Evidence browser

E2 ModerateCohortPEM not requiredLongitudinal

Study on Sports, Extracurricular Activities, Electronic Device Usage Factors Associated with Chronic Fatigue Syndrome in Taiwanese Preschoolers.

Huang, Su-Fen, Duan, Hui-Ying·Children (Basel, Switzerland)·2023

This study looked at whether exercise, extracurricular activities, and screen time affect tiredness in young children in Taiwan. Researchers found that children who exercised regularly and varied their activities felt less tired, while children who used screens out of boredom or did too many after-school activities felt more tired. The findings suggest that balanced exercise and limited screen time may help reduce fatigue in preschoolers.

Single and repeated high-level blast, low-level blast, and new-onset self-reported health conditions in the U.S. Millennium Cohort Study: An exploratory investigation.

Belding, Jennifer N, Kolaja, Claire A, Rull, Rudolph P et al.·Frontiers in neurology·2023

This study followed a large group of U.S. military personnel and veterans to investigate whether exposure to blast pressure—both from single or repeated high-level blasts and occupational low-level blast exposure—was associated with new health diagnoses. Researchers found that blast exposure was linked to several conditions including chronic fatigue syndrome, PTSD, hearing loss, depression, and nerve damage. The study suggests that repeated blast exposure may carry greater health risks than single exposure, and that combinations of different blast exposures may increase risks further.

The association between the number of symptoms and the severity of Post-COVID-Fatigue after SARS-CoV-2 infection treated in an outpatient setting.

Schmidbauer, Lena, Kirchberger, Inge, Goßlau, Yvonne et al.·Journal of neurology·2023

This study looked at 425 people who had mild-to-moderate COVID-19 treated as outpatients and followed them for about 8 months afterward. Researchers found that 37% of these people developed long-lasting fatigue (Post-COVID-Fatigue), and those who had more symptoms during their initial infection and ongoing symptoms were more likely to experience severe fatigue. The more symptoms someone had, the worse their fatigue tended to be.

Cognitive Impairment

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia: PR3-versus MPO-ANCA-associated vasculitis, an exploratory cross-sectional study.

van Eeden, Charmaine, Mohazab, Naima, Redmond, Desiree et al.·Lancet regional health. Americas·2023

This study looked at fatigue in people with ANCA-vasculitis (a type of blood vessel inflammation) and found that over half met the diagnostic criteria for ME/CFS. The researchers discovered that the type of vasculitis matters: people with MPO-ANCA had fatigue patterns more similar to fibromyalgia, while those with PR3-ANCA had fatigue linked to inflammation markers. This suggests different types of vasculitis may cause fatigue through different biological mechanisms.

Tryptophan catabolites, inflammation, and insulin resistance as determinants of chronic fatigue syndrome and affective symptoms in long COVID.

Al-Hakeim, Hussein Kadhem, Khairi Abed, Anwar, Rouf Moustafa, Shatha et al.·Frontiers in molecular neuroscience·2023

This study looked at 90 Long COVID patients and measured specific molecules in their blood related to how their body processes an amino acid called tryptophan. The researchers found that patients with the most severe Long COVID symptoms had low tryptophan levels and high levels of a related compound called kynurenine, along with markers of inflammation. These three measurements together explained about 40% of why patients had fatigue, pain, depression, and anxiety symptoms.

E2 ModerateBehavioralPEM not requiredLongitudinal

Uplifts and hassles are related to worsening in chronic fatigue syndrome: a prospective study.

Friedberg, Fred, Adamowicz, Jenna L, Bruckenthal, Patricia et al.·Journal of translational medicine·2023

This study tracked 128 ME/CFS patients over six months to see how daily pleasant and unpleasant events related to whether their illness got better, stayed the same, or got worse. Patients who worsened experienced more intense unpleasant events and had fewer pleasant events over time, while those who improved showed the opposite pattern. The findings suggest that the balance between daily hassles and uplifts may play a role in how ME/CFS progresses.

Influence of Chronic Fatigue Syndrome Codiagnosis on the Relationship between Perceived and Objective Psychoneuro-Immunoendocrine Disorders in Women with Fibromyalgia.

Otero, Eduardo, Gálvez, Isabel, Ortega, Eduardo et al.·Biomedicines·2023

This study compared women with fibromyalgia (FM), some of whom also had been diagnosed with chronic fatigue syndrome (CFS), to healthy women. Researchers measured both what patients reported feeling (like stress and pain levels) and actual biological markers in their blood (like stress hormones and immune chemicals). They found that FM patients generally felt worse than healthy women, and their blood work matched this—showing higher stress hormones and lower mood-boosting chemicals. Interestingly, FM patients who also had a CFS diagnosis showed different blood markers than those with FM alone, suggesting these two conditions may overlap in ways that current diagnosis methods don't catch.

Serum GDF-15 Levels Accurately Differentiate Patients with Primary Mitochondrial Myopathy, Manifesting with Exercise Intolerance and Fatigue, from Patients with Chronic Fatigue Syndrome.

Bermejo-Guerrero, Laura, de Fuenmayor-Fernández de la Hoz, Carlos Pablo, Guerrero-Molina, María Paz et al.·Journal of clinical medicine·2023

This study tested whether a blood marker called GDF-15 could help doctors tell the difference between ME/CFS and a rare condition called primary mitochondrial myopathy (PMM), which affects how cells produce energy. Both conditions cause fatigue and exercise intolerance that can look very similar, but PMM requires different treatment. The researchers found that GDF-15 levels were very good at distinguishing between these two conditions, which could help patients get the right diagnosis faster without needing extensive genetic testing or muscle biopsies.

Diagnostics

E2 ModerateCohortPEM requiredLongitudinal

Focus on post-exertional malaise when approaching ME/CFS in specialist healthcare improves satisfaction and reduces deterioration.

Wormgoor, Marjon E A, Rodenburg, Sanne C·Frontiers in neurology·2023

This study looked at whether ME/CFS specialists in Norway were paying attention to post-exertional malaise (PEM)—the worsening of symptoms after physical or mental effort, which is a key feature of ME/CFS. They surveyed nearly 900 patients about their experiences in specialist clinics and hospitals. The results showed that when doctors focused on PEM and helped patients avoid overexertion, patients felt better, were more satisfied with their care, and were less likely to get worse after treatment.

Post-Exertional Malaise

Long-term health outcomes of Q-fever fatigue syndrome patients.

Spronk, Inge, Brus, Iris M, de Groot, Annemieke et al.·Epidemiology and infection·2023

This study followed 368 people who developed fatigue and other health problems after Q-fever infection and checked in with them over 10+ years later. Patients reported numerous ongoing complaints, significantly reduced quality of life, severe fatigue, and worsening symptoms after physical activity. Younger and middle-aged patients experienced worse health outcomes than older patients, suggesting that age may affect how Q-fever fatigue syndrome impacts long-term health.

Post-Exertional Malaise

Connectivity Between Salience and Default Mode Networks and Subcortical Nodes Distinguishes Between Two Classes of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Su, Jiasheng, Thapaliya, Kiran, Eaton-Fitch, Natalie et al.·Brain connectivity·2023

This study used brain imaging (fMRI) to examine how different brain networks communicate in people with ME/CFS compared to healthy controls. Researchers found that people with ME/CFS have different patterns of brain connectivity, particularly in networks involved in attention and the brain's rest-state activity. Importantly, the study discovered that two different diagnostic criteria for ME/CFS (ICC and Fukuda) appear to identify distinct brain differences, suggesting they may represent different disease types.

Cognitive Impairment

E2 ModerateCohortPEM unclearCross-Sectional

Medical assistance in dying when natural death is not reasonably foreseeable: Survey of providers' experiences with patients making track 2 requests.

Wiebe, Ellen, Kelly, Michaela·Canadian family physician Medecin de famille canadien·2023

This study looked at how doctors in Canada handled requests from patients with serious chronic illnesses who asked for medical assistance in dying (MAID) between March and September 2021. Among 54 patients who made these requests, about 15% had ME/CFS or similar complex chronic conditions, and 52% had chronic pain. Doctors reported struggling most with patients who also had mental health conditions and uncertainty about whether patients had tried all available treatments.

Increased gut permeability and bacterial translocation are associated with fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome: implications for disease-related biomarker discovery.

Martín, Franz, Blanco-Suárez, Manuel, Zambrano, Paola et al.·Frontiers in immunology·2023

This study found that people with ME/CFS and fibromyalgia may have a 'leaky gut'—where the intestinal barrier doesn't work as well as it should. Researchers measured several substances in the blood that indicate gut barrier problems and inflammation, and found higher levels in both patient groups compared to healthy people. These findings suggest that gut dysfunction might play a role in these conditions and could eventually help doctors identify and understand these diseases better.

E2 ModerateCohortPEM requiredLongitudinal

An international survey of experiences and attitudes towards pacing using a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome.

Clague-Baker, Nicola, Davenport, Todd E, Madi, Mohammad et al.·Work (Reading, Mass.)·2023

This study asked 488 people with ME about their experiences using heart rate monitors to help manage their activity levels. Heart rate monitors can help you stay within a safe activity zone that doesn't trigger post-exertional malaise (the worsening of symptoms after activity). Most people in the study found that heart rate monitors helped them understand their condition better, reduce symptom severity, and even gradually increase what they could do—including returning to some work. However, people also reported challenges, so more research and better training for doctors is needed.

Post-Exertional Malaise

Long-term symptom severity and clinical biomarkers in post-COVID-19/chronic fatigue syndrome: results from a prospective observational cohort.

Legler, Franziska, Meyer-Arndt, Lil, Mödl, Lukas et al.·EClinicalMedicine·2023

This study followed 106 people with long-term fatigue after COVID-19 for up to 20 months to see how they recovered over time. Researchers found that some patients met the diagnostic criteria for ME/CFS and had persistent, severe symptoms including fatigue and post-exertional malaise (worsening after activity), while others improved more substantially. Lower muscle strength at the start of illness was linked to ongoing symptoms, especially in those with ME/CFS.

BiomarkersImmune SystemPost-Exertional Malaise