This video series is intended to review the clinical presentation, scientific underpinnings, and treatment approach for patients with post-exertional malaise (PEM)/post-exertional symptom exacerbation (PESE).

For an abbreviated version highlighting the clinical pearls, please watch videos 1, 2, and 7. Videos 3-6 offer a deeper dive into the scientific and evidence-based pathophysiology of PEM/PESE.
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Post-exertional malaise (PEM)/post-exertional symptom exacerbation (PESE) is an altered physiological state and pathognomonic finding unique to ME/CFS that is now being recognized in those with post-acute sequelae of COVID-19 (PASC), also known as Long COVID.

It is critical that healthcare professionals recognize PEM/PESE and support the patient in avoiding a push-crash-cycle which can exacerbate disease processes and contribute to worsened long-term functional prognoses.

In video four of this seven-part series Brayden Yellman, MD, and Lucinda Bateman, MD, review studies showing how moderate exercise increases expression of sensory, adrenergic and immunologic genes in those with ME/CFS.

Video details:
- Sensory, adrenergic and immunological gene expression in those with ME/CFS, multiple sclerosis, and healthy controls at varying intervals pre/post exercise challenge.
- Reported symptom and gene expression comparison.

This video was made possible by the OMF-funded Medical Education Resource Center (MERC) at BHC, our generous donors, and viewers like you.

Citations:
Light AR, White AT, Hughen RW, Light KC. Moderate exercise increases expression for sensory, adrenergic, and immune genes in chronic fatigue syndrome patients but not in normal subjects. J Pain. 2009 Oct;10(10):1099-112. doi: 10.1016/j.jpain.2009.06.003. Epub 2009 Jul 31. PMID: 19647494; PMCID: PMC2757484.

Light AR, Bateman L, Jo D, Hughen RW, Vanhaitsma TA, White AT, Light KC. Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome and Fibromyalgia Syndrome. J Intern Med. 2012 Jan;271(1):64-81. doi: 10.1111/j.1365-2796.2011.02405.x. Epub 2011 Jul 13. PMID: 21615807; PMCID: PMC3175315.

Jacob D. Meyer, Alan R. Light, Sanjay K. Shukla, Derek Clevidence, Steven Yale, Aaron J. Stegner & Dane B. Cook (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

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