Elkebir, Kamel-Eddine, Gilbert, Jo-Anne, Kugathasan, Thiffya Arabi et al. · Work (Reading, Mass.) · 2025 · DOI
This study looked at how physical activity changed in 154 people who developed post-exertional malaise (PEM)—extreme tiredness and pain that worsens after activity—following COVID-19. Researchers found that after COVID-19, these patients became much less active and spent more time sitting, especially at work. Women and those with more severe PEM were most affected by these changes.
This study documents how PEM from long COVID substantially reduces physical activity and increases sedentary time—patterns that may worsen deconditioning and complicate return-to-work efforts. Understanding these activity changes is critical for developing safe PA rehabilitation strategies and workplace accommodations for post-COVID patients, insights that are relevant to the broader ME/CFS population.
This cross-sectional design cannot establish causality or determine whether reduced activity is a consequence of PEM, a cause of worsening symptoms, or both. The study relies on self-reported activity levels rather than objective measurement, which may be subject to recall bias. Findings describe correlation between PEM severity and activity change but do not prove that reducing activity is therapeutically beneficial or harmful.
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 →
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