The worsening of symptoms that can follow a minimal cognitive, physical, emotional or social activity, or activity that could previously be tolerated. Symptoms can typically worsen 12 to 48 hours after activity and last for days or even weeks, sometimes leading to a relapse.”
Post-exertional exacerbation of symptoms or PEM:
is often delayed in onset by hours or days
is disproportionate to the activity
has a prolonged recovery time that may last hours, days, weeks or longer
Energy envelope: Certain amount of energy that a person can consume per day (i.e how much energy do i have)
Crash: Post-exertional malaise
It is imp to explain to patients
to avoid it, stick with one's energy envelope.
In Case of Myalgic Encephalomyelitis (ME)
Common symptoms of ME/CFS include
feeling extremely tired all the time – you may find it very hard to do daily activities
still feeling tired after resting or sleeping
taking a long time to recover after physical activity
problems sleeping, such as waking up often during the night
problems with thinking, memory and concentration
Some people with ME/CFS may also have other symptoms, including:
muscle or joint pain
headaches
a sore throat
flu-like symptoms
feeling dizzy or sick
fast or irregular heartbeats (heart palpitations)
The severity of symptoms can vary from day to day, or even within a day
How to avoid push and crash cycle?
go in slower pace rather than faster pace that goes hand to hand with the energy envelope
They feel extremely tired all the time, with troubles with sleep.
Brain Fog
It is heterogenous and severity can change day to day or week to week
Hypersensitivity is common.
There is a lot of stigma around it. They usually visit physicians when they have energy.
because no one see how sick they are.
Assessment of PEM
DePaul Symptom Questionnaire (Cotler et al., 2018).
Also used in case of long-covid
If you have a threshold score of 2 to 4 for frequency (half the time, most of the time, or all of the time) coupled with a score of 2 to 4 for severity (moderate, severe, or very severe) for the same item, then this is indicative of post-exertional malaise.