Thölking, Theresa, Müller, Frank, Riester, Tim et al. · Health and quality of life outcomes · 2026 · DOI
This study surveyed German adults with Long COVID and post-exertional malaise (PEM) to understand how the frequency and severity of PEM relates to quality of life. Researchers found that people reporting more frequent and more severe PEM were associated with lower quality-of-life scores, even after accounting for age, sex, and employment status. These are preliminary findings from a single survey and do not establish that PEM causes poor quality of life, but rather that the two observations occurred together in this group.
By analogy, this study's findings on PEM frequency and severity correlating with poor quality of life may be relevant to ME/CFS, since PEM is a cardinal feature of both Long COVID and ME/CFS. However, the study was conducted in a Long COVID cohort, and the extent to which these associations generalise to ME/CFS populations remains unclear. Understanding which PEM features most strongly correlate with reduced functioning could inform clinical priorities in both conditions.
This study does not establish that PEM causes poor quality of life; it documents an association in one cross-sectional sample and cannot determine direction of causality. It does not prove these findings apply to ME/CFS patients, who may have different PEM characteristics or comorbidities. It does not identify mechanisms linking PEM frequency to quality-of-life impairment, nor does it compare quality of life between Long COVID patients with and without PEM.
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
Thölking, Theresa, Müller, Frank, Riester, Tim, Lampe, Viktoria, Theil, Lena-Marie, Hummers, Eva, et al. (2026). Impact of post-exertional malaise frequency and fatigue in Long COVID patients on health-related quality of life.. Health and quality of life outcomes. https://doi.org/10.1186/s12955-026-02523-x
BibTeX
@article{mecfsatlas-thlking-2026-impact-post,
author = {Thölking, Theresa and Müller, Frank and Riester, Tim and Lampe, Viktoria and Theil, Lena-Marie and Hummers, Eva and Sarpari, Kousha and Dopfer-Jablonka, Alexandra and Happle, Christine and Steffens, Sandra and Meier-Maiwald, Mareike and Mikuteit, Marie and Schröder, Dominik},
title = {Impact of post-exertional malaise frequency and fatigue in Long COVID patients on health-related quality of life.},
journal = {Health and quality of life outcomes},
year = {2026},
doi = {10.1186/s12955-026-02523-x},
note = {PubMed: 42116095},
url = {https://www.mecfsatlas.com/evidence/thlking-2026-impact-post},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-14. https://www.mecfsatlas.com/evidence/thlking-2026-impact-post
Contribute
Private, reviewed by a human. Not a public comment thread.