Episode 149: Not all Post-Exertional Malaise (PEM) is the same

Episode 149: Not all Post-Exertional Malaise (PEM) is the same

Not all post-exertional malaise (PEM) is driven by the same physiology — and understanding the difference can completely change how you approach pacing and recovery.

In this episode, Anna breaks down the three most common patterns of post-exertional crashes seen in clinical practice: autonomic “hit the wall” crashes, metabolic “wired but exhausted” responses, and delayed immune-driven flares.

You’ll learn why timing matters, how different symptom patterns reflect different underlying mechanisms, and why applying the wrong strategy can stall progress.

This is not about avoiding movement or labelling yourself as fragile. It’s about understanding your physiology well enough to work with it.

If you’ve ever felt confused by your crashes — or wondered why generic pacing advice hasn’t quite worked for you — this episode will offer clarity.

Complimentary Episode:

Episode 146: Research Review - The PEM puzzle

Resources

Take the Chronic Fatigue Quiz: https://app.annamarsh.co.uk/quiz-page

Instagram: https://www.instagram.com/anna__marsh_

Work with me: https://annamarsh.co.uk/work-together/

Website: http://annamarsh.co.uk/

Join the Nurturing Resilience Subscription: https://annamarsh.co.uk/nurturing-resilience/

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Avsnitt(157)

Episode 156: Recovery, Recalibration & Learning to Feel Safely Again

Episode 156: Recovery, Recalibration & Learning to Feel Safely Again

In this episode, Anna explores a side of recovery that is rarely discussed: What happens when the nervous system begins to reconnect with emotions, sensations, and internal experiences that were pr...

7 Aug 38min

Episode 155: What This New Research on Glutamate Might Mean for Long COVID & ME/CFS

Episode 155: What This New Research on Glutamate Might Mean for Long COVID & ME/CFS

In this episode, Anna breaks down a recent study exploring brain neurochemicals in Long COVID and ME/CFS — with a particular focus on glutamate and its potential role in symptoms, particularly physica...

24 Juli 36min

Episode 154: Breakups, Dating & Recovery: Navigating Life After Long Covid with Lexi Boreham

Episode 154: Breakups, Dating & Recovery: Navigating Life After Long Covid with Lexi Boreham

In this episode, Anna is joined by Lexi Boreham, who shares her experience of living with and recovering from Long Covid. This conversation gently explores the reality of rebuilding a life alongsid...

10 Juli 1h 1min

Episode 153: COMT - Why Some Nervous Systems Feel Everything More Intensely

Episode 153: COMT - Why Some Nervous Systems Feel Everything More Intensely

Some people notice that they seem to experience stimulation and stress more intensely than others. They may feel overwhelmed in busy environments, react strongly to caffeine, or find it difficult t...

25 Juni 13min

Episode 152: When You’re Mostly Better… But Not Fully Stable Yet

Episode 152: When You’re Mostly Better… But Not Fully Stable Yet

There is a stage of recovery that many people reach where life has largely returned to normal. You may be working again. Socialising more. Exercising gently. Participating in daily life in ways tha...

11 Juni 22min

Episode 151: Why Gentle Movement Can Calm the Nervous System (Even With Chronic Fatigue)

Episode 151: Why Gentle Movement Can Calm the Nervous System (Even With Chronic Fatigue)

Movement can feel like a complicated topic for people living with chronic fatigue conditions. Many people have been told to exercise more. Others have experienced crashes after pushing too hard. An...

29 Maj 27min

Episode 150: Relapse or Recalibration? Why Symptoms Can Return After Years of Stability

Episode 150: Relapse or Recalibration? Why Symptoms Can Return After Years of Stability

One of the most frightening moments in recovery can be when symptoms suddenly return after a long period of stability. And many people immediately think: "I’m back where I started." But in ma...

15 Maj 56min

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