
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1267:
1226:
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1137:
1104:
1053:
1027:
990:(3): 133–146.
965:
935:
902:
871:(4): 327–338.
844:
792:
765:
742:
705:(4): 327–338.
685:
644:
617:(3): 387–389.
597:
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290:Main article:
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1574:Action for ME
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1567:Organizations
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1553:Controversies
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1245:. p. 8.
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