[Abstract] Developing An Integrative Protocol To Address Post-exertional Malaise In [ME/CFS], 2026, Moneghetti, Armstrong et al

[forestglip]

Developing An Integrative Protocol To Address Post-exertional Malaise In Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS)

Moneghetti, Kegan J.; Christopoulos, Elena M.; Howden, Erin J.; Talbot, Jack S.; Armstrong, Christopher W.

PURPOSE
The latest ACSM Guidelines for Exercise Testing and Prescription (March 2025) highlight the importance of considering post exertional malaise (PEM) in exercise prescription for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), however the aetiology of PEM remains unknown. Therefore, we aimed to design a protocol to further evaluate the mechanisms underlying PEM to further refine physical activity and pacing recommendations for ME/CFS with and without postural orthostatic tachycardia syndrome (POTS).

METHODS
To further investigate PEM aetiology, participants with ME/CFS with and without POTS (n=10 each), POTS alone (n=10), and 10 healthy controls will complete a cardiopulmonary exercise test (CPET).

To explore aetiologies of PEM beyond metabolic dysfunction as identified through a CPET, we included A) comprehensive metabolomic and proteomic analysis of blood and urine collected prior to and for up to 3 days following exertion, B) cerebral blood flow measurement via extracranial doppler ultrasound of the carotid arteries during the CPET and an active stand test to assess orthostatic responses, C) maximal handgrip strength tests pre- and post-exertion to measure neuromuscular fatigue, and D) a heart rate and activity monitor worn to monitor orthostatic related fluctuations.

To integrate these techniques to identify aetiologies of PEM, daily symptom questionnaires will be utilized to track PEM and orthostatic intolerance symptoms and match those with biological markers.

RESULTS
We identified a diagnostic technique that integrates metabolic, hemodynamic, molecular, and neuromuscular assessments with symptom tracking in a unified framework to capture the onset and progression of PEM (Figure 1).

CONCLUSIONS
This protocol provides a comprehensive, integrated physiological data set to further define PEM in ME/CFS and clarifies the influence of POTS on PEM severity.



Web | DOI | PDF | Medicine & Science in Sports & Exercise | Abstract

 

[Braganca]

I’m not sure who the audience is for this protocol. Who is using this ACSM guidelines book? Why is it necessary to further refine physical activity and pacing recommendations for ME/CFS? Surely the correct recommendations should be do only as much as you can without invoking PEM.

The CPET is barbaric and dangerous for people with MECFS. I did two day cpet in Ithaca for the purpose of proving disability to a long term disability insurer. It worked for that purpose — but I went from moderate to severe and remained severe since.

 

[Andy]

And we don't know that the two day CPET demonstrates PEM. Yes, it demonstrates a difference between cases and controls, but currently it is only assumed to be evidence of PEM.

 

[Jonathan Edwards]

I don't understand what they are trying to do.

 

[rvallee]

The latest ACSM Guidelines for Exercise Testing and Prescription (March 2025) highlight the importance of considering post exertional malaise (PEM) in exercise prescription for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

Not only is there not a single reason to prescribe exercise for ME/CFS, there are many reasons why it's a terrible, harmful idea. It has nothing to do with considering PEM or not, exercise is not a valid treatment for chronic illness, doing so is simply reality avoidance, and massively incompetent. So this is looking at the problem the wrong way.

No effort should be made at mitigating implementing a bad idea, bad ideas should not be implemented in the first place. Every other industry manages to either avoid this, or realize their mistakes and adapt. No other industry gets caught this long doing something this wrong for absolutely no benefit whatsoever. What a disturbing dystopian nightmare.