Barr, Julia, Marsden, Lowri, Dassanayake, Theshan et al. · Journal of clinical medicine · 2026 · DOI
This study tested whether a personalised 8-week management plan—including increased fluid and salt intake, pacing strategies, and calf exercises—was feasible and associated with improvements in symptoms of orthostatic intolerance (dizziness on standing) in people with ME/CFS or Long COVID. Sixteen patients completed the program, and the researchers observed modest improvements in symptom questionnaires and heart rate responses, though the authors note these changes may not translate to meaningful relief for patients in everyday life. This is preliminary evidence from a small study without a comparison group, so it cannot confirm whether the protocol itself caused the improvements.
Orthostatic intolerance is a common and disabling feature in ME/CFS and Long COVID, and conservative first-line management options lack robust efficacy evidence. By analogy, this feasibility study may inform conservative treatment approaches for dysautonomia in ME/CFS, though relevance to ME/CFS-specific outcomes and the generalisability of these findings remain unclear. The variable adherence and modest effect sizes highlight challenges in managing this symptom cluster.
This study does not establish that the protocol causes symptom improvement—the lack of a control or comparator group means other factors (placebo, natural recovery, increased attention) cannot be ruled out. It does not demonstrate clinical meaningfulness or sustained benefit beyond the 8-week period, nor does it generalise beyond the 16 completers (five discontinued, one was withdrawn). The variable adherence to interventions also makes it unclear which components, if any, were responsible for observed associations.
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 →
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