Övningar för ME/CFS — PEM-medveten pacing, NICE 2021-ram, ALDRIG GET

NICE NG206 (2021) explicitly withdrew graded exercise therapy (GET) from ME/CFS recommendations after an evidence review concluded the harm-benefit ratio was unfavorable for many patients. The IOM/NAM 2015 report established post-exertional malaise (PEM) as the cardinal feature of ME/CFS — exertion above an individual's threshold worsens symptoms 24-72 hours after, sometimes longer. This is biologically distinct from deconditioning and cannot be addressed by 'just push through.' Pacing — symptom-titrated activity that stays below the individual's PEM threshold — has replaced progression as the framework. Heart-rate-monitored activity (typically staying below anaerobic threshold, ~50-60% of HRmax for many patients) supports pacing. Long COVID overlap is significant — Davis 2023 estimated ~50% of long COVID patients meet ME/CFS criteria 6 months post-acute COVID, applying the same pacing principles. The exercise priorities are therefore: pacing-based gentle movement, breath/parasympathetic anchors for autonomic regulation, supine + seated foundations that don't trigger orthostatic intolerance, and respect for the daily energy envelope. AVOID push-through patterns; AVOID rapid progression; AVOID 'just do a little more' framing.

Volya's catalogue carries the foundation moves chosen for low PEM-trigger risk and orthostatic tolerance: diaphragmatic-breathing for parasympathetic regulation + autonomic support, supine-knee-to-chest for low-back release without orthostatic load, supported-glute-bridge for gentle posterior chain, cat-cow for spinal mobility, scapular-retraction for posture, supine-piriformis-stretch, wall-push-up for upper body when energy allows, ankle-pump for circulation + orthostatic intolerance support, sit-to-stand for functional strength only when team-cleared. The AI coach also knows the nutrition side — small frequent meals (4-6/day often tolerated better than 3 large), Mediterranean / anti-inflammatory backbone (Russell 2015 chronic low-grade inflammation), hydration 2.5-3 L/day + electrolytes (sodium 4-10 g/day if BP tolerates per cardiologist) for orthostatic intolerance (common comorbidity per Dysautonomia Project), B12 + iron + vitamin D + magnesium + thiamine annual labs, AVOID restrictive diets (keto, low-carb extreme) without clinical supervision, AVOID 'push through' nutrition + high-stimulant pre-workouts, caffeine moderate + AVOID after 1400 (sleep architecture already disrupted), alcohol AVOID excess (many ME/CFS patients have severe alcohol intolerance + worsened PEM). CRITICAL: ME/CFS-specialty clinics + Bateman Horne Center + Solve M.E. + Long COVID Research Initiative + 988. Long COVID overlap (Davis 2023): same pacing principles. This is NEVER a replacement for ME/CFS clinical care.