When exertion makes things worse: life with ME/CFS and Long COVID

“While we are postponing, life speeds by.”

Seneca, Moral Letters to Lucilius I.2, Richard M. Gummere's translation. Below, we question turning this sentence into an instruction to do more. Involuntary limits on activity are not equivalent to wasting life.

What this article is about

In an imagined scene, someone keeps up a conversation at a meeting, then reports feeling considerably worse afterwards. The response is, “But you looked fine at the time.” In another scene, every postponed task is assigned to a relatively accessible day to catch up, after which the plan falls apart again. Other people see an activity; its possible delayed cost remains outside the frame.

This article concerns discussing deterioration after exertion in ME/CFS and Long COVID. These are not declared one diagnosis, nor every kind of fatigue one mechanism. We distinguish an event, symptom timing, a personal hypothesis, and medical assessment, then examine why the general idea of building stamina is not a suitable universal recommendation here. Seneca, the Tao Te Ching, and Buddhist ethical poetry help question how a day is valued. The practical aim is an accessible conversation about worsening symptoms and necessary changes to conditions, without deliberately provoking symptoms, prescribing activity, or requiring a perfect energy account to deserve assistance.

I. Being able to do something does not establish its full cost

People commonly judge ability by whether an action succeeds now. Reaching a place, making a presentation, or answering a message is taken as proof that the task is accessible. In some conditions, the observation may be incomplete: consequences outside that moment matter too.

CDC describes post-exertional malaise, PEM as worsening symptoms after even minor physical or mental effort previously tolerated. The worsening can be delayed. This specialist description does not authorise a diagnosis from one difficult evening. It does explain why having seen someone perform an action does not settle whether it was tolerable.

An imagined person speaks with a relative by telephone. The relative hears a calm voice and concludes that longer calls are possible. The person reports subsequent deterioration. These accounts need not contradict each other: they concern different parts of the event. The conversation does not become a performance of health because its consequences were inaudible in the voice.

A new explanation should not become all-encompassing either. Every deterioration must not automatically be attributed to a familiar condition or the last conspicuous activity. Medical assessment and other possible causes remain relevant. The narrower question here is which information about timing and change needs preserving so that an event is not judged solely by apparent success.

This introduces a distinction between observation and obligation. Naming an action's cost can help; repeating it to prove that cost is not required. A person need not demonstrate tolerability to make an account persuasive. If detailed record-keeping is itself demanding, that too affects access to care. Attention should not become a competition for the most accurate diary. One accessible description may be more useful than an elaborate system someone cannot maintain. It can keep a question open without pretending that a pattern, cause, or diagnosis has already been established.

II. Similar symptoms do not make conditions identical

ME/CFS is a distinct illness. Long COVID has its own clinical context and diverse manifestations. CDC's Long COVID guidance describes possible symptom overlap with other conditions, including ME/CFS and PEM. Overlap does not mean that everyone after COVID has ME/CFS or that all post-activity deterioration has the same explanation.

This distinction protects against opposite errors. The first dismisses a report because everybody gets tired. The second finds a familiar description and transfers a diagnosis, prognosis, and another person's programme wholesale. Both shorten investigation where it is still needed. Trusting a person's report does not require knowing its sole cause in advance.

An imagined reader notices difficulty concentrating after an illness. A friend finds a similar story and suggests following all its author's advice immediately. Similarity in one feature does not establish what is happening now or which recommendations are suitable. A more precise beginning concerns the change, medical assessment, and instructions already received. Another person's story can help someone find words while remaining another person's story.

The absence of one laboratory finding must not become proof that no real difficulties exist. CDC explicitly advises against laboratory and imaging findings being the only assessment of well-being in Long COVID. This does not cancel investigation or validate every interpretation offered by a patient. A report, an investigation, and a diagnosis retain different roles.

Keeping conditions distinct makes a conversation less dramatic and more useful. “This is exactly the same” can give way to asking what is established, what is suspected, and which change needs separate attention. Not knowing does not make someone an unreliable narrator. It prevents an attractive resemblance from closing a necessary clinical question. Respect for someone and precision about the limits of knowledge can support each other rather than compete.

III. Why “increase a little each time” is not universal advice

Progressive increases are often treated as common sense: if something is difficult after a break, gradually become accustomed to it. Gradual does not by itself make advice appropriate. The relevant condition and what happens when exertion changes both matter.

CDC cautions that standard exercise recommendations for healthy people can substantially harm people with ME/CFS. NICE NG206, 1.11.12–1.11.14 distinguishes an individual, flexible programme under appropriate supervision from programmes using fixed increases. The latter are not offered as ME/CFS treatment. This does not mean that every activity is prohibited for everyone. It rejects a universal staircase to be climbed regardless of symptoms.

An imagined acquaintance proposes doing a little more daily and sees a difficult day as failed discipline. Information that should test a plan's suitability has become an obligation to conform to it. If deterioration is treated only as inadequate effort, information that should change support is no longer being used.

Pacing, managing activity with attention to individual capacity, must not become another table for everyone either. In this article, it names a topic for discussion with an appropriate team, not a supplied regimen. No minutes, steps, heart-rate targets, rest intervals, or intensity levels are determined. What one person calls a small effort does not become small for another through a shared label.

It is particularly important not to promise that precise adherence guarantees no deterioration. Otherwise, someone once again becomes morally responsible for every difficult day. Care can account for limits and remain imperfect. A change calls for review rather than automatic blame. Asking what needs clarification in the approach preserves more useful information than demanding an explanation for another missed quota. The purpose of an individual discussion is to learn about the person, not simply to defend a schedule.

IV. A day with fewer symptoms is not a debt owed to yesterday

Relative relief can invite an urgent attempt to catch up: tasks, messages, relationships, the right to be considered one's former self. The decision contains an understandable longing for access. Relief is not a signed promise that the body will now complete the accumulated list.

In his first letter, Seneca urges care for time and distinguishes ways of losing it. Contemporary culture readily turns such an appeal into constant use of every hour. For an ill reader, lost time may already mean hours of limitation they did not choose. Calling those hours carelessness turns philosophical discipline into unjust accounting.

Seneca is not reducible to a productivity slogan: the same letter also distinguishes impoverishment through no fault of one's own. The tension deserves reading, rather than one sentence becoming a command. A person can care about time without filling it with the greatest possible number of actions. Sometimes the important question is which external demands already control the day that is accessible.

CDC's ME/CFS material describes the risk of a push-and-crash cycle. This does not diagnose every attempt to return to tasks. It supports discussing what catching up means in a particular situation. Repeating an activity to confirm a pattern is not required here.

An imagined person postpones replying to friends and feels guilty. A more accessible day is to be spent entirely on explanations so that nobody doubts their affection. Relationships can be discussed differently: a short agreed way of communicating availability, no demand for an immediate answer, or help organising contact. What changes is not affection but the cost of proving it. Attachment need not be demonstrated through a test of exertional tolerance. Someone may want contact deeply while needing different conditions for it.

V. A visible pause does not reveal what happens within it

From outside, rest looks like an absence of action. It is easily mistaken for free time to fill with conversation, an educational video, or a quick decision. Something that does not look like physical work is not necessarily effortless. The source describes possible deterioration after mental effort too; particular limits need individual discussion.

In an imagined household, a person is lying down and someone suggests a useful podcast so the time will not be wasted. This kindness contains a measure according to which every pause must become self-development. An offer can itself be a task: listen, understand, respond, reassure someone else. Declining neither establishes absent interests nor explains disease mechanisms.

In Tao Te Ching 48, following the Tao is described through diminishing intentional doing, in contrast to accumulating learning. This is a philosophical and political context, not a PEM rest protocol. It must not become advice to move less or a promise that non-action cures. It does make another question visible: why does adding always appear a more respectable response than reducing what is imposed?

A pause must not become a new duty to remain perfectly calm. Someone can be bored, irritated, and interested in company while having limits. Wanting something does not establish the possibility of doing it without consequences. Support needs both parts rather than selecting a convenient version: either the person wants nothing, or wanting means being able.

A meaningful result may be one unnecessary demand removed: no immediate response, no long conversation to prove gratitude, an explanation in a more accessible form. This is neither universal treatment nor a guarantee of an easy day. It concerns a burden made by a relationship or procedure that can actually be discussed separately from the illness. Naming that distinction avoids asking a person to solve a medical condition through better manners while leaving negotiable demands untouched.

VI. Knowing yourself is not a duty to calculate your illness alone

Tao Te Ching 33 contrasts knowing others with knowing oneself and power over others with power over oneself. A contemporary reader may find a question about personal measures useful. The ancient text does not claim that sufficient attention makes symptoms precisely predictable.

A battery or limited-reserve metaphor can help someone explain. It remains a metaphor: it does not measure metabolism, establish a diagnosis, or promise a measurable remainder of capacity. Read literally, it creates a harsh arithmetic in which yesterday's ability requires the same reserve today. Variability becomes a reporting error.

An imagined person says they cannot promise whether Thursday will be possible and is accused of refusing to plan. Their precise position may be a distinction between wanting and an unknown ability. Agreements that permit review and an accessible way of communicating can be discussed. This is an organisational question, not permission to ignore every responsibility or proof of the medical cause of uncertainty.

Symptom records have a limited role. They can communicate observations when accessible, but should not become the price of trust. An event, deterioration, and a proposed connection remain separate. A clinician assesses more than a tidy table; family confidence is no substitute for a medical decision either. Getting a date wrong does not mean inventing the whole difficulty.

Self-knowledge is more helpful here as permission to notice experience than as a promise of complete self-sufficiency. Someone can know that things became worse without knowing why, or need assistance describing it. They may have no convenient writing method, device, or person nearby. The question of suitable support remains valid without an impeccable personal research project. More uncertainty may call for help interpreting information, rather than a more demanding obligation to collect it alone.

VII. Lacking resources does not mean organising the day badly

Activity-management discussions can become advice for someone with money, flexible hours, and a helper. Necessary tasks remain for people who cannot hire deliveries or give up paid work. Such constraints must not be presented as a failure to understand their condition.

An imagined worker cannot arrange remote work and continues to face demanding requirements. Careful allocation of effort may be a reasonable subject, but it does not supply missing conditions. Separate conversations about the task, medical explanation of a need, and actual local procedures may be necessary. No particular benefit, leave entitlement, or adjustment is established without country and date.

Some barriers are communicative. Access to help requires a long call, repeated history, and several forms, although this is precisely the activity the person finds difficult. They can ask which alternative format exists and who can assist with consent. The required format is not promised to exist. The difficulty of the procedure is nevertheless information about access, not proof that the request is insufficiently serious.

Where a chosen supporter helps, they must not become the sole owner of the story. They can convey an agreed question while preserving its source and disclosure limits. A nonspeaking or severely exhausted person does not automatically lose a voice. Without a safe helper, an exercise must not require disclosure to a random person.

Sometimes the immediate result is an accurately named barrier without a solution. That is neither a system's victory nor a reader's failure. Uncertainty, limited services, and the need for further assistance may remain. A philosophical article does its part by preventing these levels from being confused. It must not make someone prove that a difficult situation can be repaired through one wiser attitude towards time. A necessary social or practical change does not disappear because the person's description of it has become clearer.

VIII. Life is not wholly postponed until former stamina returns

When days are valued by accessible activity, someone may feel that real life begins only after recovery. Everything now becomes waiting. This is understandable but excludes relationships, preferences, and moments already happening from the field of value.

Dhammapada 204 values health highly. It is Buddhist ethical poetry, not a claim that an ill life ceases to be life. Valuing health and ranking human dignity by its possession are different actions. Confusing them turns an attractive verse into a painful reminder of supposedly incomplete existence.

Seneca questions giving time away thoughtlessly; the Taoist text challenges endless addition; the Buddhist verse describes goods in a context of liberation. These are not one medical teaching about energy. Their differences help examine the initial measure: must a day justify itself through the amount accomplished?

A reader can want improvement and still consider today's conversation important. A short, accessible encounter can be enjoyed without a promise that pleasure treats illness. Someone can also find no enjoyment without receiving an additional failing grade. Support does not depend on converting a limitation into wisdom.

At the beginning, others saw a successful meeting and missed its consequences. Both parts of the account can now be retained without one cancelling the other. Medical uncertainty remains a subject of investigation. Organisational demands remain matters for agreement. Human worth need not await the outcome of either. Saying what is happening and what one wants to ask already restores precision to a life too easily assessed from outside. It may not restore stamina, settle a diagnosis, or remove a difficult barrier. Its value does not require pretending that it has done those other things.

What this means in practice

Do not test tolerance through an exercise for this article. Use an already known situation if one is available and recalling it is manageable. What happened, which symptoms changed, when was the change noticed, and what does the team already know? Do not invent exact dates. One spoken description may be enough to begin.

Distinguish observation from inference: feeling worse after a meeting is not the same as knowing its sole cause. A useful question may be: “Please help assess the pattern of deterioration and discuss a plan that accounts for my condition.” Ask who addresses that question and which changes need separate attention. A new dangerous acute condition must not automatically be called familiar PEM. Urgent assistance takes precedence over an exercise or record.

Identify one condition obstructing participation too: a long telephone call, a rigid response procedure, or a meeting that cannot be reviewed. An accessible alternative can be discussed without promising it exists. A helper may convey an agreed sentence, without automatic authority to decide everything or disclose the entire history.

No step count, heart-rate target, rest duration, exercise, medicine, salt, fluid, or device is prescribed here. Pacing does not become a universal recipe. ME/CFS, Long COVID, and other causes of deterioration are not collapsed into one diagnosis. Individual specialist discussion matters because differences have consequences.

With few resources, the result may be one clear question or a request to explain an accessible contact. Without money, a telephone, or safe family, the need remains valid. Where agreement is not yet possible, an identified barrier is an accurate intermediate result. Afterwards, check what was explained and agreed rather than scoring stamina or the correctness of a life.

Key quotation

“he who knows himself is intelligent”

Tao Te Ching 33.1, James Legge's translation, one clause. Self-knowledge is considered as a philosophical question. It neither supplies diagnostic ability nor makes someone responsible for unpredictable symptoms.

Connections between traditions

Seneca / Taoist diminishing. Letter I and chapter 48 pose different questions about time and action. Care for time is not identical to accumulating tasks; non-action is not prescribed medical rest.
Stoic discipline / Buddhist goods. Seneca I and Dhammapada 204 distinguish the value of time and health. Their ethical foundations differ; neither makes illness proof of a wasted life.
Taoist self-knowledge / clinical observation. Chapter 33 may open attention to experience. Medical assessment needs other grounds; philosophy does not promise a calculable safe exertion threshold.
Seneca / contemporary access. Time given away meets the cost of procedures and explanations. This is an editorial comparison, not evidence that Seneca described PEM or social services.
Dhammapada / present life. Valuing health need not rank people. This ethical boundary can acknowledge severe illness without requiring suffering to be called a spiritual gift.

Primary texts and specialist materials

CDC, Strategies to Prevent Worsening of Symptoms. PEM, planning, and individual-limit sections read. Regimens, medicines, and tests from other sections are not prescribed.
CDC, Long COVID Clinical Guidance. Definition, assessment, symptom overlap, and PEM read; distinct conditions remain distinct.
NICE NG206, 1.11.12–1.11.14 and Box 4. Displayed recommendations read, including flexible individual approaches versus fixed increases. The whole guideline and all studies are not claimed read.
Seneca, Moral Letters I, Richard M. Gummere. Whole letter read; translator's edition checked on the collection page. Critical reflection on time, not an instruction to raise productivity.
Tao Te Ching 33 and 48, James Legge. Chapters and nearby context read. Self-knowledge and diminishing intentional action are not presented as therapy.
Dhammapada XV, 197–205, F. Max Müller. Actual reading from LHD-108 reused; verse 204 remains ethical rather than clinical.

About the authors

Andrey Zarinsh — author and founder of United Wisdom. He explores inner transformation, the unity of traditions, intercultural dialogue, and contemporary spiritual discipline. Instagram: @andrey.zarinsh.

Maria Evilkut — co-author of United Wisdom. Alongside research, she seeks to examine these ideas in practice and observe how principles of unity and mutual understanding work in real life between people and cultures. Instagram: @ilkutki.