Long COVID Fatigue and PEM: Why Activity Can Make You Worse

Why does Long COVID cause you to CRASH after ordinary activities? Can post-exertional malaise (PEM) last for years? Is recovery possible, and are there any treatments that actually work? POST-EXERTIONAL MALAISE (PEM), also called POST-EXERTIONAL SYMPTOM EXACERBATION (PESE), is more than ordinary fatigue. Physical, mental, emotional and social activities can trigger a delayed worsening of symptoms, sometimes lasting days or longer. For people living with Long COVID, these unpredictable crashes can disrupt work, relationships and everyday life. Managing PEM can be particularly difficult when your activity tolerance changes from day to day, and even those closest to you struggle to understand your illness. In this video, Dr Chris Ho, an Australian GP, examines PEM, its relationship with ME/CFS, what current research tells us about recovery and relapses, and why there is still no established medication specifically for PEM. We also explore PACING and ENERGY MANAGEMENT, with practical examples of managing everyday activities without repeatedly triggering crashes. Can you learn to live with a chronic illness while still hoping to recover? Managing your limitations today doesn't necessarily mean giving up hope for tomorrow. FOR PARTNERS, FAMILY & FRIENDS Someone with PEM may look perfectly well today but be unable to function tomorrow. Understanding delayed crashes, respecting individual limits and offering practical help can make a meaningful difference. If you're experiencing PEM and finding it difficult to explain your condition, consider sharing this video with someone close to you. Subscribe to NO-HYPE HEALTH TALK for practical, evidence-based discussions about health, healthy ageing and medical research. WATCH MORE Long COVID Explained (2026): Why You're Still Sick After COVID    • Long COVID Explained (2026): Why You’re St...    COMING NEXT: Long COVID Pacing — How Do You Find Your Limits Without Crashing? ————————- REFERENCES & FURTHER READING 1. WHO (2025). Clinical Management of COVID-19: Living Guideline. https://www.who.int/publications/i/it... 2. CDC. Long COVID Clinical Guidance. https://www.cdc.gov/long-covid/hcp/cl... MEDICAL DISCLAIMER This video provides general health information and does not replace individual medical advice. Long COVID symptoms and activity tolerance vary considerably. New chest pain, worsening breathlessness, fainting or other concerning symptoms require appropriate medical assessment. #LongCOVID #PostExertionalMalaise #PEM #PESE #LongCOVIDRecovery CHAPTERS 00:00 Why Activity Can Trigger a Long COVID Crash 01:15 What Is PEM and PESE? 02:21 The Boom-and-Bust Cycle 03:00 PEM and ME/CFS 03:20 What Causes PEM? 03:59 Will I Ever Get Better? 04:43 Living With PEM Without Giving Up Hope 05:55 Are There Any Effective Treatments? 07:22 Pacing and Energy Management 08:48 Practical Ways to Manage Daily Activities 10:03 Finding Stability and Avoiding Repeated Crashes 11:04 Understanding PEM: A Message for Family and Friends 11:37 Moving Forward If you’re living with PEM, what has helped you manage everyday activities and reduce repeated crashes? Have you experienced periods of improvement followed by setbacks? Partners, family members and friends are welcome to share their experiences too. Your practical suggestions may help someone else facing similar difficulties. Remember that everyone’s circumstances and activity tolerance are different. What helps one person may not work for another.