An, Yi, Guo, Ziyu, Fan, Jin et al. · General hospital psychiatry · 2024 · DOI
Researchers looked at 12 studies involving 2,665 patients with long COVID to understand how common post-exertional malaise (PEM)—a worsening of symptoms after physical or mental effort—is among those affected. They found that more than half of long COVID patients experience PEM. The study also identified seven different questionnaires that researchers use to measure PEM, with the DePaul Symptom Questionnaire being the most commonly used tool.
PEM is recognized as a core symptom in long COVID and shares mechanistic similarities with ME/CFS. Establishing PEM prevalence (>50%) in PACS validates its significance as a treatment target and highlights the urgent need for evidence-based interventions. Standardizing PEM measurement tools is essential for clinical trials and comparative research across ME/CFS and long COVID populations.
This review does not establish the biological mechanisms underlying PEM or determine whether PEM in PACS and ME/CFS are identical conditions. It cannot prove causation or establish whether PEM is directly caused by COVID-19 viral effects versus other post-infectious processes. The prevalence estimate depends on how well studies defined and measured PEM, which varied across included studies.
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 →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
An, Yi, Guo, Ziyu, Fan, Jin, Luo, Tingting, Xu, Huimin, Li, Huiying, et al. (2024). Prevalence and measurement of post-exertional malaise in post-acute COVID-19 syndrome: A systematic review and meta-analysis.. General hospital psychiatry. https://doi.org/10.1016/j.genhosppsych.2024.10.011
BibTeX
@article{mecfsatlas-an-2024-prevalence-measurement,
author = {An, Yi and Guo, Ziyu and Fan, Jin and Luo, Tingting and Xu, Huimin and Li, Huiying and Wu, Xi},
title = {Prevalence and measurement of post-exertional malaise in post-acute COVID-19 syndrome: A systematic review and meta-analysis.},
journal = {General hospital psychiatry},
year = {2024},
doi = {10.1016/j.genhosppsych.2024.10.011},
note = {PubMed: 39490027},
url = {https://www.mecfsatlas.com/evidence/an-2024-prevalence-measurement},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/an-2024-prevalence-measurement
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