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. 2023 Dec 4:14:1257557.
doi: 10.3389/fphys.2023.1257557. eCollection 2023.

Post-exertional malaise in daily life and experimental exercise models in patients with myalgic encephalomyelitis/chronic fatigue syndrome

Nina K Vøllestad  1 , Anne Marit Mengshoel  1
Affiliations

Post-exertional malaise in daily life and experimental exercise models in patients with myalgic encephalomyelitis/chronic fatigue syndrome

Nina K Vøllestad et al. Front Physiol. .

Abstract

Post-exertional malaise (PEM) is commonly recognized as a hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is often used as one of several criteria for diagnosing ME/CFS. In this perspective paper we want to reflect on how PEM is understood, assessed, and evaluated in scientific literature, and to identify topics to be addressed in future research. Studies show that patients use a wide variety of words and concepts to label their experience of PEM in everyday life, and they report physical or mental exertions as triggers of PEM. They also report that PEM may have an immediate or delayed onset and may last from a few days to several months. When standardized exercise tests are used to trigger PEM experimentally, the exacerbation of symptoms has a more immediate onset but still shows a wide variability in duration. There are indications of altered muscular metabolism and autonomic nervous responses if exercise is repeated on successive days in patients with ME/CFS. The decreased muscular capacity appears to be maintained over several days following such controlled exercise bouts. These responses may correspond to patients' experiences of increased exertion. Based on this background we argue that there is a need to look more closely into the processes occurring in the restitution period following exercise, as PEM reaches the peak in this phase.

Keywords: adrenaline; cardiopulmonary exercise test (CPET); exercise; muscle weakness; myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); neuroendocrinological system; noradrenaline; post-exertional malaise (PEM).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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References

    1. Adachi H. (2017). Cardiopulmonary exercise test. Int. Heart J. 58 (5), 654–665. 10.1536/ihj.17-264 - DOI - PubMed
    1. Armstrong L. E., Bergeron M. F., Lee E. C., Mershon J. E., Armstrong E. M. (2021). Overtraining syndrome as a complex systems phenomenon. Front. Netw. Physiol. 1, 794392. 10.3389/fnetp.2021.794392 - DOI - PMC - PubMed
    1. Åstrand P. O., Rodahl K., Dahl H. A., Strømme S. B. (2003). Textbook of work Physiology. Physiological bases of exercise. 4th ed. Champaign, Ill: Human Kinetics.
    1. Baraniuk J. N., Adewuyi O., Merck S. J., Ali M., Ravindran M. K., Timbol C. R., et al. (2013). A Chronic Fatigue Syndrome (CFS) severity score based on case designation criteria. Am. J. Transl. Res. 5 (1), 53–68. - PMC - PubMed
    1. Barhorst E. E., Andrae W. E., Rayne T. J., Falvo M. J., Cook D. B., Lindheimer J. B. (2020). Elevated perceived exertion in people with myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: a meta-analysis. Med. Sci. Sports Exerc 52 (12), 2615–2627. 10.1249/mss.0000000000002421 - DOI - PMC - PubMed

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