Twomey, Rosie, DeMars, Jessica, Franklin, Kelli et al. · Physical therapy · 2022 · DOI
This study looked at 213 people with long COVID to measure how severe their fatigue and postexertional malaise (PEM—worsening of symptoms after activity) were. Researchers found that over 71% had chronic fatigue as severe as or worse than other serious illnesses, and nearly 59% experienced PEM similar to what people with ME/CFS report. The study highlights that fatigue and symptom flare-ups after activity are major problems that need careful monitoring and should shape how doctors design rehabilitation programs.
This study provides empirical evidence that long COVID-associated fatigue is clinically significant and comparable in severity to ME/CFS, strengthening recognition of long COVID as a serious post-viral condition. The finding that most participants experience PEM underscores why standard rehabilitation approaches may be harmful and why pacing-based strategies deserve clinical priority. This work validates patient-reported experiences and builds the evidence base for tailored, individually-designed interventions.
This study does not establish causality or mechanisms underlying fatigue and PEM in long COVID. It cannot determine whether long COVID and ME/CFS share identical pathophysiology, only that fatigue severity is comparable. The cross-sectional design means we cannot track how fatigue or PEM evolve over time or predict which interventions will be most effective for individual patients.
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
Twomey, Rosie, DeMars, Jessica, Franklin, Kelli, Culos-Reed, S Nicole, Weatherald, Jason, & Wrightson, James G (2022). Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study.. Physical therapy. https://doi.org/10.1093/ptj/pzac005
BibTeX
@article{mecfsatlas-twomey-2022-chronic-fatigue,
author = {Twomey, Rosie and DeMars, Jessica and Franklin, Kelli and Culos-Reed, S Nicole and Weatherald, Jason and Wrightson, James G},
title = {Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study.},
journal = {Physical therapy},
year = {2022},
doi = {10.1093/ptj/pzac005},
note = {PubMed: 35079817},
url = {https://www.mecfsatlas.com/evidence/twomey-2022-chronic-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/twomey-2022-chronic-fatigue
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