Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome.
Balke, Maryam, Garbsch, René, Cormann, Jessica et al. · Frontiers in rehabilitation sciences · 2025 · DOI
Quick Summary
Researchers developed a simple daily diary to help post-COVID patients track their energy levels throughout the day. The diary showed that patients had more energy in the morning than evening, and that rest helped restore energy while active therapy temporarily reduced it. Most patients found the diary helpful for understanding how their body responds to different activities and for learning to pace themselves better.
Why It Matters
Energy tracking tools could help ME/CFS and post-COVID patients better understand their individual fatigue patterns and practice pacing—a key self-management strategy. This study provides evidence that a simple, patient-centered diary can objectively reflect fatigue changes and may improve patients' awareness of how different types of activity affect their energy, potentially supporting safer rehabilitation planning.
Observed Findings
Morning energy levels were significantly higher (49.6 ± 18.6%) than evening levels (33.4 ± 19.7%, p ≤ 0.0001) in post-COVID patients at rehabilitation admission.
Active therapy was associated with approximately 5% decrease in daily energy levels, while passive therapy correlated with approximately 5% increase (p < 0.0001).
The diary showed good negative correlation with MFI-20 fatigue scores at discharge (r = -0.5358, p < 0.0001).
95% of patients (N=19) rated the diary as useful for self-reflection and learning pacing strategies.
Inferred Conclusions
The energy-level diary is a valid tool for detecting and monitoring fatigue changes during post-COVID rehabilitation.
Daily energy patterns in post-COVID patients show clear circadian variation and sensitivity to therapy type, suggesting that therapy can be individualized based on patient response.
The diary supports patient self-awareness of activity-fatigue relationships and may facilitate implementation of pacing strategies in daily life.
This tool could be adapted for use in other fatigue-related conditions beyond post-COVID syndrome.
Remaining Questions
Does using the diary prospectively to guide individualized pacing actually improve long-term recovery outcomes compared to standard rehabilitation without energy tracking?
What This Study Does Not Prove
This study does not prove that using the diary improves clinical outcomes or recovery speed in post-COVID patients—only that the tool reliably measures energy changes. It does not establish causation between activity type and energy depletion, nor does it demonstrate that pacing based on diary data prevents post-exertional malaise or improves long-term prognosis. The study is limited to post-COVID syndrome and may not directly apply to ME/CFS populations.
Tags
Symptom:Cognitive DysfunctionFatigue
Phenotype:Long COVID Overlap
Method Flag:Weak Case DefinitionNo ControlsExploratory Only
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →