Post-exertional malaise (PEM) is a worsening of chronic fatigue syndrome symptoms that occurs after exertion. PEM involves increased fatigue, and an exacerbation of other symptoms. PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Post-exertional malaise typically begins 12–48 hours after the activity that triggers it, and lasts for days, but this is highly variable. Management of PEM is symptomatic, and patients are recommended to pace their activities to avoid triggering PEM.
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