Journal article
Post-Exertional Symptom Exacerbation after Sub-Maximal Exercise in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-Acute Sequelae of COVID-19
Medicine and science in sports and exercise, Vol.58(4), pp.637-649
04/2026
DOI: 10.1249/MSS.0000000000003891
PMID: 41185151
Abstract
In individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and post-acute sequelae of SARS-CoV-2 infection (PASC), physical activity can exacerbate symptoms for days-to-weeks, referred to as post-exertional symptom exacerbation (PESE). This study characterized the trajectory of PESE symptoms before and for 7 days after a sub-maximal exercise task in individuals with ME/CFS or PASC.
Individuals with ME/CFS (n=30) or PASC (n=30) and matched controls (n=30) were recruited from a university hospital and the community setting. Participants completed a 25-minute moderate intensity exercise on a whole-body cycle ergometer. The trajectory of 8 commonly reported PESE symptoms (physical fatigue, mental fatigue, pain, physical function, flu-like symptoms, gastrointestinal symptoms, sleep dysfunction, anxiety) before and for 7 days after exercise.
There was variability in the proportion of those who experienced increased symptoms ranging from 46/60 reporting physical fatigue to only 18/30 reporting anxiety. There was no change in any of the symptoms across the 7-day period when analyzed individually. An aggregate score of 4-5 symptoms that includes physical fatigue, mental fatigue, physical function and flu-like symptoms, with or without pain, was more comprehensive in capturing maximal changes in PESE. Changes were greatest during the 72h post-exercise and for those with ME/CFS. The aggregate score shows 8/30 of individuals with ME/CFS and 12/30 with PASC show minimal-to-no increase in PESE, while 6-7/30 show increases greater than 3/10 points.
PESE to a clinically relevant exercise task is variable in individuals with ME/CFS and PASC as submaximal exercise does not exacerbate symptoms for some, while modifications of intensity may be necessary to minimize PESE in others.
Details
- Title: Subtitle
- Post-Exertional Symptom Exacerbation after Sub-Maximal Exercise in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-Acute Sequelae of COVID-19
- Creators
- Giovanni Berardi - University of IowaAdam Janowski - University of IowaSamuel McNally - University of IowaAndrew Post - University of IowaAlpana Garg - Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IAKathleen A Sluka - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Medicine and science in sports and exercise, Vol.58(4), pp.637-649
- DOI
- 10.1249/MSS.0000000000003891
- PMID
- 41185151
- NLM abbreviation
- Med Sci Sports Exerc
- ISSN
- 0195-9131
- eISSN
- 1530-0315
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
- Grant note
- Institute for Clinical and Translational Science at the University of Iowa under the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program: UM1TR004403 NIH: R01AR077418, R01AR077418-S1 National Institutes of Neurological Disease and Stroke: U24NS112873-03S2 NIAMS: UH3 AR076387-02S1
TriNetX, REDCap, and the Clinical Research Unit are supported by the Institute for Clinical and Translational Science at the University of Iowa under the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant UM1TR004403. Supported by the NIH under award number: R01AR077418 and R01AR077418-S1. Postdoctoral support for G. B. was provided by the National Institutes of Neurological Disease and Stroke (U24NS112873-03S2). Predoctoral support for A. J. was provided by Foundation for Physical Therapy Research Promotion of Doctoral Studies I and II, and postdoctoral support for A. J. was provided by T32 NS045549. Predoctoral support for A. P. was provided by PODS I and II and NIAMS UH3 AR076387-02S1. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. No conflicts of interest were disclosed. The datasets generated during and/or analyzed during the current study are not publicly available in a public repository but are available from the corresponding author (kathleen-sluka@uiowa.edu). The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by the American College of Sports Medicine.
- Language
- English
- Electronic publication date
- 11/04/2025
- Date published
- 04/2026
- Academic Unit
- Iowa Neuroscience Institute; Nursing; Physical Therapy and Rehabilitation Science; Neuroscience and Pharmacology
- Record Identifier
- 9985024253002771
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