Lessons from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome for Long COVID


Part 3: “Energy System First Aid” for People With Post Exertional Symptom Exacerbation, by Todd E Davenport, Staci R Stevens, Jared Stevens, Christopher R Snell, J Mark Van Ness in JOSPT, February 16, 2022 [https://doi.org/10.2519/jospt.blog.20220216]


Blog post extract:

In a previous post, we demonstrated that the symptoms and physiology of postexertional symptom exacerbation (PESE) are inconsistent with deconditioning. PESE worsens in response to exercise and demonstrates a variable clinical presentation. We will build a clinical rationale for energy system first aid as a place to start helping people with PESE.


First aid is an important part of rehabilitation. Energy system first aid for people with PESE focuses on helping patients to use the metabolic systems that function well, and to limit the use of the aerobic system that current evidence suggests is functioning abnormally. Working together, patients and clinicians can use widely available tools and simple insights from physiological data to promote improvements in symptoms and functioning.

How to Explain Energy System First Aid to Patients

Recommendations for energy first aid in people with PESE have been made based on symptom acuity and irritability. The energy envelope hypothesis is a patient-friendly way to summarize energy system first aid for patients (FIGURE). A patient’s energy envelope is the physiological capacity for function at any moment in time. Although not curative, people can be coached to stay within their energy envelopes to avoid accessing a dysfunctional aerobic energy system. In turn, adherence to the energy envelope can improve predictability of daily energy level and the capacity for function.5

Heart rate monitoring can be an effective, objective way for patients to monitor the intensity of their daily activities, stay within the energy envelope, and predict PESE before it occurs. The predictive ability of heart rate monitoring is important because of the time delay between an exacerbating activity and resultant PESE.

Read the full blog post

Read Part 1: Postexertional Symptom Exacerbation is an Abnormal Response to Exercise/Activity

Read Part 2: Physiological characteristics during acute exercise are abnormal in people with Postexertional Symptom Exacerbation

Read Part 4: Heart Rate Monitoring to Manage Postexertional Symptom Exacerbation

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