Post-Exertional Malaise: Cardiopulmonary Exercise Studies / Video 3 of 7

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 three of this seven-part series Brayden Yellman, MD, and Lucinda Bateman, MD, discuss how Serial 2-Day Cardiopulmonary Exercise Testing (CPET) is a reliable, reproducible and accurate measure of PEM/PESE among those with ME/CFS.

Video details:
Peak VO2
Ventilatory Anaerobic Threshold (VAT)
Impact on ATP production/utilization
Objective measurements supporting eligibility for disability benefits.

*NOTE: Healthcare providers must weigh the benefits of CPET testing against its potential harms, which could include the induction of a prolonged worsening on an individual’s ME/CFS as a result of the provocation of an extended episode of PEM.*

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

Video citations:
J. Mark Vanness, Christopher R. Snell & Staci R. Stevens (2007) Diminished Cardiopulmonary Capacity During Post-Exertional Malaise, Journal of Chronic Fatigue Syndrome, 14:2, 77-85, DOI: 10.1300/J092v14n02_07

Stevens S, Snell C, Stevens J, Keller B, VanNess JM. Cardiopulmonary Exercise Test Methodology for Assessing Exertion Intolerance in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Pediatr. 2018;6:242. Published 2018 Sep 4. doi:10.3389/fped.2018.00242

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Learn more about CPET testing: Workwell Foundation https://workwellfoundation.org/