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Dr David Tuller: Trial by Error: Why Are Exercise Studies for Long Covid Still Failing to Address PEM Adequately?
https://www.virology.ws/2023/03/29/trial-by-error-why-are-exercise-studies-for-long-covid-that-overlook-post-exertional-malaise/?fbclid=IwAR2jKw6XLaFvC5092mA4UrpAH2onkePrCFfdVVDc56tT62Kx5L_z2EqyRYw
29 March 2023 by David Tuller Leave a Comment
By David Tuller, DrPH
https://www.virology.ws/2023/03/29/trial-by-error-why-are-exercise-studies-for-long-covid-that-overlook-post-exertional-malaise/?fbclid=IwAR2jKw6XLaFvC5092mA4UrpAH2onkePrCFfdVVDc56tT62Kx5L_z2EqyRYw
29 March 2023 by David Tuller Leave a Comment
By David Tuller, DrPH
I have written previously about the issue of exercise studies for long Covid patients. As with the discredited PACE trial for the illness or cluster of illnesses currently being referred to as ME/CFS, the theory behind these studies posits deconditioning as a central cause of patients’ disability. This approach tends to overlook the phenomenon of post-exertional malaise (PEM) or post-exertional symptom exacerbation (PESE), which is characteristic of ME/CFS and reported by many patients with long Covid.
When such studies do mention PEM/PESE, it is not clear they have properly distinguished it from the tiredness that often accompanies exercise and is exacerbated in those who are in fact decondition. In December, for example, I wrote a post about a study called “Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome.” Among many other methodological issues, some of the PEM episodes documented lasted just one to three hours. Were these examples of PEM, or just standard fatigue?