Garcia, Sara, Tzartzas, Konstantinos, von Plessen, Christian et al. · Revue medicale suisse · 2026 · DOI
This review article describes post-exertional malaise (PEM)—a pattern of symptom worsening that occurs after physical, cognitive, emotional, or social exertion—and discusses how primary care doctors can recognise and manage it. The authors note that PEM was first identified in ME/CFS but is now also observed in long COVID and other post-infectious conditions. Early detection and appropriate management are reported as important to prevent long-term functional decline, though this review does not provide evidence that specific treatments prevent such decline.
For ME/CFS patients and clinicians, this guideline may help primary care practitioners recognise PEM as a cardinal feature and distinguish it from simple fatigue or deconditioning. By analogy, a standardised approach to PEM detection and management in primary care could reduce misdiagnosis and delays in appropriate support, though whether this guideline-based approach itself improves patient outcomes remains to be tested empirically.
This guideline review does not establish causation between any intervention and improved outcomes. It does not present randomised or controlled evidence for specific management strategies. It does not confirm that early detection prevents long-term functional decline—only that such prevention is a clinical goal. The relevance of recommendations developed in an overlapping post-infectious population may not generalise directly to all ME/CFS patients.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Garcia, Sara, Tzartzas, Konstantinos, von Plessen, Christian, Favrat, Bernard, & Kokkinakis, Ioannis (2026). [Recognizing and managing post-exertional malaise in primary care].. Revue medicale suisse. https://doi.org/10.53738/REVMED.2026.22.1.e48753
BibTeX
@article{mecfsatlas-garcia-2026-recognizing-managing,
author = {Garcia, Sara and Tzartzas, Konstantinos and von Plessen, Christian and Favrat, Bernard and Kokkinakis, Ioannis},
title = {[Recognizing and managing post-exertional malaise in primary care].},
journal = {Revue medicale suisse},
year = {2026},
doi = {10.53738/REVMED.2026.22.1.e48753},
note = {PubMed: 42899626},
url = {https://www.mecfsatlas.com/evidence/garcia-2026-recognizing-managing},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-10-21. https://www.mecfsatlas.com/evidence/garcia-2026-recognizing-managing
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