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I just googled and the dictionary says "physical or mental effort". Unless you are talking about BPS-type effort preference, effort in everyday sense means expending energy. Effort preference, btw, is not the cause of (delayed) PEM as far as I understood. It is the cause of fatigue. To make it...

But exertion is not what causes PEM. Your low threshold for exertion is. So, severely ill patients could be in constant state of PEM just by being alive and breathing while it takes running up a hill for a recovering patient.

Huh? I thought they equated 6 hrs of extreme exercise to 12 hours of leisurely one. It doesn't make sense to say 6 hours is extreme when 12 hours is leisurely.

Spending calories to move muscle or fire neurons. Will that work?

Good cripes. People should stop seeing doctors once they are satisfied with their ME/CFS diagnosis. There is nothing they can do for you. They'll only can make you feel worse with BPS recommendations.

I don't think you need to worry about getting back into shape. You'd naturally move/exercise more once you have an effective treatment. We are the bunch that constantly get into PEM sickness because we do more than we should, after all. I remember cramping all over after walking in my boots...

I think they are the same thing. There is fight-or-flight factor in competition that makes you push beyond the certain level without realizing. But it still comes down to the level of intensity. If you look at the Olympic records, you'd see that the lap times come down only 5-10% when doubling...

Exertion is the cause of PEM, but some people have reported stress as a trigger. If you think about it, stress, either physical or mental, is a form of exertion.

I guess it could be if you call falling flat on the ground a position. Maybe "unstable" was a more correct term when talking about a state in a fine balance.

I've been thinking that ME/CFS is the result of the monostability of the immune system that needs to maintain the fine balance between protecting you from the environmental insult and making you sick all the time. It falls, and it can't right itself up easily since it is monostable.

That's how I ended up with ME/CFS, by wrestling 4 days a week for 90 minutes each in ripe middle age. That was when I was able to hike 12 hours a day for days on end. The toll judo took on me was on entirely different level. I'm experiencing the similar now in the recovery stage of ME/CFS. Just...

This was my first thought. The difference between the two is an order of magnitude. People who can hike for 12 hours a day won't be able to run for 30 min unless he trained for it. A super-fit newbie won't last 30 sec when wresting either.

Great, I learned a new word today! I don't think this is an uncommon experience. Bruce Campell talks about how he struggled with fatigue prior to the onset of flu-like sickness that didn't go away (and how he managed to get out of it by cutting back by 10%). So did Dean Anderson and Jamison...

That may be, but we still need to define the problem in order to investigate the problem. You'd be just kicking the tires around otherwise. It could well be a reiterative process of investigating - learning - redefining as you said, till we get the full picture. And starting the gradient walk...

I meant for studying. If you want to test your hypothesis about PEM, only include those with often-delayed worsening as subjects. That may entail the risk of incomplete picture, but that's better than ending up with a wrong picture. At least till we have some idea what its mechanism is. That...

Is your PEM always immediate? Just curious...

Except that it does not fit the description of "often delayed" if it is not delayed. For diagnostic purpose, "often delayed" (mostly white) may be fine. For research purpose however, I do think it should be "must delayed" (white) rather than "may or may not be delayed" (white or black). You...

Mea Culpa. I left out "typically" or "often". Actually, no. I'm talking more about PEM definition applied to other condition rather than ME/CFS. Not requiring the delay will end up including energy deficit and others. And I'm not sure if requiring prolonged recovery time can differentiate...

Maybe this "typically delayed" is the crux of the problem. It may not be much of an issue within ME/CFS context, but you won't be able to distinguish rapid fatiguability of COPD, for example, from the ME/CFS ("real") PEM if you leave out the delay. Same issue applies to DePaul PEM Questionnaire...

What looks like a black swan may not be a swan at all in this case. It may be black, but it could be a goose in reality. You don't know that because we don't know what the underlying biology looks like in case of ME/CFS. If we did, we wouldn't need the symptomatic definition at the first place.