Bomans, Sarah, Michotte, Naomi, El M'Rabet, Imane et al. · PloS one · 2026 · DOI
Researchers compared two different exercise tests—one simpler and potentially more accessible (the 6-minute incremental step test) and one more complex (the cardiopulmonary exercise test)—to see if they could both measure post-exertional malaise in long COVID patients. In a small study of 25 people, the two tests did not measure the same outcomes equally well, though some measures like fatigue and effort perception showed moderate agreement. The simpler test may need further refinement before it can reliably replace the standard test.
By analogy with long COVID, this research addresses a critical clinical need in ME/CFS: objective, accessible, and reliable assessment of post-exertional malaise, a core diagnostic feature. The two-day exercise testing paradigm is relevant to ME/CFS research because capturing symptom worsening over 24 hours may better reflect the condition's temporal pattern. However, because this study was conducted in long COVID and not ME/CFS, relevance to ME/CFS patients should not be assumed without direct replication.
This study does not establish that the 6MIST is suitable for clinical or research use in ME/CFS; it only reports moderate agreement for some subjective measures in a small long COVID cohort. It does not prove the 6MIST will replace CPET or that protocol refinement will succeed. It does not establish causation or mechanism; it measures only agreement between two testing methods.
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
Bomans, Sarah, Michotte, Naomi, El M'Rabet, Imane, Jimenez Garcia, Berenice, Leemans, Lynn, Janssens, Peter, et al. (2026). Agreement and reliability between the two-day 6-minute incremental step test and two-day cardiopulmonary exercise test in post COVID-19 condition for assessing post-exertional malaise: The REVEAL-study.. PloS one. https://doi.org/10.1371/journal.pone.0353132
BibTeX
@article{mecfsatlas-bomans-2026-agreement-reliability,
author = {Bomans, Sarah and Michotte, Naomi and El M'Rabet, Imane and Jimenez Garcia, Berenice and Leemans, Lynn and Janssens, Peter and Hanon, Shane and De Waele, Elisabeth and Beckwée, David},
title = {Agreement and reliability between the two-day 6-minute incremental step test and two-day cardiopulmonary exercise test in post COVID-19 condition for assessing post-exertional malaise: The REVEAL-study.},
journal = {PloS one},
year = {2026},
doi = {10.1371/journal.pone.0353132},
note = {PubMed: 42447127},
url = {https://www.mecfsatlas.com/evidence/bomans-2026-agreement-reliability},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-08-16. https://www.mecfsatlas.com/evidence/bomans-2026-agreement-reliability
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