Post-exertional malaise: Difference between revisions

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Worsening symptoms include [[chronic fatigue]], flu-like symptoms, brain fog ([[cognitive dysfunction]]), [[unrefreshing sleep]], chronic pain, [[orthostatic intolerance]], [[neurally mediated hypotension]], [[POTS]] and more. "As with the severity, the exertion needed to trigger PEM theories case-by-case. For some, it might kick in after a little bit of exercise on top of a day's regular activities. For others, is incredible as it may seem, it can just take a trip to the mailbox, a shower, or sitting upright for an hour."  <ref>[https://www.verywell.com/what-is-post-exertional-malaise-716023 What Is Post-exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[https://www.verywell.com/post-exertional-malaise-715670 Post Exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[http://www.webmd.com/chronic-fatigue-syndrome/chronic-fatigue-syndrome-symptoms Chronic Fatigue Syndrome - Web MD]</ref><ref>[http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf PEM Series - Solve ME/CFS - Jenny Spotila]</ref> Onset of PEM can be delayed 24-72 hours.<ref>[http://www.whathealth.com/awareness/event/internationalcfsmeawarenessday.html What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America]</ref>
Worsening symptoms include [[chronic fatigue]], flu-like symptoms, brain fog ([[cognitive dysfunction]]), [[unrefreshing sleep]], chronic pain, [[orthostatic intolerance]], [[neurally mediated hypotension]], [[POTS]] and more. "As with the severity, the exertion needed to trigger PEM theories case-by-case. For some, it might kick in after a little bit of exercise on top of a day's regular activities. For others, is incredible as it may seem, it can just take a trip to the mailbox, a shower, or sitting upright for an hour."  <ref>[https://www.verywell.com/what-is-post-exertional-malaise-716023 What Is Post-exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[https://www.verywell.com/post-exertional-malaise-715670 Post Exertional Malaise - Very Well - Adrienne Dellwo]</ref><ref>[http://www.webmd.com/chronic-fatigue-syndrome/chronic-fatigue-syndrome-symptoms Chronic Fatigue Syndrome - Web MD]</ref><ref>[http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf PEM Series - Solve ME/CFS - Jenny Spotila]</ref> Onset of PEM can be delayed 24-72 hours.<ref>[http://www.whathealth.com/awareness/event/internationalcfsmeawarenessday.html What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America]</ref>
A 2016 DePaul University study focused on deciphering if post-exertional malaise was a generalized, full-body fatigue and/or a muscle-specific fatigue. The results suggested that PEM is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.<ref name="McManimen, 2016"/>


==2015 Institute of Medicine report==
==2015 Institute of Medicine report==
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==Notable studies==
==Notable studies==
*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27557649 Deconstructing post-exertional malaise: An exploratory factor analysis.] <blockquote> "Abstract: Post-exertional malaise is a cardinal symptom of myalgic encephalomyelitis and chronic fatigue syndrome. There are two differing focuses when defining post-exertional malaise: a generalized, full-body fatigue and a muscle-specific fatigue. This study aimed to discern whether post-exertional malaise is a unified construct or whether it is composed of two smaller constructs, muscle fatigue and generalized fatigue. An exploratory factor analysis was conducted on several symptoms that assess post-exertional malaise. The results suggest that post-exertional malaise is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue."<ref name="McManimen, 2016"/></blockquote>
*1999, [https://www.ncbi.nlm.nih.gov/pubmed/10209352 Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome]
*1999, [https://www.ncbi.nlm.nih.gov/pubmed/10209352 Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome]
*2013, [http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444 Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression], ''Meyer et al'', 2013<ref name="MeyerJ2013"/>
*2013, [http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444 Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression], ''Meyer et al'', 2013<ref name="MeyerJ2013"/>
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| url    = http://www.cortjohnson.org/about-chronic-fatigue-syndrome-mecfs/symptoms/  
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<ref name="McManimen, 2016">
{{Citation
| last1  = McManimen                  | first1 = SL                  | authorlink1 =
| last2  = Sunnquist                  | first2 = ML                  | authorlink2 =
| last3  = Jason                  | first3 = LA                    | authorlink3 = Leonard Jason
| title  = Deconstructing post-exertional malaise: An exploratory factor analysis.
| journal = Journal of Health Psychology    | volume =    | issue =    | page =
| date    = 2016
| pmid    = 27557649
| doi    = 10.1177/1359105316664139
}}
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[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]

Revision as of 19:49, September 30, 2016

Post-exertional malaise (PEM) is a worsening of many ME/CFS symptoms as a result of physical or mental exertion. It is often referred to as "the marker" by patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field. PEM can last for days to weeks after the exertion.[1][2]

Worsening symptoms include chronic fatigue, flu-like symptoms, brain fog (cognitive dysfunction), unrefreshing sleep, chronic pain, orthostatic intolerance, neurally mediated hypotension, POTS and more. "As with the severity, the exertion needed to trigger PEM theories case-by-case. For some, it might kick in after a little bit of exercise on top of a day's regular activities. For others, is incredible as it may seem, it can just take a trip to the mailbox, a shower, or sitting upright for an hour." [3][4][5][6] Onset of PEM can be delayed 24-72 hours.[7]

A 2016 DePaul University study focused on deciphering if post-exertional malaise was a generalized, full-body fatigue and/or a muscle-specific fatigue. The results suggested that PEM is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.[8]

2015 Institute of Medicine report[edit | edit source]

PEM chart from the 2015 Institute of Medicine report

This landmark report published in 2015 by the United States Institute of Medicine report, which assessed all the evidence available, concluded:

"There is sufficient evidence that PEM is a primary feature that helps distinguish ME/CFS from other conditions"

Pages 84-86 of the report describe the evidence for post-exertional malaise in ME/CFS patients.[9]

Prevalence[edit | edit source]

Symptom recognition[edit | edit source]

Notable studies[edit | edit source]

Post-exertional worsening of symptoms, VanNess et al 2010.png

Notable articles[edit | edit source]

Talks & interviews[edit | edit source]

Possible causes[edit | edit source]

Potential treatments[edit | edit source]

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. Johnson, C, Health Rising: ME/CFS Symptoms, retrieved Mar 2016 Check date values in: |access-date= (help)
  2. Fighting Fatigue, Post-Exertional Malaise – A Hallmark Symptom of ME/CFS, retrieved Mar 2016 Check date values in: |access-date= (help)
  3. What Is Post-exertional Malaise - Very Well - Adrienne Dellwo
  4. Post Exertional Malaise - Very Well - Adrienne Dellwo
  5. Chronic Fatigue Syndrome - Web MD
  6. PEM Series - Solve ME/CFS - Jenny Spotila
  7. What Health - International CFS/ME Awareness Day 2017 - CFIDS Association of America
  8. 8.0 8.1 McManimen, SL; Sunnquist, ML; Jason, LA (2016), "Deconstructing post-exertional malaise: An exploratory factor analysis.", Journal of Health Psychology, doi:10.1177/1359105316664139, PMID 27557649
  9. Institute of Medicine report pages 84-86, search term exercise
  10. Meyer, JD; Light, AR; Shukla, SK; Clevidence, D; Yale, S; Stegner, AJ; Cook, DB (October 2, 2013), "Post-exertion malaise in chronic fatigue syndrome: symptoms and gene expression", Fatigue: Biomedicine, Health & Behavior, 1 (4): 190-209, doi:10.1080/21641846.2013.838444
  11. Jason, LA; Zinn, ML; Zinn, MA (September 2015), "Myalgic Encephalomyelitis: Symptoms and Biomarkers", Current Neuropharmacology, 13(5): 701-734, doi:10.2174/1570159X13666150928105725
  12. Shukla, SK; Cook, D; Meyer, JD; et al. (December 18, 2015), "Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)", Plos One, 10(12), doi:10.1371/journal.pone.0145453
  13. ME Blogg (December 30, 2015), Suggestion to replace PEM by PAR
  14. Cook, DB (November 19, 2015), "Deciphering Post Exertion Malaise: The Intersection of Biology and Behavior", Solve ME/CFS (video)
  15. Spotila, JM (2010), "Post-Exertional Malaise in Chronic Fatigue Syndrome" (PDF), Solve ME/CFS
  16. Spotila, JM (May 23, 2012), "Post-Exertional Malaise: Cause and Effect", Solve ME/CFS
  17. About Health (October 8, 2015), Definition of Post-Exertional Malaise
  18. Post-Exertional Malaise - The ME/CFS Ghost

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