Post-Exertional Symptom Exacerbation after Sub-Maximal Exercise in Individuals with [ME/CFS] and Post-Acute Sequelae of COVID-19, 2025, Berardi et al

[Utsikt]

PEM and PESE are typically used as synonyms. I don't think one can critisise the authors for that.

I thought PESE was part or PENE, which is a concept that speculates far too much about the cause of the symptoms?

Regardless, they seem to think it means post-exercise-SE.

Maybe the additional 0 is a typo?

Might be. The supplementary file includes tracked changes in the pdf so the attention to detail isn’t great.

 

[EndME]

I thought PESE was part or PENE, which is a concept that speculates far too much about the cause of the symptoms?

Regardless, they seem to think it means post-exercise-SE.

Since they mention physical, cognitive, or emotional stressors as confounders for PESE they seem to be aware of some greater picture, despite their focus elsewhere.

If someone believes that something is anways just people with maladaptive thoughts then they probably have no reason to think that the cause of worsening has to be restricted to thinking one can only gets worse after exercise in the first place, because it's all just thoughts anyways.

 

[Utsikt]

Since they mention physical, cognitive, or emotional stressors as confounders for PESE they seem to be aware of some greater picture, despite their focus elsewhere.

But they do not mention it outside the limitations and did not even attempt to control it whatsoever. So they can’t think it’s very important.

 

[Evergreen]

Maybe riding a bicycle is a form of exercise that is better tolerated than others, due to the hemodynamics?

It is something that has surprised me when I did a stress test on an ergometer.

Walking seems like it would cause greater orthostatic stress than cycling. Maybe the stronger use of leg muscles in cycling also promotes better blood flow?

An interesting question is also to what degree the symptom exacerbation associated with exertion is caused by orthostatic stress and not the activity per se. In my opinion even sitting upright causes some orthostatic stress... and maybe we tend to blame the activity that we did for the symptoms while forgetting about the orthostatic stress.

When I started GET, my ME/CFS was mild. I was still doing a fair bit of walking, e.g.. to and from (part-time) work, within work and going for the odd walk. I didn't cycle at all. My GET started with 15 mins of walking, immediately followed by 5 mins of cycling an exercise bike (a recumbent one, where I was sitting as if in a chair, not leaning forward). The walking portion always gave me a headache within a couple of minutes, which disappeared quickly with cycling. I was always so relieved to sit down on the bike because I felt better soon after I did.

It was, in my view, because the orthostatic burden of walking was higher than the orthostatic burden of cycling, because you're fully upright for walking and sitting for cycling. When walking, you're literally shaking the blood down into your boots. When cycling, you can only shake it down as far as your abdomen so you've more chance of getting some back to your head.

 

[Mij]

I never thought of that, when I was using my stationary bike years ago I didn't have OI during that period. But brisk walking doesn't negatively affect my walking so who knows if it's even OI that I have. In fact I feel better after my walks in the evening and can sit upright until I go to bed.