PEM. What is it?
Post-exertional malaise (PEM) stands as a defining and often debilitating feature of Long COVID, contributing to the prolonged and complex nature of the condition. This overview delves into the typical symptoms, the demographic profile of those affected, and the prevalence of post-exertional malaise in the context of Long COVID.
Typical Symptoms:
Post-exertional malaise refers to a disproportionate and prolonged worsening of symptoms following physical or cognitive exertion. In the context of Long COVID, individuals experiencing PEM report a range of symptoms, including heightened fatigue, cognitive fog, muscle and joint pain, and a general sense of unwellness.
The exacerbation of symptoms is not immediate, often occurring hours or even days after the exertion. This delayed response adds an additional layer of complexity, making it challenging for individuals to predict and manage their energy expenditure effectively.
Who Gets It?:
Post-exertional malaise in Long COVID does not discriminate based on age, gender, or initial COVID-19 severity. It can affect individuals who had mild initial symptoms as well as those with severe acute cases. The diverse demographic profile of those experiencing PEM highlights its indiscriminate nature in the aftermath of the virus.
Studies suggest that individuals with Long COVID, regardless of their initial symptom severity, may be susceptible to post-exertional malaise. Moreover, the condition appears to impact both genders and individuals across different ethnic backgrounds, emphasizing the need for a comprehensive understanding of its implications.
Prevalence:
The prevalence of post-exertional malaise in Long COVID is notably high, with a significant proportion of individuals reporting its persistence as a prominent symptom during the post-acute phase. Various studies and patient surveys consistently highlight PEM as a key contributor to the prolonged recovery period experienced by those with Long COVID.
Understanding the prevalence of post-exertional malaise is crucial for healthcare providers to tailor management strategies and support for individuals navigating the challenges of Long COVID. Additionally, recognizing PEM as a distinct and pervasive symptom contributes to ongoing research efforts aimed at unraveling the complexities of this condition.
In conclusion, post-exertional malaise plays a central role in the landscape of Long COVID, impacting individuals across diverse demographics and significantly influencing their ability to engage in daily activities. This overview emphasizes the need for increased awareness, research, and targeted interventions to address the unique challenges posed by post-exertional malaise in the context of Long COVID.
Post-exertional malaise in Long COVID is like an invisible storm, with symptoms intensifying long after the exertion has ceased. It underscores the lingering complexities of this condition, affecting individuals from all walks of life and emphasizing the need for tailored support and understanding in the journey towards recovery.
Long Covid The Answers
Relief:
1. This website gives a general overview of Long COVID with some useful links and resource leaflets and videos to help with the most common symptoms. It has a section for sufferers and a section for Healthcare Professionals. http://www.phsa.ca/health-info/post-covid-19-care-recovery#Self-care–info
2. This is an excellent episode.
TLC Sessions – Living with Long Covid
Episode 10: Darren Brown – Long Covid Physio
Physiotherapist Darren Brown is a Long Covid sufferer and founder of Long Covid Physio. In our conversation this week he lays out the fundamentals of our rehabilitation needs and explains how pacing might be the key to getting a handle on our symptoms. He takes his experience working in HIV and Oncology rehabilitation and demonstrates how we can apply our knowledge of treating those conditions, with their fluctuating health challenges, when facing Long Covid. Patient advocate, peer supporter and a strong voice leading the charge in developing an understanding of the needs of Long Covid sufferers, Darren opens our eyes to the breadth of the role physio might have in our recovery. Living with Long Covid? How was your week?
Website – https://www.tlcsessions.net/ Twitter – @SessionsTlc https://twitter.com/sessionstlc Insta – @tlcsessions https://www.instagram.com/tlcsessions
Listen on Apple Podcasts:
3. Wearables are a good way of people detecting their heart rate and working out the way to pace from that. Such as adding 15 beats to your resting heart rate and not going above that amount if you’ve crashed. Recommended wearables:
Garmin, Oura ring, visible and the Apple Watch and Bootstrap.
See wearables in action with PEM: https://www.youtube.com/watch?v=lFmmyuUZ0Gs
4. This video from Long COVID Physio Resource page, gives lots of explanation and resource about how to manage PEM and what it is.
5. Poster from CDC – https://www.cdc.gov/me-cfs/pdfs/interagency/Managing-PEM_508.pdf
6. Long Covid and Post-Exertional Malaise: what is it and how to manage it? https://covidaidcharity.org/advice-and-information/long-covid-and-post-exertional-malaise
7. SolveME.org
https://solvecfs.org/wp-content/uploads/2021/09/PEM-REST-Combined.pdf
8. Really good toolkit found online https://www.omf.ngo/wp-content/uploads/2018/03/PEM-Avoidance-Toolkit-2018.pdf –
Credible Sources of Information:
1. Very good article from The Atlantic –
May be behind a paywall, but you can read on Apple News for free if subscribe to this. https://apple.news/Axt78LXNtQey-rdARe3UZjw
2. Paper about how when people were exercised who had PEM they were shown via muscle biopsies done before exercise and after to have muscle tissue damage post exercise – https://www.nature.com/articles/s41467-023-44432-3
Study Reveals Metabolic Dysfunction and Post-Exertional Malaise in Long COVID Patients
A study in Nature Communications (2024) uncovers metabolic dysfunction and post-exertional malaise in Long COVID patients. Muscle biopsies show mitochondrial function impairment and high-fatigable glycolytic fibers. Patients exhibit lower exercise capacity, increased amyloid-containing deposits, and abnormal muscle metabolomics compared to healthy individuals.
- Long COVID patients display metabolic dysfunction and post-exertional malaise.
- Muscle biopsies reveal impaired mitochondrial function and high-fatigable glycolytic fibers.
- Patients have reduced exercise capacity and increased amyloid-containing deposits in muscles.
- Symptoms post-exercise include muscle pain, fatigue, and cognitive issues.
- Abnormal muscle metabolomics observed in Long COVID patients.
3. Good information on PEM https://www.youtube.com/@LCCWYCD
