Mathew, Joscilin, Nugent, Kenneth · The Yale journal of biology and medicine · 2024 · DOI
Some people who had COVID-19 develop long-lasting symptoms and struggle with exercise—a condition called long COVID. This article explains that exercise problems can happen for different reasons: heart issues, lung problems, weak muscles, being out of shape, or symptoms that seem worse than what physical tests show. While many patients improve with standard rehabilitation programs, those with post-exertional malaise (getting worse after activity) need special, carefully monitored exercise plans.
This study is important because it distinguishes long COVID patients with post-exertional malaise from those with simple deconditioning, highlighting that some patients may need different rehabilitation approaches. For ME/CFS patients and researchers, this reinforces that not all exercise limitation is treated equally, and that one-size-fits-all rehabilitation protocols may harm patients with post-exertional malaise.
This editorial does not prove that all long COVID patients have the same underlying cause of exercise limitation, nor does it establish which rehabilitation approaches are most effective for specific subgroups. It also does not demonstrate whether skeletal muscle findings are directly responsible for post-exertional malaise or are simply correlated findings. The review cannot establish causation for any observed mechanisms.
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
Mathew, Joscilin & Nugent, Kenneth (2024). Post-Acute Sequelae of SARS-CoV-2 Infections: Exercise Limitation and Rehabilitation.. The Yale journal of biology and medicine. https://doi.org/10.59249/NHFT4839
BibTeX
@article{mecfsatlas-mathew-2024-post-acute,
author = {Mathew, Joscilin and Nugent, Kenneth},
title = {Post-Acute Sequelae of SARS-CoV-2 Infections: Exercise Limitation and Rehabilitation.},
journal = {The Yale journal of biology and medicine},
year = {2024},
doi = {10.59249/NHFT4839},
note = {PubMed: 39703612},
url = {https://www.mecfsatlas.com/evidence/mathew-2024-post-acute},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/mathew-2024-post-acute
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