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==Exertion in ME/CFS == Only a minimal amount of exertion causes a marked increase in symptoms in people with [[ME/CFS]]<ref name="Nijs2008">{{Cite journal | last = Nijs | first = Jo | last2 = Almond | first2 = Freya | last3 = De Becker | first3 = Pascale | last4 = Truijen | first4 = Steven | last5 = Paul | first5 = Lorna | date = 2008 | title = Can exercise limits prevent post-exertional malaise in chronic fatigue syndrome? An uncontrolled clinical trial| url = https://www.ncbi.nlm.nih.gov/pubmed/18441039|journal=Clinical Rehabilitation|volume=22|issue=5 | pages = 426β435|doi=10.1177/0269215507084410|issn=0269-2155|pmid=18441039|via=|quote=The severe exacerbation of symptoms following exercise, as seen in CFS patients, is not present in other disorders where fatigue is a predominant symptom such as depression, rheumatoid arthritis, systemic lupus erythematosus, or multiple sclerosis. 10,11 | author-link = Jo Nijs | authorlink2 = Freya Almond | authorlink3 = Pascale De Becker | authorlink4 = Steven Truijen | authorlink5 = Lorna Paul}}</ref>, for instance [[chronic fatigue]], [[chronic pain]], [[cognitive dysfunction]] (e.g., [[brain fog|brain fog)]], [[flu-like symptoms]], [[muscle fatigability]], [[unrefreshing sleep]], and more, this is known as ME/CFS's hallmark symptom [[post-exertional malaise]] (PEM).<ref name="Nijs2008" /><ref>{{Cite news |url =https://solvecfs.org/deciphering-post-exertional-malaise/ | title = Deciphering Post-Exertional Malaise | date = 2014-11-21|work=Solve ME/CFS Initiative|access-date=2018-10-11|language=en-US}}</ref> Depending on a patient's disease severity exertion capabilities is different and results in varying symptoms and degree of symptom severity.<ref name="CDE">{{Cite web | url=https://www.commondataelements.ninds.nih.gov/Doc/MECFS/PEM_Subgroup_Summary.pdf | title=NINDS CDE Project - Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Post Exertional Malaise Subgroup | last = | first = | date = |website=nig.gov|archive-url=|archive-date=|url-status=|access-date=}}</ref> Physical, mental or rben emotional exertion can trigger PEM.<ref name="Chu2018">{{Cite journal | last = Chu | first = Lily | last2 = Valencia | first2 = Ian J. | last3 = Garvert | first3 = Donn W. | last4 = Montoya | first4 = Jose G. | date = 2018 | title = Deconstructing post-exertional malaise in myalgic encephalomyelitis/ chronic fatigue syndrome: A patient-centered, cross-sectional survey| url = https://www.ncbi.nlm.nih.gov/pubmed/29856774|journal=PloS One|volume=13|issue=6| pages = e0197811|doi=10.1371/journal.pone.0197811|issn=1932-6203|pmc=5983853|pmid=29856774|quote= | author-link = Lily Chu | authorlink2 = Ian Valencia | authorlink3 = Donn Garvert | authorlink4 = Jose Montoya|via=}}</ref><ref name="CDC-symptoms">{{Cite web | url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]] | date = Jan 27, 2021|access-date = 2021-02-25}}</ref><ref name="Arroll2014">{{Cite journal | last = Arroll | first = Megan A. | last2 = Attree | first2 = Elizabeth A. | last3 = O'Leary | first3 = John M. | last4 = Dancey | first4 = Christine P. | date = 2014-04-03 | title = The delayed fatigue effect in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)| url = https://www.tandfonline.com/doi/abs/10.1080/21641846.2014.892755|journal=Fatigue: Biomedicine, Health & Behavior|language=en|volume=2|issue=2 | pages = 57β63|doi=10.1080/21641846.2014.892755|issn=2164-1846|quote= | author-link = Megan Arroll | authorlink2 = Elizabeth Attree | authorlink3 = John O'Leary | authorlink4 = Christine Dancey | authorlink5 = |via=}}</ref> This post-exertional malaise is not limited to just musculoskeletal pain or fatigue, and does not occur in illnesses like [[depression]], [[multiple sclerosis]], or [[Systemic lupus erythematosus|systemic lupus erthematosus]] or [[rheumatoid arthritis]].<ref name="Nijs2008" /> Intolerance to exertion and [[exercise]] was built into the renaming of ME/CFS by the [[National Academy of Medicine]] (NAM) in the 2015 [[Institute of Medicine report]] (IOM report) where the name [[Systemic Exertion Intolerance Disease]] (SEID) was coined.<ref name="IOM2015">{{Cite book | last = Institute of Medicine | first = | date = 2015-03-16 | title = Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | url =https://www.nap.edu/read/19012/chapter/9#228| publisher = The National Academies Press|language=en | page = 228 | pages = |doi=10.17226/19012|via=|quote= | author-link = Institute of Medicine}}</ref>
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