Which of the following is NOT a factor that increases PRM?

• A. Physical exercise
• B. Fever
• C. Osteopathic manipulative treatment
• D. Fatigue

Answer: (D)

PRM reflects the body's capacity to mount a heightened physiologic response to stimuli. Factors that raise metabolic demand or stimulate autonomic and reflex pathways tend to increase PRM. Physical exercise boosts circulation and autonomic drive, which can amplify the body’s responsive state. Fever elevates metabolic rate and inflammatory signaling, also elevating physiologic responsiveness. Osteopathic manipulative treatment activates mechanoreceptors and reflex pathways that transiently enhance autonomic and lymphatic activity, increasing PRM as well. Fatigue, however, signals depleted energy reserves and reduced systemic responsiveness, so it does not drive an increase in PRM.