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For many people with long COVID, a major symptom is dificuly with exercising, because when these patients push past their limits it can lead to a devastating cycle of fatigue that boosts the risk of worsening their condition These issues with exercise, which is known as post-exertional malaise (PEM), are also the defining symptoms of myalgic encephalomyelits / chronic fatique syndrome (ME/CES). Now a new study, published in the journal Nature Communications, provides an explanation for this feeling of exhaustion, suggesting that patients with long COVID experience a range of changes in their body after exercising, including widespread muscle damage, changes in muscle composition, and disrupted energy metabolism. This study “actually shows the damage” to the body that is being caused by post-exertional malaise, says Lucinda Bateman, a physician at the Bateman Horme Center, who specializes in treating patients with ME/CFS and long COVID. As Bateman notes, this includes showing “the inflammation, the damage, the scarring, the clots,” which are all found in the muscles of long COVID patients. Researchers also found differences in the activity of the mitochondria—the body’s microscopic energy factories—following exercise. The suggested response to PEM: pace yourself.