Evidence map›Paper›PMID 42501245›Full record

ArticleSports medicine (Auckland, N.Z.)2026

Wearable Heart Rate Variability Monitoring, Autonomic Dysfunction and Post-exertional Malaise in Long COVID: An Observational Study.

Twan M Ruijgt, Anouk Slaghekke, Anneke Ellens, Kasper W Janssen, Rob C I Wüst

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Article in Sports medicine (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Twan M RuijgtDepartment of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Anouk SlaghekkeDepartment of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
Anneke EllensSports and Exercise Medicine Clinic, DeSportarts, Dublinstraat 2, 3541 CD, Utrecht, The Netherlands.
Kasper W JanssenSports and Exercise Medicine Clinic, DeSportarts, Dublinstraat 2, 3541 CD, Utrecht, The Netherlands. kasperjanssen@desportarts.nl.
Rob C I WüstDepartment of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. r.wust@vu.nl.ORCID http://orcid.org/0000-0003-3781-5177

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesPatients with long coronavirus disease (COVID) experience disabling fatigue, autonomic dysfunction, reduced exercise capacity and post-exertional malaise (PEM). Heart rate variability (HRV) can evaluate autonomic function and monitor overexertion, potentially helping to mitigate PEM. This study aimed to use continuous multi-day HRV recordings to monitor overexertion and study autonomic function in long COVID.

methodHeart rate and HRV were continuously measured in 121 patients with long COVID (43 ± 11 years, 32% male) and 21 healthy controls (42 ± 13 years, 48% male), with daily life activities tracked in a logbook. Participants underwent a (sub)maximal cardiopulmonary exercise test to determine heart rate at the first ventilatory threshold (VT1) to study HRV responses to exercise at different intensities. RESULTS AND DISCUSSION: HRV was lower in patients with long COVID compared with healthy controls during various daily activities and sleep (p = 0.027). Across all exercise intensities surrounding the VT1, HRV remained lower for 24 h in patients compared with controls (p = 0.010). Nighttime HRV decreased with intense exercise and longer durations in patients with long COVID (p = 0.018), indicative of exercise-induced diurnal disturbances of the autonomic nervous system in long COVID.

conclusionHeart rate variability, assessed by wearables, suggests autonomic dysfunction in patients with long COVID. The delayed recovery of the sympathovagal balance after exercise close to and above VT1, suggests that the risk of PEM rises above VT1. APPLICATION: These results confirm the applicability of wearables to assess autonomic function and manage overexertion in patients with long COVID.

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Registered trials

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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.