Evidence browser

Qigong and Tai Chi for ME/CFS: A Systematic Review of Randomized Controlled Trials.

Markwart, Michaela, Felsenstein, Donna, Mehta, Darshan H et al.·Global advances in integrative medicine and health·2024

This review looked at studies testing whether Qigong (a gentle Chinese exercise practice) might help people with ME/CFS. Researchers found 5 good-quality studies with a total of 481 people. The results suggest Qigong may help reduce symptom severity and improve both physical and emotional well-being, though more research is needed to be sure. Currently, there are no similar high-quality studies on Tai Chi for ME/CFS.

Immune SystemPost-Exertional Malaise

The gastrointestinal microbiota in the development of ME/CFS: a critical view and potential perspectives.

Stallmach, Andreas, Quickert, Stefanie, Puta, Christian et al.·Frontiers in immunology·2024

This review examines whether changes in gut bacteria might play a role in ME/CFS, particularly in cases that develop after infections like COVID-19. The authors found that many ME/CFS patients do show differences in their gut bacteria compared to healthy people, and these changes might trigger immune and inflammatory problems. However, the review concludes that current research hasn't proven that gut bacteria changes actually cause ME/CFS—only that they often occur together.

E0 ConsensusGuidelinePEM requiredGuideline

[Interdisciplinary, collaborative D-A-CH (Germany, Austria and Switzerland) consensus statement concerning the diagnostic and treatment of myalgic encephalomyelitis/chronic fatigue syndrome].

Hoffmann, Kathryn, Hainzl, Astrid, Stingl, Michael et al.·Wiener klinische Wochenschrift·2024

This is a clinical guidance document created by doctors and experts from Germany, Austria, and Switzerland to help diagnose and treat ME/CFS. The document emphasizes that ME/CFS is a serious, long-term illness affecting multiple body systems, and highlights post-exertional malaise (PEM)—where symptoms worsen after physical or mental effort—as the key symptom to recognize. The guide provides doctors with practical tools like questionnaires and examination methods to accurately diagnose ME/CFS, and describes two main treatment approaches: pacing (carefully managing activity levels) and symptom relief.

E0 ConsensusReviewPEM unclearReview-Narrative

Long COVID in pediatrics-epidemiology, diagnosis, and management.

Toepfner, Nicole, Brinkmann, Folke, Augustin, Silvia et al.·European journal of pediatrics·2024

This review looked at what we know about Long COVID in children and teenagers after COVID-19 infection. Most young people recover within a few months, but some experience long-lasting symptoms like fatigue, difficulty with exercise, and anxiety that can last over a year and affect daily life. The review found that a small number of these children meet the criteria for ME/CFS, but currently there are no blood tests or scans to confirm Long COVID, making it difficult to diagnose.

E0 ConsensusReviewPEM not requiredMeta-Analysis

Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis.

Kuut, T A, Buffart, L M, Braamse, A M J et al.·Psychological medicine·2024

This study combined data from 8 clinical trials involving 1,298 people with ME/CFS to see whether cognitive behavior therapy (CBT) works and who benefits most from it. Researchers found that CBT did help reduce fatigue, improve daily functioning, and increase physical activity—but the amount of benefit varied depending on patient characteristics like age, how much disability someone had, and their activity patterns. Younger patients, those with less severe disability at the start, and those with fluctuating activity patterns saw the most improvement.

Severe MEPost-Exertional Malaise

E0 ConsensusReviewPEM not requiredReview-Narrative

Long COVID: lights and shadows on the clinical characterization of this emerging pathology.

Cogliandro, Viola, Bonfanti, Paolo·The new microbiologica·2024

This review examined Long COVID, a condition affecting 10-20% of people who had COVID-19 infection. Long COVID causes multiple symptoms across different body systems that significantly reduce quality of life. The review highlights that some Long COVID patients develop conditions like POTS (a heart rhythm problem when standing), ME/CFS (severe fatigue and post-exertional symptoms), and brain fog, and summarizes what treatments might help.

Long COVID OverlapPost-Exertional Malaise

Severe MESleepPost-Exertional Malaise

The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

Dehlia, Ankush, Guthridge, Mark A·The Journal of infection·2024

Researchers looked at studies of people with Long COVID to see how many also meet the diagnostic criteria for ME/CFS. They found that about half of Long COVID patients have symptoms that match ME/CFS, including severe fatigue, sleep problems, muscle and joint pain, and post-exertional malaise (feeling much worse after physical activity). This suggests that Long COVID and ME/CFS may be very similar conditions, at least in some patients.

E0 ConsensusReviewPEM unclearSystematic-Review

A review of Patient Reported Outcome Measures (PROMs) for characterizing Long COVID (LC)-merits, gaps, and recommendations.

Ejalonibu, Hammed, Amah, Adelaide, Aburub, Alaa et al.·Journal of patient-reported outcomes·2024

This study reviewed existing questionnaires and measurement tools that patients can use to report their Long COVID symptoms and how the illness affects their daily life. The researchers found that a combination of specific, validated questionnaires—particularly the Post-COVID Functional Status Scale paired with tools measuring fatigue, thinking problems, mood, headaches, sleep, and post-exertional malaise—work best for capturing the full range of Long COVID effects.

E0 ConsensusReviewPEM unclearSystematic-Review

[Long COVID - neurological or somatoform disease?].

Tényi, Dalma, Tényi, Tamás, Janszky, József·Ideggyogyaszati szemle·2024

This study reviews research on long COVID to understand what causes its main symptoms like extreme fatigue, pain, and brain fog. Doctors are still debating whether long COVID is primarily a brain/nerve disease, a whole-body illness affecting multiple systems, or a condition where the brain becomes overly sensitive to signals. The researchers found that long COVID shares many similarities with ME/CFS and other hard-to-diagnose conditions, but no single test currently exists to confirm long COVID diagnosis.

NeuroinflammationPost-Exertional Malaise

Severe MEPost-Exertional Malaise

Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and comparison of pathogenesis.

Bai, Natalie A, Richardson, Christie S·Chronic diseases and translational medicine·2023

This review examined 18 studies comparing two similar chronic illnesses: posttreatment Lyme disease syndrome (PTLDS), which affects about 10% of Lyme disease patients even after antibiotic treatment, and ME/CFS. Both conditions cause severe fatigue, cognitive problems, pain, and sleep issues that last for months or years. The researchers found that patients with PTLDS experience many of the same symptoms as ME/CFS patients, suggesting these different illnesses may develop through similar biological pathways in the body.

Long COVID OverlapPost-Exertional Malaise

Fatigue in Adults: Evaluation and Management.

Latimer, Kelly M, Gunther, Althea, Kopec, Michael·American family physician·2023

Fatigue is a very common reason people visit their doctors, and it can significantly impact daily life and work safety. This guideline explains that fatigue can come from different causes—normal tiredness that improves with rest and better habits, fatigue from other medical conditions, or chronic fatigue like ME/CFS. ME/CFS is a serious, long-lasting illness with no proven cure that causes a symptom called postexertional malaise, where activity makes symptoms worse, so patients need to carefully manage their energy levels.

Exercise Training in Non-Hospitalized Patients with Post-COVID-19 Syndrome-A Narrative Review.

Sick, Johanna, König, Daniel·Healthcare (Basel, Switzerland)·2023

This review looked at seven studies involving 935 people with long-COVID symptoms who were not hospitalized during their initial infection. The studies found that exercise programs improved fitness, physical function, and reduced symptoms like shortness of breath, fatigue, and depression. The exercise was generally well-tolerated, but the authors urge caution for people with post-exertional malaise or ME/CFS, since these conditions may respond differently to exercise.

E0 ConsensusGuidelinePEM requiredGuideline

[Tiredness/Fatigue-S3 guideline update].

Kornder, Nele, Baum, Erika, Maisel, Peter et al.·ZFA. Zeitschrift fur Allgemeinmedizin·2023

This guideline helps family doctors diagnose and treat fatigue by providing a systematic approach. When fatigue has no clear cause, doctors should ask about sleep, mood, medications, and life stressors, and perform basic blood tests. The guideline emphasizes that fatigue often has multiple causes working together, and recommends checking specifically for post-exertional malaise (PEM)—a key feature of ME/CFS—so patients can receive appropriate specialized care.

Immune SystemPost-Exertional Malaise

Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC).

Sherif, Zaki A, Gomez, Christian R, Connors, Thomas J et al.·eLife·2023

This review examines how COVID-19 can lead to Long COVID, a condition where people experience ongoing fatigue, difficulty with exercise, and brain fog that can last months or years. The researchers explored multiple possible explanations for why this happens, including lingering virus in the body, problems with blood clotting, nerve signaling problems, immune system dysfunction, and reactivation of old viruses like Epstein-Barr. Since Long COVID affects different people in different ways, the authors suggest that different patients may need different treatments.

E0 ConsensusReviewPEM requiredEditorial

The Draft Report by the Institute for Quality and Efficiency in Healthcare Does Not Provide Any Evidence That Graded Exercise Therapy and Cognitive Behavioral Therapy Are Safe and Effective Treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Vink, Mark, Vink-Niese, Alexandra·Diseases (Basel, Switzerland)·2023

This study examined whether a German health institute's recommendation for graded exercise therapy (GET) and cognitive behavioral therapy (CBT) to treat ME/CFS was supported by good evidence. The researchers found serious problems with the studies being used to make this recommendation, including weak study designs, reliance on patient reports rather than objective measurements, and inclusion of people who may not have had ME/CFS. They concluded these treatments should not be recommended based on the available evidence.

E0 ConsensusReviewPEM unclearReview-Narrative

Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Grach, Stephanie L, Seltzer, Jaime, Chon, Tony Y et al.·Mayo Clinic proceedings·2023

This review explains how doctors can diagnose and manage ME/CFS, a serious illness that causes extreme tiredness and other symptoms, often starting after an infection. The authors note that ME/CFS shares many similarities with long COVID, the condition some people experience after having COVID-19. They provide practical guidance to help healthcare providers recognize and treat this condition.

Long COVID OverlapPost-Exertional Malaise

A scoping review of 'Pacing' for management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): lessons learned for the long COVID pandemic.

Sanal-Hayes, Nilihan E M, Mclaughlin, Marie, Hayes, Lawrence D et al.·Journal of translational medicine·2023

This review looked at 17 studies about 'pacing'—a strategy where people with ME/CFS carefully manage their activity level to avoid making symptoms worse. The researchers found that studies on pacing had very different designs and results: some showed pacing helped, some showed no benefit, and a few suggested it could be harmful. The evidence so far isn't strong enough to confidently say whether pacing works best for everyone.

Exercise Pathophysiology in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Postacute Sequelae of SARS-CoV-2: More in Common Than Not?

Joseph, Phillip, Singh, Inderjit, Oliveira, Rudolf et al.·Chest·2023

This review compares how the body responds to exercise in people with long COVID (PASC) and ME/CFS, two conditions that share similar symptoms like extreme tiredness and worsening symptoms after activity. Researchers found that both conditions show similar abnormalities in heart function, blood flow, and breathing during exercise that go beyond simple deconditioning or being out of shape. These shared patterns suggest both conditions may involve similar underlying biological problems, which could help doctors develop better tests and treatments.

E0 ConsensusReviewPEM not requiredReview-Narrative

Cognitive dysfunction in post-COVID-19 condition: Mechanisms, management, and rehabilitation.

Möller, Marika, Borg, Kristian, Janson, Christer et al.·Journal of internal medicine·2023

Many people experience brain fog and memory problems long after COVID-19 infection, affecting thinking, attention, and processing speed. This review found that 17–28% of people have these cognitive problems more than 3 months after infection, and some experience them for years. Treatment approaches include cognitive training, memory aids, lifestyle adjustments, and education about managing these symptoms.

NeuroinflammationPost-Exertional Malaise

E0 ConsensusReviewPEM unclearMeta-Analysis

Clinical overlap between fibromyalgia and myalgic encephalomyelitis. A systematic review and meta-analysis.

Ramírez-Morales, Ricardo, Bermúdez-Benítez, Elyzabeth, Martínez-Martínez, Laura-Aline et al.·Autoimmunity reviews·2022

This study looked at how often fibromyalgia and ME/CFS occur together in the same patients by reviewing 21 published research papers. The researchers found that nearly half of people diagnosed with one condition also had the other condition. This overlap suggests these two illnesses share common features, particularly fatigue, unrefreshing sleep, and brain fog.