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@tomkindlon.bsky.social Oct 11, 2026, 2:00 PM

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POST-EXERTIONAL MALAISE (PEM) IN ME/CFS

#mecfs #pem #postexertionalmalaise

POST-EXERTIONAL MALAISE (PEM) IN ME/CFS
PEM is the delayed worsening of symptoms, such as cognitive dysfunction and fatigue, following minimal physical and/or mental exertion. It often has a profound impact on daily activities.
ME/CFS research highlights:
• Lower threshold for anaerobic respiration / lactic acid (lactate) production. Elevated lactate at rest associated with more severe PEM.
• Sodium-potassium pump dysfunction in skeletal muscle may impair mitochondria and contribute to PEM.
• Increased activation of certain brain regions post-exercise may be associated with PEM.
Although these studies have limitations, they provide a foundation for future research.
PEM is the hallmark feature of ME/CFS
•

INFORM. INFLUENCE. INVEST. Full overview and references at [tinyurl.com/PEMsymptomsat]
1111111 111141 RESEARCH UK 00030042

@tomkindlon.bsky.social Oct 11, 2026, 1:53 PM

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What post-exertional malaise (PEM) in ME/CFS feels like

#mecfs #pem #PostExertionalMalaise

What post-exertional malaise (PEM) in ME/CFS feels like
worst flu
complete energy drain
worst hangover
poisoned pain aching
sleep making no difference
having been run over/hit by a vehicle
made of lead
nausea weak
body shutdown
jet lag

bone deep exhaustion
wading through mud
plug pulled out
Recurring themes from ME Research UK
Symptom Saturday PEM Survey
INFORM. INFLUENCE. INVEST.

R UK e

@tomkindlon.bsky.social Oct 3, 2026, 11:57 PM

Post-Exertional Malaise in Long COVID and Post-Vaccine Syndrome: Why “Exercise More” Is the Wrong Answer

drpierrekory.com/blog/post-ex...

Pity that there is only one reference to ME/CFS in the (long) article

Screenshot from October AMMES newsletter

#LongCovid #PostExertionalMalaise #PEM

Image of somebody with their head in their hands with the following text
Post-Exertional Malaise in Long COVID and Post-Vaccine Syndrome: Why “Exercise More” Is the Wrong Answer

A walk around the block, a few hours of focused work, a social event, or a workout you thought you were finally ready for. It didn’t feel excessive at the time.

Then, 12 to 72 hours later, something happened that has no parallel in “normal” human experience. Not tiredness. Not soreness. A complete systemic collapse, with fatigue so profound it feels neurological, brain fog that makes thinking feel like wading through quicksand, muscle pain, sensory sensitivity, and a return of every symptom you thought you’d been making progress on.

This is post-exertional malaise. And if you have Long COVID or Post-Vaccine Syndrome, you’ve almost certainly experienced it.

What you may not have received is an honest clinical explanation of what it actually is, why it happens, and why the treatment most clinicians prescribe — pushing through, gradually increasing activity, “deconditioning” management — is not just ineffective but genuinely harmful.
Read more here>>

@benking01.bsky.social Oct 3, 2026, 12:33 PM

13:30 Saturday afternoon.

LOTS of welcome REST 🙏

A single #VisibleHealth PacePoint, despite a shopping trip and a fair bit of light housework this morning.

#LongCovid #Pacing to avoid debilitating #PostExertionalMalaise

@benking01.bsky.social Sep 19, 2026, 2:13 PM

Invigilating exams is itself pretty sedentary.

Moving chairs and tables beforehand and afterwards is more energetic...

Repeatedly walking upstairs to the staffroom in-between the four exams also resulted in exertion 🤔

But the overall impact has been low 🙏

#Pacing to avoid #PostExertionalMalaise

Heartrate graph from Visible showing short periods of exertion

@tomkindlon.bsky.social Sep 18, 2026, 12:27 AM

The Debt Came Due: Notes From a Crash by @darthfoo.bsky.social

darthfoo.substack.com/p/the-debt-c...

Screenshot from September AMMES newsletter

#MEcfs #LongCovid #PostExertionalMalaise #PEM #PwME

Image of someone lying flat on the sand, looking exhausted with the following text

The Debt Came Due: Notes From a Crash
"There is a version of my life that exists in my memory like a photograph from a trip I’ll never take again. In that version, I wake up and get out of bed without negotiating with my body first. I drive to work. I talk to people. I solve problems. I go home. I am tired in the way ordinary people are tired, the kind of tired that a night’s sleep fixes.

That life is gone.

What replaced it has a name. Long COVID. ME/CFS. Post-exertional malaise. The clinical language is clean and distant, which is probably why it fails so completely to describe what it actually feels like to live inside this body right now.

Here is what it feels like: I am in a crash."
Read more here>>

@crashmargulies.bsky.social Sep 8, 2026, 12:08 AM

Full essay, 3,026 words - crashmargulies.dreamwidth.org/35286.html

#MyalgicEncephalomyelitis #LongCOVID #PostExertionalMalaise #SpoonTheory #PENE #PEM #MEcfs #MillionsMissing

@tomkindlon.bsky.social Sep 8, 2026, 12:03 AM

From Germany

Registered interventional trials fail to cover patient-prioritised treatments in Post-COVID condition (PCC)

www.researchsquare.com/article/rs-1...

s4me.info/threads/regi...

Screenshot from latest Science for ME weekly update

#LongCovid #PostExertionalMalaise

Registered interventional trials fail to cover patient-prioritised treatments in Post-COVID condition (PCC) — Gabriel et al
"The most pronounced discrepancy between research activity and patient priorities, however, concerns neither pharmacological interventions nor a speciﬁc treatment modality, but a highly relevant patient-centred outcome: PEM."
Preprint | Thread

@crashmargulies.bsky.social Sep 7, 2026, 6:59 PM

New Essay: New Essay: Post-Exertional Neuroimmune Exhaustion and Living Below the Spoon Theory

Read the whole thing here: crashmargulies.dreamwidth.org/35286.html

Or this thread for a preview: 🧵

#PEM #PENE #pwME #MyalgicE #LongCOVID #MEcfs #PostExertionalMalaise

@tomkindlon.bsky.social Sep 5, 2026, 12:47 PM

eNOS Uncoupling, Shear-Stress Tolerance, and the Two-Threshold Model of Post-Exertional Malaise in Long COVID

onlinelibrary.wiley.com/doi/10.1111/...

Discussion where lead author takes part:
s4me.info/threads/shea...

Screenshot from Science for ME update

#LongCovid #PostExertionalMalaise #PEM

eNOS Uncoupling, Shear-Stress Tolerance, and the Two-Threshold Model of Post-Exertional Malaise in Long COVID: A Mechanistic Hypothesis With Implications for Physiotherapy and Recovery Protocols — Karipidis and Karipidis
Hypothesis. "Within the proposed framework, PEM severity may depend not only on the initiating exertional load, but also on the biochemical and hemodynamic environment during the subsequent 24–48 h recovery period."
Article | Thread

@crashmargulies.bsky.social Sep 3, 2026, 8:05 AM

New blog: Math is hard, PEM is harder.
crashmargulies.dreamwidth.org/34488.html

#PostExertionalMalaise #pwME #MEcfs #MyalgicE