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Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients. — ME/CFS Atlas

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Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients.

Tomaskovic, Aleksandar, Weber, Vincent, Ochmann, David T et al. · Sports medicine - open · 2026 · DOI

Quick Summary

A cross-sectional study of 92 severely ill post-COVID patients found that those meeting ME/CFS criteria had lower measured aerobic capacity (oxygen uptake and power output) on exercise testing compared to post-COVID patients without ME/CFS. Two-thirds of all patients showed objective signs of work disability on testing, and these measurements correlated with patients' own reports of disability and their employment status. The relevance of these findings specifically to ME/CFS requires caution, as the study enrolled primarily post-COVID patients, and the overlap between these conditions remains incompletely understood.

Why It Matters

This study provides quantified CPET data associated with work disability in a cohort with high prevalence of ME/CFS criteria, potentially supporting the use of exercise testing in occupational and disability evaluations. By analogy, the observed associations between reduced aerobic parameters and disability severity may be relevant to ME/CFS populations, though direct application requires validation in ME/CFS-defined cohorts. The data contribute to objective documentation of functional limitation in conditions where standard organ-focused diagnostics often appear unremarkable.

Observed Findings

In the ME/CFS subgroup (n~45), VO₂peak was significantly lower compared to post-COVID without ME/CFS (13.0±3.1 vs. 15.4±4.9 mL/min/kg).
Peak power output was significantly lower in ME/CFS patients (0.9±0.3 vs. 1.1±0.5 W/kg).
Oxygen pulse was significantly lower in ME/CFS patients (7.7±2.0 vs. 8.5±1.9 mL/bpm).
Across all 92 PCC patients, 66% met objective work disability thresholds (VO₂peak <15 mL/min/kg or PPO <1 W/kg), and VO₂peak and PPO were associated with Bell Disability Scale scores and employment status.
79% of the cohort screened positive on the DSQ-PEM (post-exertional malaise questionnaire).

Inferred Conclusions

The authors interpret that ME/CFS patients within this post-COVID cohort demonstrate objective physiological markers of reduced work capacity on CPET, distinct from those without ME/CFS criteria.
The authors propose that VO₂peak and PPO may be useful proxies for assessing occupational disability and informing return-to-work decisions in severely affected post-COVID patients.
The alignment between CPET findings and subjective disability scores is interpreted as supporting the validity of CPET for occupational health evaluation in this population.

Remaining Questions

Whether these CPET abnormalities in post-COVID ME/CFS patients reflect the same underlying physiology as ME/CFS defined primarily in non-post-COVID populations remains unclear.

What This Study Does Not Prove

This cross-sectional design does not establish that reduced VO₂peak or PPO causes work disability; it demonstrates association only. The study does not establish whether CPET findings are mechanistically linked to ME/CFS pathophysiology or whether they represent secondary deconditioning. Findings cannot be generalized beyond severely affected post-COVID patients, and direct applicability to ME/CFS populations is not established without replication in ME/CFS-primary cohorts. The study does not recommend CPET as a diagnostic test for ME/CFS.

Topics

Severe ME Diagnostics Long COVID Overlap Post-Exertional Malaise

Metadata

DOI: 10.1186/s40798-026-00995-1
PMID: 42043742
Evidence level: Single-study or moderate support from human research
Last updated: 28 April 2026

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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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Primary citation

Tomaskovic, Aleksandar, Weber, Vincent, Ochmann, David T, Hillen, Barlo, Neuberger, Elmo W I, Brahmer, Alexandra, et al. (2026). Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients.. Sports medicine - open. https://doi.org/10.1186/s40798-026-00995-1

BibTeX

@article{mecfsatlas-tomaskovic-2026-cardiopulmonary-exercise,
  author  = {Tomaskovic, Aleksandar and Weber, Vincent and Ochmann, David T and Hillen, Barlo and Neuberger, Elmo W I and Brahmer, Alexandra and Lachtermann, Ella and Lieb, Klaus and Simon, Perikles},
  title   = {Cardiopulmonary Exercise Testing Reveals Functional Limitations and Work Disability in Severe Post-COVID-19 and ME/CFS Patients.},
  journal = {Sports medicine - open},
  year    = {2026},
  doi     = {10.1186/s40798-026-00995-1},
  note    = {PubMed: 42043742},
  url     = {https://www.mecfsatlas.com/evidence/tomaskovic-2026-cardiopulmonary-exercise},
}

Atlas snapshot reference

ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-05. https://www.mecfsatlas.com/evidence/tomaskovic-2026-cardiopulmonary-exercise

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