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Post-exertional malaise (PEM) is worsening of symptoms after exertion, sometimes delayed and lasting beyond the activity. Immediate comfort does not prove an activity is within your limits.

• Include everyday tasks and mental, emotional and social effort in your energy plan.
• Avoid fixed increases, catch-up days and trying to exercise your way out of ME/CFS.
• If you choose a movement programme, seek a clinician with ME/CFS expertise who can adapt it to your baseline and response.
• Severe illness may require help with positioning and personal care; any movement needs individual assessment.

Long COVID can also involve post-exertional symptom worsening. Tell your clinician about it so rehabilitation can be adapted.

• Change the task: sit for preparation, simplify the activity or share the work.
• Change the setting: use a quieter space, comfortable temperature or easier access.
• Use support: mobility aids, transport, seating or assistance may help you take part.
• Choose meaning: a valued activity can be the goal; a workout is not required.

Using assistance does not reduce the value of participation. Choose adaptations that suit your care plan.

• Notice: What matters today, and what could make it difficult?
• Adapt: Choose one change in position, setting, task or support.
• Allow recovery: Consider your response during the activity and afterwards.

You can reduce, pause or skip an activity. There is no automatic progression to a longer or harder version.

A physiotherapist may help with movement, joint support or rehabilitation. An accredited exercise physiologist can provide condition-specific exercise advice where appropriate. An occupational therapist can help adapt everyday tasks, equipment and surroundings.

Ask whether the clinician understands your conditions, including PEM, dysautonomia, hypermobility and sensory needs. Agree on goals, adaptations and what to do if symptoms worsen. A plan for one diagnosis may need changing when another condition overlaps.

Pause and seek advice for new or worsening symptoms, repeated falls, joint instability, fainting or activity that causes a delayed crash. Do not assume symptoms are anxiety, poor fitness or something to push through.

Chest pain, severe breathing difficulty, or sudden weakness or speech difficulty needs urgent care. In Australia call 000.