From the Guidelines
To treat post-exertional malaise (PEM) from new exercise, the most effective approach is to pace your activity levels and allow for proper recovery, as excessive exertion can lead to catastrophic events, including rhabdomyolysis, as noted in the interassociation recommendations endorsed by 13 medical and sports medicine organisations 1. When experiencing PEM, it is essential to reduce your current exercise intensity and duration until symptoms subside. Implement a gradual return using the 10% rule—increase activity by no more than 10% per week. This approach is supported by the concept of phasing in activity during transition periods, considering factors such as days/week, body part, activity/exercise, sets/repetitions/distance, load, and work–rest ratio, as outlined in the British Journal of Sports Medicine 1. Rest is crucial; take complete breaks when symptoms appear rather than pushing through. Stay hydrated and consider over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) for temporary symptom relief. Apply ice to sore muscles for 15-20 minutes several times daily. Gentle stretching and warm baths with Epsom salts can help muscle recovery. Ensure adequate nutrition with protein-rich foods and consider magnesium supplements (300-400mg daily) if deficient. Additionally, it is essential to be aware of general guidelines for individual exercise programming, such as exercising only when feeling physically well, avoiding vigorous exercise soon after eating, and drinking fluids before, during, and after moderate-to-vigorous intensity exercise, as recommended by the American Heart Association 1. By respecting your body's limits and gradually building tolerance, you can minimize the effects of PEM and improve exercise capacity over time. Some key points to consider when treating PEM include:
- Reducing exercise intensity and duration until symptoms subside
- Implementing a gradual return using the 10% rule
- Allowing for proper recovery and rest
- Staying hydrated and using over-the-counter pain relievers as needed
- Applying ice to sore muscles and using gentle stretching and warm baths for recovery
- Ensuring adequate nutrition and considering magnesium supplements if deficient.
From the Research
Treatment of Post-Exertional Malaise from New Exercise
- There is no direct evidence on how to treat post-exertional malaise from new exercise, but studies suggest that individualized physical exercise training programs can help improve exercise performance in people with long COVID and post-exertional malaise 2.
- A best practice proposal for exercise training recommendations has been developed, which differentiates exercise procedures according to the presence of no, mild/moderate, or severe post-exertional malaise in people with long COVID 2.
- Post-exertional malaise is a complex symptom that can vary greatly between individuals and can lead to a diminished quality of life 3.
- Patients with myalgic encephalomyelitis/chronic fatigue syndrome describe post-exertional malaise as all-encompassing, with symptoms affecting every part of the body, difficult to predict or manage, and requiring complete bedrest to fully or partially recover 3.
- Exercise specialists and healthcare professionals working with people with chronic cancer-related fatigue must be aware that post-exertional malaise may be an issue and should monitor symptom exacerbation after exercise, tailoring and adapting exercise to limit the potential for harm 4.
- Post-exertional malaise may be composed of two empirically different experiences: generalized fatigue and muscle-specific fatigue, suggesting that treatment approaches may need to address these different aspects of the symptom 5.
Management of Post-Exertional Malaise
- There is a need for further research to identify subtypes of post-exertional malaise and to develop targeted therapeutic options 3.
- Better understanding of how post-exertional malaise is assessed may help improve the diagnostic reliability and validity of myalgic encephalomyelitis, myalgic encephalomyelitis/chronic fatigue syndrome, and chronic fatigue syndrome 6.
- Healthcare professionals should be aware of the potential for post-exertional malaise in people with chronic cancer-related fatigue and take steps to prevent or minimize its occurrence 4.