Post-exertional malaise: Difference between revisions

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'''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.<ref name="JohnsonCsymptoms"/><ref name="FightFatiguePEM"/>
'''Post-exertional malaise''' (PEM) is a worsening of many [[ME/CFS]] symptoms as a result of physical or mental exertion.  Patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field often referred to it as "the marker," i.e., the main symptom that differentiates [[ME]] and [[CFS]] from other fatiguing illnesses. PEM can last for days to weeks after the exertion.<ref name="JohnsonCsymptoms" /><ref name="FightFatiguePEM" />


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 (symptom)|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"/>
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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==Symptom recognition==
==Symptom recognition==
===Required===
*In the [[International Consensus Criteria]], postexertional neuroimmune exhaustion is required for a diagnosis of ME.
*In diagnosing [[Systemic Exertion Intolerance Disease]] (SEID).
===Optional===
*In the [[Fukuda criteria]], the symptom of post-exertional malaise can be used to help form a diagnosis.<ref>[http://www.cfids-me.org/cdcdefine.html The CDC (Fukuda 1994) Definition for Chronic Fatigue Syndrome]</ref> Unusually, it is not a required symptom for diagnosis.
*In the [[Fukuda criteria]], the symptom of post-exertional malaise can be used to help form a diagnosis.<ref>[http://www.cfids-me.org/cdcdefine.html The CDC (Fukuda 1994) Definition for Chronic Fatigue Syndrome]</ref> Unusually, it is not a required symptom for diagnosis.
*In the [[Canadian Consensus Criteria]] PEM is an option with an and/or with fatigue although most researchers require PEM.
*In the [[Holmes criteria]], prolonged (24 hours or greater) generalized fatigue after levels of exercise that would have been easily tolerated in the patient's premorbid state is an optional criteria for diagnosis, under the section ''Minor Symptom Criteria''.<ref>[http://www.cfids-me.org/holmes1988.html The 1988 Holmes Definition for CFS]</ref>
*In the [[Holmes criteria]], prolonged (24 hours or greater) generalized fatigue after levels of exercise that would have been easily tolerated in the patient's premorbid state is an optional criteria for diagnosis, under the section ''Minor Symptom Criteria''.<ref>[http://www.cfids-me.org/holmes1988.html The 1988 Holmes Definition for CFS]</ref>


==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>
*2018, Comparing Post-Exertional Symptoms Following Serial Exercise Tests<ref>Lariel J. Mateo, University of the Pacific, Poster at 2018 Pacific Undergraduate Research and Creativity Conference (PURCC)</ref> [https://scholarlycommons.pacific.edu/purcc/2018/events/87/ (Abstract)]
*1999, [https://www.ncbi.nlm.nih.gov/pubmed/10209352 Demonstration of delayed recovery from fatiguing exercise in chronic fatigue syndrome]
*2016, Deconstructing post-exertional malaise: An exploratory factor analysis<ref name="McManimen, 2016" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325824/ (Full Text)]
*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"/>
*2015, [[Myalgic Encephalomyelitis]]: Symptoms and [[Biomarker]]s<ref name="JasonL2015bio" /> [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/#!po=2.51799 (Full Text)]
*2015, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/#!po=2.51799 Myalgic Encephalomyelitis: Symptoms and Biomarkers], ''Jason et al'', 2015<ref name="JasonL2015bio"/>
*2015, Changes in Gut and Plasma [[Microbiome]] following [[Exercise]] Challenge in [[ME/CFS|Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)]]<ref name="ShuklaS2015" /> [http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0145453 (Full Text)]
*2015, [http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0145453 Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)], ''Shukla et al'', 2015<ref name="ShuklaS2015"/>
*2013, Post-exertion malaise in [[chronic fatigue syndrome]]: symptoms and gene expression<ref name="MeyerJ2013" /> [[http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444 (Abstract)]
*1999, Demonstration of delayed recovery from fatiguing [[exercise]] in [[chronic fatigue syndrome]] [https://www.ncbi.nlm.nih.gov/pubmed/10209352 (Abstract)]


[[File:2010 VanNess Post exertional worsening of symptoms chart.png|right|frame|Post-exertional worsening of symptoms, VanNess et al 2010.png]]
[[File:2010 VanNess Post exertional worsening of symptoms chart.png|right|frame|Post-exertional worsening of symptoms,<ref name="VanNess2010" />]]


==Notable articles==
==Notable articles==
*Nov 4, 2016 [http://www.medscape.com/viewarticle/871482#vp_1 Postexertion 'Crash,' not Fatigue per se, Marks Syndrome], MedScape By: Miriam Tucker
*Nov 4, 2016 [http://www.medscape.com/viewarticle/871482#vp_1 Postexertion 'Crash,' not Fatigue per se, Marks Syndrome], MedScape By: Miriam Tucker


*Dec 30, 2015 [http://me-cfs.se/blogg/suggestion-to-replace-pem-by-par/ Suggestion to replace PEM (Post Exertional Malaise) with PAR (Post Activity Relapse)], ''ME Blogg'', 2015
*Dec 30, 2015 [http://me-cfs.se/blogg/suggestion-to-replace-pem-by-par/ Suggestion to replace PEM (Post Exertional Malaise) with PAR (Post Activity Relapse)], ''ME Blogg'', 2015<ref name="MEBlogg2015" />


==Talks & interviews==
==Talks & interviews==
*2016, [https://www.youtube.com/watch?v=ux93w7yGQ5g&feature=youtu.be Inducing Post-Exertional Malaise in ME/CFS: A Look at the Research Evidence] ([[Peter Rowe]])
*2016, [https://www.youtube.com/watch?v=ux93w7yGQ5g&feature=youtu.be Inducing Post-Exertional Malaise in ME/CFS: A Look at the Research Evidence] ([[Peter Rowe]])
*2015, [https://www.youtube.com/watch?v=vfmrPd4-rIE Post-Exertion Malaise: The Intersection of Biology and Behavior], ''[[Dane Cook]], [[Solve ME/CFS]]''<ref name="CookD20151119v"/>
*2015, [https://www.youtube.com/watch?v=vfmrPd4-rIE Post-Exertion Malaise: The Intersection of Biology and Behavior], ''[[Dane Cook]], [[Solve ME/CFS]]''<ref name="CookD20151119v" />
*2015, [https://www.youtube.com/watch?v=F1PP21TmUPs 72. Gene-expression and exercise / Gen-expressie en inspanning – dr. Lucinda Bateman] ([[Lucinda Bateman]], [[Science for Patients]])
*2015, [https://www.youtube.com/watch?v=F1PP21TmUPs 72. Gene-expression and exercise / Gen-expressie en inspanning – dr. Lucinda Bateman] ([[Lucinda Bateman]], [[Science for Patients]])
*2013, [https://www.youtube.com/watch?v=zZ8aPYihkpQ CFS gene expression after exercise (part 1)] ([[Lucinda Bateman]])
*2013, [https://www.youtube.com/watch?v=zZ8aPYihkpQ CFS gene expression after exercise (part 1)] ([[Lucinda Bateman]])
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==Possible causes==
==Possible causes==
Dysfunction of the ATP ADP cycle.  Dr. Sarah Myhill has developed a test to assess ATP profiles.  www.healthrising.org/forums/resources/hips-overview-of-dr-myhills-atp-work-in-chronic-fatigue-syndrome-me-cfs.390/


==Potential treatments==
==Potential treatments==


==Learn more==
==Learn more==
*[http://www.whathealth.com/awareness/event/internationalcfsmeawarenessday.html International CFS/ME Awareness Day 2017 - What Health] (PEM Definition Included) [[CFIDS Association of America]]  
*[http://www.whathealth.com/awareness/event/internationalcfsmeawarenessday.html International CFS/ME Awareness Day 2017 - What Health] (PEM Definition Included) [[CFIDS Association of America]]  
*[http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf Post-Exertional Malaise in Chronic Fatigue Syndrome], ''[[Jennie Spotila]], [[Solve ME/CFS]]'', 2010<ref name="SpotilaJ2010"/>
*[http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf Post-Exertional Malaise in Chronic Fatigue Syndrome], ''[[Jennie Spotila]], [[Solve ME/CFS]]'', 2010<ref name="SpotilaJ2010" />
*[http://solvecfs.org/post-exertional-malaise-cause-and-effect/ Post-Exertional Malaise: Cause and Effect], ''[[Jennie Spotila]], [[Solve ME/CFS]]'', 2012<ref name="SpotilaJ20120523"/>
*[http://solvecfs.org/post-exertional-malaise-cause-and-effect/ Post-Exertional Malaise: Cause and Effect], ''[[Jennie Spotila]], [[Solve ME/CFS]]'', 2012<ref name="SpotilaJ20120523" />
*[http://chronicfatigue.about.com/od/cfsglossary/g/malaise.htm Definition of Post-Exertional Malaise], ''About Health'', 2015<ref name="AboutHealthPEM"/>
*[http://chronicfatigue.about.com/od/cfsglossary/g/malaise.htm Definition of Post-Exertional Malaise], ''About Health'', 2015<ref name="AboutHealthPEM" />
*[https://www.youtube.com/watch?v=ckT9BbSH0Lo Post-Exertional Malaise] Video, ''[[ME/CFS Ghost]]'', 2016<ref>[https://www.youtube.com/watch?v=ckT9BbSH0Lo Post-Exertional Malaise - The ME/CFS Ghost]</ref>
*[https://www.youtube.com/watch?v=ckT9BbSH0Lo Post-Exertional Malaise] Video, ''[[ME/CFS Ghost]]'', 2016<ref>[https://www.youtube.com/watch?v=ckT9BbSH0Lo Post-Exertional Malaise - The ME/CFS Ghost]</ref>
*2016, [http://www.healthrising.org/blog/2016/07/04/exercise-intolerance-fibromyalgia-chronic-fatigue-pots-explained/ The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained?]
*2016, [http://www.healthrising.org/blog/2016/07/04/exercise-intolerance-fibromyalgia-chronic-fatigue-pots-explained/ The Exercise Intolerance in POTS, ME/CFS and Fibromyalgia Explained?]


==See also==
==See also==
*[[Exercise]]
*[[Exercise]]


== References ==
== References ==
<references>
<references>
<ref name="AboutHealthPEM">{{citation
<ref name="AboutHealthPEM">{{citation
| author  = About Health
| author  = About Health
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| url    = http://chronicfatigue.about.com/od/cfsglossary/g/malaise.htm
| url    = http://chronicfatigue.about.com/od/cfsglossary/g/malaise.htm
}}</ref>
}}</ref>
<ref name="CookD20151119v">{{citation
<ref name="CookD20151119v">{{citation
| last1  = Cook              | first1 = DB                  | authorlink1 = Dane Cook
| last1  = Cook              | first1 = DB                  | authorlink1 = Dane Cook
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| url    = https://www.youtube.com/watch?v=vfmrPd4-rIE
| url    = https://www.youtube.com/watch?v=vfmrPd4-rIE
}}</ref>
}}</ref>
<ref name="FightFatiguePEM">{{citation
<ref name="FightFatiguePEM">{{citation
| author  = Fighting Fatigue
| author  = Fighting Fatigue
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| url    = http://www.fightingfatigue.org/post-exertional-malaise-a-hallmark-symptom-of-mecfs/
| url    = http://www.fightingfatigue.org/post-exertional-malaise-a-hallmark-symptom-of-mecfs/
}}</ref>
}}</ref>
<ref name="JasonL2015bio">{{Citation
<ref name="JasonL2015bio">{{Citation
| last1  = Jason            | first1 = LA                  | authorlink1 = Leonard Jason
| last1  = Jason            | first1 = LA                  | authorlink1 = Leonard Jason
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| url    = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/#!po=2.51799
| url    = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761639/#!po=2.51799
}}</ref>
}}</ref>
<ref name="JohnsonCsymptoms">{{citation
<ref name="JohnsonCsymptoms">{{citation
| last1  = Johnson          | first1 = C                | authorlink1 = Cort Johnson
| last1  = Johnson          | first1 = C                | authorlink1 = Cort Johnson
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| url    = http://www.cortjohnson.org/about-chronic-fatigue-syndrome-mecfs/symptoms/  
| url    = http://www.cortjohnson.org/about-chronic-fatigue-syndrome-mecfs/symptoms/  
}}</ref>
}}</ref>
 
<ref name="McManimen, 2016">{{Citation
<ref name="McManimen, 2016">
| last1  = McManimen                  | first1 = SL               | authorlink1 =  
{{Citation
| last2  = Sunnquist                  | first2 = ML               | authorlink2 = Madison Sunnquist
| last1  = McManimen                  | first1 = SL                   | authorlink1 =  
| last3  = Jason                      | first3 = LA               | authorlink3 = Leonard Jason  
| last2  = Sunnquist                  | first2 = ML                   | authorlink2 =  
| last3  = Jason                      | first3 = LA                   | authorlink3 = Leonard Jason  
| title  = Deconstructing post-exertional malaise: An exploratory factor analysis.
| title  = Deconstructing post-exertional malaise: An exploratory factor analysis.
| journal = Journal of Health Psychology    | volume =    | issue =    | page =  
| journal = Journal of Health Psychology    | volume =    | issue =    | page =  
Line 113: Line 120:
}}
}}
</ref>
</ref>
<ref name="MEBlogg2015">{{citation
<ref name="MEBlogg2015">{{citation
| author  = ME Blogg
| author  = ME Blogg
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| url    = http://me-cfs.se/blogg/suggestion-to-replace-pem-by-par/  
| url    = http://me-cfs.se/blogg/suggestion-to-replace-pem-by-par/  
}}</ref>
}}</ref>
<ref name="MeyerJ2013">{{citation
<ref name="MeyerJ2013">{{citation
| last1  = Meyer            | first1 = JD                  | authorlink1 = Jacob Meyer  
| last1  = Meyer            | first1 = JD                  | authorlink1 = Jacob Meyer  
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| url    = http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444  
| url    = http://www.tandfonline.com/doi/abs/10.1080/21641846.2013.838444  
}}</ref>
}}</ref>
<ref name="ShuklaS2015">{{Citation
<ref name="ShuklaS2015">{{Citation
| last1  = Shukla            | first1 = SK                  | authorlink1 = Sanjay Shukla
| last1  = Shukla            | first1 = SK                  | authorlink1 = Sanjay Shukla
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| url    = http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0145453
| url    = http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0145453
}}</ref>
}}</ref>
<ref name="SpotilaJ2010">{{citation
<ref name="SpotilaJ2010">{{citation
| last1  = Spotila          | first1 = JM                  | authorlink1 = Jennie Spotila
| last1  = Spotila          | first1 = JM                  | authorlink1 = Jennie Spotila
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| url    = http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf
| url    = http://solvecfs.org/wp-content/uploads/2013/10/pem-series.pdf
}}</ref>
}}</ref>
<ref name="SpotilaJ20120523">{{citation
<ref name="SpotilaJ20120523">{{citation
| last1  = Spotila          | first1 = JM                  | authorlink1 = Jennie Spotila
| last1  = Spotila          | first1 = JM                  | authorlink1 = Jennie Spotila
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| url    = http://solvecfs.org/post-exertional-malaise-cause-and-effect/
| url    = http://solvecfs.org/post-exertional-malaise-cause-and-effect/
}}</ref>
}}</ref>
 
<ref name="VanNess2010">{{Citation
<ref name="Nijs2010">
| last1  = VanNess               | first1 = M                  | authorlink1 = Mark VanNess
{{Citation
| last2  = Stevens               | first2 = S                  | authorlink2 = Staci Stevens
| last1  = Nijs                  | first1 = J                  | authorlink1 = J Nijs
| last3  = Bateman               | first3 = L                  | authorlink3 = Lucinda Bateman
| last2  = Van Oosterwijck                  | first2 = J                  | authorlink2 = J Van Oosterwijck
| last4  = Stiles                 | first4 = TL                 | authorlink4 = TL Stiles
| last3  = Meeus                  | first3 = M                  | authorlink3 = M Meeus
| last5  = Snell                  | first5 = CR                 | authorlink5 = Christopher Snell
| last4  = Lambrecht                  | first4 = L                  | authorlink4 = L Lambrecht
| display-authors =  
| last5  = Metzger                  | first5 = K                  | authorlink5 = K Metzger
| last6  = Frémont                  | first6 = K                  | authorlink6 = K Frémont
| last7  = Paul                  | first7 = L                  | authorlink7 = L Paul
| display-authors = 7
| title  = Unravelling the nature of postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: the role of elastase, complement C4a and interleukin-1beta
| journal = Journal of Internal Medicine    | volume =    | issue =    | page =
| date    = April 2010
| pmid    = 20433584
| doi    = 10.1111/j.1365-2796.2009.02178.x
}}
</ref>
 
<ref name="VanOosterwijck2010">
{{Citation
| last1  = Van Oosterwijck                  | first1 = J                  | authorlink1 = J Van Oosterwijck
| last2  = Nijs                  | first2 = J                  | authorlink2 = J Nijs
| last3  = Meeus                | first3 = M                  | authorlink3 = M Meeus
| last4  = Lefever                  | first4 = I                  | authorlink4 = I Lefever
| last5  = Huybrechts                  | first5 = L                  | authorlink5 = L Huybrechts
| last6  = Lambrecht                  | first6 = L                  | authorlink6 = L Lambrecht
| last7  = Paul                  | first7 = L                  | authorlink7 = L Paul
| display-authors = 7
| title  = Pain inhibition and postexertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome: an experimental study
| journal = Journal of Internal Medicine    | volume =    | issue =    | page =
| date    = September 2010
| pmid    = 20412374
| doi    = 10.1111/j.1365-2796.2010.02228.x
}}
</ref>
 
<ref name="VanNess2010">
{{Citation
| last1  = VanNess                 | first1 = M                  | authorlink1 = Mark VanNess
| last2  = Stevens                 | first2 = S                  | authorlink2 = Staci Stevens
| last3  = Bateman                 | first3 = L                  | authorlink3 = Lucinda Bateman
| last4  = Stiles                 | first4 = TL                   | authorlink4 = TL Stiles
| last5  = Snell                  | first5 = CR                   | authorlink5 = Christopher Snell
| display-authors = 5
| title  = Postexertional malaise in women with chronic fatigue syndrome
| title  = Postexertional malaise in women with chronic fatigue syndrome
| journal = Journal of Women's Health    | volume =    | issue =    | page =  
| journal = Journal of Women's Health    | volume =    | issue =    | page =  

Revision as of 02:52, June 15, 2018

Post-exertional malaise (PEM) is a worsening of many ME/CFS symptoms as a result of physical or mental exertion. Patients, ME/CFS organizatons, clinicians and researchers that work in the ME/CFS field often referred to it as "the marker," i.e., the main symptom that differentiates ME and CFS from other fatiguing illnesses. 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]

Required[edit | edit source]

Optional[edit | edit source]

  • In the Fukuda criteria, the symptom of post-exertional malaise can be used to help form a diagnosis.[10] Unusually, it is not a required symptom for diagnosis.
  • In the Canadian Consensus Criteria PEM is an option with an and/or with fatigue although most researchers require PEM.
  • In the Holmes criteria, prolonged (24 hours or greater) generalized fatigue after levels of exercise that would have been easily tolerated in the patient's premorbid state is an optional criteria for diagnosis, under the section Minor Symptom Criteria.[11]

Notable studies[edit | edit source]

Post-exertional worsening of symptoms,[16]

Notable articles[edit | edit source]

Talks & interviews[edit | edit source]

Possible causes[edit | edit source]

Dysfunction of the ATP ADP cycle. Dr. Sarah Myhill has developed a test to assess ATP profiles. www.healthrising.org/forums/resources/hips-overview-of-dr-myhills-atp-work-in-chronic-fatigue-syndrome-me-cfs.390/

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 March 29, 2016
  2. Fighting Fatigue, Post-Exertional Malaise – A Hallmark Symptom of ME/CFS, retrieved March 29, 2016
  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. The CDC (Fukuda 1994) Definition for Chronic Fatigue Syndrome
  11. The 1988 Holmes Definition for CFS
  12. Lariel J. Mateo, University of the Pacific, Poster at 2018 Pacific Undergraduate Research and Creativity Conference (PURCC)
  13. Jason, LA; Zinn, ML; Zinn, MA (September 2015), "Myalgic Encephalomyelitis: Symptoms and Biomarkers", Current Neuropharmacology, 13(5): 701-734, doi:10.2174/1570159X13666150928105725
  14. 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
  15. 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
  16. VanNess, M; Stevens, S; Bateman, L; Stiles, TL; Snell, CR (February 2010), "Postexertional malaise in women with chronic fatigue syndrome", Journal of Women's Health, doi:10.1089/jwh.2009.1507, PMID 20095909
  17. ME Blogg (December 30, 2015), Suggestion to replace PEM by PAR
  18. Cook, DB (November 19, 2015), "Deciphering Post Exertion Malaise: The Intersection of Biology and Behavior", Solve ME/CFS (video)
  19. Spotila, JM (2010), "Post-Exertional Malaise in Chronic Fatigue Syndrome" (PDF), Solve ME/CFS
  20. Spotila, JM (May 23, 2012), "Post-Exertional Malaise: Cause and Effect", Solve ME/CFS
  21. About Health (October 8, 2015), Definition of Post-Exertional Malaise
  22. Post-Exertional Malaise - The ME/CFS Ghost