Cherneva, Radostina, Cherneva, Zheyna, Youroukova, Vania et al. · Biomedicines · 2025 · DOI
More than two years after COVID-19 infection, about a quarter of people still experience persistent symptoms including fatigue, breathing problems, and reduced ability to exercise. Researchers tested how well patients' hearts and lungs worked during exercise and found that those with moderate-to-severe symptoms had noticeably reduced fitness levels and felt more exhausted even when not working as hard as their test results showed they should be.
This study demonstrates persistent cardio-respiratory dysfunction in long-term post-COVID-19 patients, paralleling pathophysiological findings in ME/CFS including reduced aerobic capacity and exaggerated perceived exertion relative to actual workload. The three-year follow-up provides crucial data on the chronic trajectory of post-COVID-19 syndrome and supports the hypothesis that some patients develop exercise intolerance with measurable physiological abnormalities similar to ME/CFS.
This study cannot establish causation or identify the specific mechanisms underlying the cardio-respiratory impairment, nor does it confirm post-exertional malaise (PEM), which is central to ME/CFS diagnosis. The cross-sectional design prevents determination of whether dysfunction is improving or worsening over time. The study also does not compare PCS directly to ME/CFS patients or establish whether PCS and ME/CFS share identical pathophysiology.
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
Cherneva, Radostina, Cherneva, Zheyna, Youroukova, Vania, Kadiyska, Tanya, Valev, Dinko, Hayrula-Manaf, Ebru Myuyun, et al. (2025). Cardio-Respiratory Fitness and Fatigue in Post-COVID-19 Syndrome-A Three-Year Update.. Biomedicines. https://doi.org/10.3390/biomedicines13051097
BibTeX
@article{mecfsatlas-cherneva-2025-cardio-respiratory,
author = {Cherneva, Radostina and Cherneva, Zheyna and Youroukova, Vania and Kadiyska, Tanya and Valev, Dinko and Hayrula-Manaf, Ebru Myuyun and Mitev, Vanyo},
title = {Cardio-Respiratory Fitness and Fatigue in Post-COVID-19 Syndrome-A Three-Year Update.},
journal = {Biomedicines},
year = {2025},
doi = {10.3390/biomedicines13051097},
note = {PubMed: 40426924},
url = {https://www.mecfsatlas.com/evidence/cherneva-2025-cardio-respiratory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/cherneva-2025-cardio-respiratory
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