Physical activity and sedentariness levels in patients with post-exertional malaise resulting from post-COVID-19 syndrome.
Elkebir, Kamel-Eddine, Gilbert, Jo-Anne, Kugathasan, Thiffya Arabi et al. · Work (Reading, Mass.) · 2025 · DOI
Quick Summary
This study looked at how physical activity changed in 154 people who developed post-exertional malaise (PEM)—extreme tiredness and pain that worsens after activity—following COVID-19. Researchers found that after COVID-19, these patients became much less active and spent more time sitting, especially at work. Women and those with more severe PEM were most affected by these changes.
Why It Matters
This study documents how PEM from long COVID substantially reduces physical activity and increases sedentary time—patterns that may worsen deconditioning and complicate return-to-work efforts. Understanding these activity changes is critical for developing safe PA rehabilitation strategies and workplace accommodations for post-COVID patients, insights that are relevant to the broader ME/CFS population.
Observed Findings
Individuals with PEM became significantly more sedentary and inactive following COVID-19 diagnosis.
Physical activity at work decreased notably in women and in those whose last infection occurred over one year ago.
Walking behavior diverged by sex: decreased in women but increased in men post-COVID-19.
Bike/cycling journeys generally decreased after COVID-19 across the sample.
PEM severity, pace of recovery, and fear of triggering malaise were associated with changes in physical activity patterns.
Inferred Conclusions
Post-COVID-19 syndrome leads to increased sedentary behavior and reduced physical activity, with effects more pronounced in women and those more severely affected by PEM.
Psychological factors (fear of malaise) and clinical severity (PEM intensity) are important drivers of activity reduction in this population.
Return-to-work and activity resumption programs must account for potential deconditioning and gender-specific activity changes in post-COVID patients.
Remaining Questions
Does reduced physical activity in PEM patients represent an appropriate physiological response to protect against symptom exacerbation, or does it contribute to secondary deconditioning that worsens long-term outcomes?
What This Study Does Not Prove
This cross-sectional design cannot establish causality or determine whether reduced activity is a consequence of PEM, a cause of worsening symptoms, or both. The study relies on self-reported activity levels rather than objective measurement, which may be subject to recall bias. Findings describe correlation between PEM severity and activity change but do not prove that reducing activity is therapeutically beneficial or harmful.
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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