ReviewInfection2025
Towards an understanding of physical activity-induced post-exertional malaise: Insights into microvascular alterations and immunometabolic interactions in post-COVID condition and myalgic encephalomyelitis/chronic fatigue syndrome.
Review in Infection, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed.
- COVID-19 as a Modifier of Genetically Determined Coagulation Phenotype: Implications for Precision Risk Stratification After Infection.Biochemical genetics · 2026Observational
- A cardiometabolic perspective on post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID.Cardiovascular diabetology · 2026Article
- Article
- eNOS Uncoupling, Shear-Stress Tolerance, and the Two-Threshold Model of Post-Exertional Malaise in Long COVID: A Mechanistic Hypothesis With Implications for Physiotherapy and Recovery Protocols.Microcirculation (New York, N.Y. : 1994) · 2026Review
- Skeletal muscle properties in long COVID and ME/CFS differ from those induced by bed rest.Nature communications · 2026Article
- Metabolomic Classification of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome via Explainable Ensemble Learning and Pareto-Guided Feature Selection.International journal of molecular sciences · 2026Article
- Feasibility, Adherence, Acceptance and Usability of a Multimodal Telemonitoring for Pediatric Post-COVID Syndrome: A Bicentric Pilot Study.Journal of medical systems · 2026Article
- Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients.Sports medicine - open · 2026Article
- Mitochondrial innate immune signaling in skeletal muscle adaptation to exercise.Trends in endocrinology and metabolism: TEM · 2026Review
- Longitudinal functional lung imaging in children with Post-COVID-19 syndrome.Molecular and cellular pediatrics · 2026Article
- Associations between heart rate and physical activity in people with post-COVID-19 condition accounting for myalgic encephalomyelitis/chronic fatigue syndrome symptoms.Journal of rehabilitation medicine · 2026Observational
- Lessons from irritable bowel syndrome: potential for understanding and managing post-COVID.Frontiers in immunology · 2026Review
- COVID-19-associated neurological and psychological manifestations.Nature reviews. Disease primers · 2025Review
- Physical activity, sedentary time, and associated factors in post-COVID-19 condition: a cross-sectional study.Journal of rehabilitation medicine · 2025Observational
- Possible link between steatotic liver diseases, severe COVID-19 and cognitive impairment in post-COVID-19 syndrome.Infection · 2025Article
- Cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study.Infection · 2025Article
- The post-COVID-19 pulmonary sequelae: manifestations, mechanisms and treatment strategies.Journal of thoracic disease · 2025Review
- Mitochondrial Dysfunction in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.Physiology (Bethesda, Md.) · 2025Review
- Post-COVID-19 Condition in Track and Field Master Athletes: Severity, Symptoms, and Associations With Quality of Life and C-Reactive Protein Levels.Scandinavian journal of medicine & science in sports · 2025Article
- Patient Perspectives on the Care in a Long COVID Outpatient Clinic-A Regional Qualitative Analysis from Germany.Healthcare (Basel, Switzerland) · 2025Article
Corrections and comments
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Authors and funding
19 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA considerable number of patients who contracted SARS-CoV-2 are affected by persistent multi-systemic symptoms, referred to as Post-COVID Condition (PCC). Post-exertional malaise (PEM) has been recognized as one of the most frequent manifestations of PCC and is a diagnostic criterion of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Yet, its underlying pathomechanisms remain poorly elucidated. PURPOSE AND
methodsIn this review, we describe current evidence indicating that key pathophysiological features of PCC and ME/CFS are involved in physical activity-induced PEM.
resultsUpon physical activity, affected patients exhibit a reduced systemic oxygen extraction and oxidative phosphorylation capacity. Accumulating evidence suggests that these are mediated by dysfunctions in mitochondrial capacities and microcirculation that are maintained by latent immune activation, conjointly impairing peripheral bioenergetics. Aggravating deficits in tissue perfusion and oxygen utilization during activities cause exertional intolerance that are frequently accompanied by tachycardia, dyspnea, early cessation of activity and elicit downstream metabolic effects. The accumulation of molecules such as lactate, reactive oxygen species or prostaglandins might trigger local and systemic immune activation. Subsequent intensification of bioenergetic inflexibilities, muscular ionic disturbances and modulation of central nervous system functions can lead to an exacerbation of existing pathologies and symptoms.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.