Post-exertional malaise
Worsening of symptoms with activity
Post-exertional malaise
Post-exertional malaise (PEM) is a worsening of existing symptoms or appearance of new symptoms that occurs after even minimal exertion. It is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is a symptom for about half of people with long COVID. PEM is often severe enough to be disabling, and is triggered by ordinary activities that individuals tolerated before their illness. 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. Example triggers are taking a shower or holding a conversation. It can be assessed by a questionnaire, and in research settings, measured with a 2-day cardiopulmonary exercise test. Individuals are recommended to pace their activities to stay within their individual energy limits to avoid triggering PEM. During a crash, management involves a further reduction in activity levels and rest. The use of assistive technologies can help people...
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