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Post-exertional malaise
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====Formerly used to define Chronic fatigue syndrome==== In the 1988 [[Holmes criteria]] for [[Chronic fatigue syndrome|CFS]], unexplained generalized [[muscle weakness]] was one of the 11 minor symptoms, yet it was fatigue that set the tone. Another minor symptom referred to "prolonged (24 hours or greater) generalized fatigue after levels of [[exercise]] that would have been easily tolerated in the patient's premorbid state".<ref name="Holmes1988">{{Cite journal | last = Holmes | first = G. P. | last2 = Kaplan | first2 = J.E. | last3 = Gantz | first3 = N.M. | last4 = Komaroff | first4 = A.L. | last5 = Schonberger | first5 = L.B. | last6 = Straus | first6 = S.E. | last7 = Jones | first7 = J.F. |last8 = Dubois | first8 = R.E. | last9 = Cunningham-Rundles | first9 = C. | date = Mar 1988 | title = Chronic fatigue syndrome: a working case definition|url=https://www.ncbi.nlm.nih.gov/pubmed/2829679|journal=Annals of Internal Medicine|volume=108|issue=3|pages=387β389|issn=0003-4819|pmid=2829679}}</ref> PEM is not a mandatory symptom under the Holmes definition. The wording "postexertional malaise" was used in the article Symptoms and signs of chronic fatigue syndrome by Anthony Komaroff and Dedra Buchwald, from 1991.<ref>{{Cite journal|title=Symptoms and Signs of Chronic Fatigue Syndrome|date=1991-01-01|url=http://academic.oup.com/cid/article/13/Supplement_1/S8/423106/Symptoms-and-Signs-of-Chronic-Fatigue-Syndrome|journal=Clinical Infectious Diseases|volume=13|issue=Supplement_1|pages=S8βS11|last=Komaroff|first=Anthony L.|last2=Buchwald|first2=Dedra|language=en|doi=10.1093/clinids/13.Supplement_1.S8|issn=1537-6591}}</ref> The wording "postexertional malaise" was used as one of the 8 minor symptoms in the 1994 [[Fukuda criteria]], but without further clarification of the term, except that it lasts more than 24 hours. PEM is not a mandatory symptom under the Fukuda criterion.
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