Gloeckl, Rainer, Zwick, Ralf H, Fürlinger, Ulrich et al. · Sports medicine - open · 2024 · DOI
This study created practical guidelines for exercise training in people with long COVID, especially those who experience post-exertional malaise (PEM)—when symptoms get worse after physical activity. The researchers reviewed 46 previous studies and surveyed 14 international experts to develop three different exercise approaches depending on whether someone has no PEM, mild/moderate PEM, or severe PEM. These guidelines aim to help healthcare professionals safely design exercise programs tailored to each person's specific situation.
For ME/CFS patients, post-exertional malaise is a defining and debilitating feature that makes standard exercise recommendations potentially harmful. This guideline specifically addresses PEM severity as a stratifying factor, filling a critical clinical gap and providing healthcare providers with structured, evidence-informed approaches to exercise prescription that prioritize safety and individual tolerance.
This study does not prove that the proposed exercise protocols are effective at improving outcomes—it is a consensus guideline based on expert opinion and heterogeneous literature, not a clinical trial demonstrating efficacy. It does not establish which specific exercise modality or intensity is optimal for any PEM severity category, nor does it provide quantitative outcome data validating the stratification approach.
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
Gloeckl, Rainer, Zwick, Ralf H, Fürlinger, Ulrich, Schneeberger, Tessa, Leitl, Daniela, Jarosch, Inga, et al. (2024). Practical Recommendations for Exercise Training in Patients with Long COVID with or without Post-exertional Malaise: A Best Practice Proposal.. Sports medicine - open. https://doi.org/10.1186/s40798-024-00695-8
BibTeX
@article{mecfsatlas-gloeckl-2024-practical-recommendations,
author = {Gloeckl, Rainer and Zwick, Ralf H and Fürlinger, Ulrich and Schneeberger, Tessa and Leitl, Daniela and Jarosch, Inga and Behrends, Uta and Scheibenbogen, Carmen and Koczulla, Andreas Rembert},
title = {Practical Recommendations for Exercise Training in Patients with Long COVID with or without Post-exertional Malaise: A Best Practice Proposal.},
journal = {Sports medicine - open},
year = {2024},
doi = {10.1186/s40798-024-00695-8},
note = {PubMed: 38658496},
url = {https://www.mecfsatlas.com/evidence/gloeckl-2024-practical-recommendations},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/gloeckl-2024-practical-recommendations
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