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Stop. Rest. Pace is important and recommended advice for people experiencing post-exertional malaise (PEM) due to post-viral chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) that some people develop.
If people experience worsening fatigue or malaise following exertion, graded exercise is not approach. They shouldn’t be encouraged to “push it”.
Their symptoms should be validated. https://www.meaction.net/stoprestpace/
Their symptoms should be validated. https://www.meaction.net/stoprestpace/
However, I think what is getting lost in the debate around the approach towards resuming physical activity post Covid is that not everyone will have PEM or even develop post viral CFS/ME.
Fatigue is one of the most common symptoms reported post COVID. https://jamanetwork.com/journals/jama/fullarticle/2768351
This isn’t surprising as post-viral fatigue is common after any viral infection. However post-viral fatigue is not necessarily chronic and is often self-limiting.
https://wchh.onlinelibrary.wiley.com/doi/10.1002/pnp.698
This isn’t surprising as post-viral fatigue is common after any viral infection. However post-viral fatigue is not necessarily chronic and is often self-limiting.
https://wchh.onlinelibrary.wiley.com/doi/10.1002/pnp.698
Therefore the fatigue experienced by people post-Covid may not necessarily be CFS/ME. The exact prevalence of CFS/ME post-COVID is still unknown. The early estimates suggested that the prevalence may only approach about 10%. https://www.frontiersin.org/articles/10.3389/fmed.2020.606824/full
Therefore not every patient post Covid should be following the recommendation to Stop. Rest. Pace. Perhaps not even the majority based on whats known now.
The recommendations for return to physical activity post-viral infection even with fatigue is generally a symptom-limited graded exercise program.
If people experience PEM or worsening of fatigue or malaise after attempting symptom-limited graded exercise (especially if prolonged), then the recommendation should be to discontinue and consider following stop. rest. pace.
We need to make sure that this is clearly communicated to people. This distinction is important. The last thing we want to do is encourage people who probably are safe and appropriate to attempt graded exercise/activity to avoid it; that can create unnecessary harm as too.
Nuance matters.
The truth defies simplicity.
The truth defies simplicity.
