Aschman, Tom, Wyler, Emanuel, Baum, Oliver et al. · Acta neuropathologica communications · 2023 · DOI
Researchers examined muscle tissue from people with long COVID who experience fatigue and worsening symptoms after activity. They found that these patients had fewer blood vessels in their muscles, thicker vessel walls, and signs of immune cells that might have been triggered by the initial infection. These physical changes in the muscle's blood supply could explain why exercise makes their symptoms worse.
This study provides direct tissue evidence for a physiological basis of post-COVID exercise intolerance, offering validation for the symptom severity experienced by patients. Understanding that structural changes in muscle blood vessels may drive post-exertional malaise could guide future therapeutic approaches and support recognition of this condition as a legitimate medical disorder.
This study does not prove that capillary alterations are the sole cause of post-COVID exercise intolerance, nor does it establish that these findings apply to all long COVID patients or to ME/CFS patients without prior COVID infection. The cross-sectional design cannot determine whether these vascular changes persist long-term or whether they cause the fatigue or simply correlate with it.
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
Aschman, Tom, Wyler, Emanuel, Baum, Oliver, Hentschel, Andreas, Rust, Rebekka, Legler, Franziska, et al. (2023). Post-COVID exercise intolerance is associated with capillary alterations and immune dysregulations in skeletal muscles.. Acta neuropathologica communications. https://doi.org/10.1186/s40478-023-01662-2
BibTeX
@article{mecfsatlas-aschman-2023-post-covid,
author = {Aschman, Tom and Wyler, Emanuel and Baum, Oliver and Hentschel, Andreas and Rust, Rebekka and Legler, Franziska and Preusse, Corinna and Meyer-Arndt, Lil and Büttnerova, Ivana and Förster, Alexandra and Cengiz, Derya and Alves, Luiz Gustavo Teixeira and Schneider, Julia and Kedor, Claudia and Bellmann-Strobl, Judith and Sanchin, Aminaa and Goebel, Hans-Hilmar and Landthaler, Markus and Corman, Victor and Roos, Andreas and Heppner, Frank L and Radbruch, Helena and Paul, Friedemann and Scheibenbogen, Carmen and Dengler, Nora F and Stenzel, Werner},
title = {Post-COVID exercise intolerance is associated with capillary alterations and immune dysregulations in skeletal muscles.},
journal = {Acta neuropathologica communications},
year = {2023},
doi = {10.1186/s40478-023-01662-2},
note = {PubMed: 38066589},
url = {https://www.mecfsatlas.com/evidence/aschman-2023-post-covid},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/aschman-2023-post-covid
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