Arienti, Chiara, Cordani, Claudio, Lazzarini, Stefano G et al. · European journal of physical and rehabilitation medicine · 2022 · DOI
This study looked at what treatments have helped people with fatigue and exercise problems in other conditions to understand what might help people with long COVID. Researchers found that exercise programs, telehealth rehabilitation, and educational interventions showed promise for fatigue, while combined aerobic and anaerobic training helped with exercise intolerance. However, they found very little research specifically on post-exertional malaise (feeling much worse after activity) or orthostatic intolerance (dizziness when standing), which are key symptoms in post-COVID and ME/CFS.
This systematic analysis provides a foundation for understanding which rehabilitation approaches might help with fatigue and exercise limitations in ME/CFS and long COVID, addressing a critical gap where little direct research exists. The WHO used these findings to develop official clinical practice guidelines, making this work directly relevant to treatment recommendations for patients.
This study does not prove these interventions are safe or effective specifically for ME/CFS or post-COVID patients, as it only maps evidence from other conditions. The findings do not establish that mechanisms causing fatigue in cancer or COPD are the same as in ME/CFS. Most importantly, the absence of research on post-exertional malaise means the study cannot recommend treatments for this signature symptom.
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
Arienti, Chiara, Cordani, Claudio, Lazzarini, Stefano G, Del Furia, Matteo J, Negrini, Stefano, & Kiekens, Carlotte (2022). Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition.. European journal of physical and rehabilitation medicine. https://doi.org/10.23736/S1973-9087.22.07802-9
BibTeX
@article{mecfsatlas-arienti-2022-fatigue-post,
author = {Arienti, Chiara and Cordani, Claudio and Lazzarini, Stefano G and Del Furia, Matteo J and Negrini, Stefano and Kiekens, Carlotte},
title = {Fatigue, post-exertional malaise and orthostatic intolerance: a map of Cochrane evidence relevant to rehabilitation for people with post COVID-19 condition.},
journal = {European journal of physical and rehabilitation medicine},
year = {2022},
doi = {10.23736/S1973-9087.22.07802-9},
note = {PubMed: 36472558},
url = {https://www.mecfsatlas.com/evidence/arienti-2022-fatigue-post},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/arienti-2022-fatigue-post
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