{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:29:58Z","timestamp":1788931798934,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T00:00:00Z","timestamp":1702598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007192","name":"Rijksinstituut voor Volksgezondheid en Milieu","doi-asserted-by":"publisher","award":["3910090442\/3910105642\/3910121041"],"award-info":[{"award-number":["3910090442\/3910105642\/3910121041"]}],"id":[{"id":"10.13039\/501100007192","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exercise-based treatments can worsen\/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM and OI are not routinely assessed by clinicians. We estimated PEM and OI proportions in PL-PCC, as well as in people not living with PCC (PnL-PCC) and negatives (i.e., never reported a SARS-CoV-2 positive test), and identified associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants from the Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study were included. PEM and OI were assessed using validated questionnaires. PCC was defined as feeling unrecovered after SARS-CoV-2 infection. Multivariable regression analyses to study PEM and OI were stratified for sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Data from 3,783 participants were analyzed. In PL-PCC, the proportion of PEM was 48.1% and 41.2%, and the proportion of OI was 29.3% and 27.9% in women and men, respectively. Proportions were higher in PL-PCC than negatives, for PEM in women OR=4.38 [95%CI:3.01\u20136.38]; in men OR = 4.78 [95%CI:3.13\u20137.29]; for OI in women 3.06 [95%CI:1.97-4.76]; in men 2.71 [95%CI:1.75\u20134.21]. Associated factors were age \u2264 60 years, \u22651 comorbidities, and living alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High proportions of PEM and OI are observed in PL-PCC. Standard screening for PEM and OI is recommended in PL-PCC to promote appropriate therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2023.1292446","type":"journal-article","created":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T06:06:47Z","timestamp":1702620407000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study"],"prefix":"10.3389","volume":"10","author":[{"given":"Demi M. E.","family":"Pagen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Van Herck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line J. A.","family":"van Bilsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Brinkhues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Konings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper D. J.","family":"den Heijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn A.","family":"Spruit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian J. P. A.","family":"Hoebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole H. T. M.","family":"Dukers-Muijrers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,15]]},"reference":[{"key":"B1","unstructured":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"n1648","DOI":"10.1136\/bmj.n1648","article-title":"Long covid\u2014mechanisms, risk factors, and management","volume":"374","author":"Crook","year":"2021","journal-title":"BMJ"},{"key":"B3","doi-asserted-by":"publisher","first-page":"101019","DOI":"10.1016\/j.eclinm.2021.101019","article-title":"Characterizing long COVID in an international cohort: 7 months of symptoms and their impact","volume":"38","author":"Davis","year":"2021","journal-title":"EClinicalMedicine."},{"key":"B4","doi-asserted-by":"publisher","first-page":"606824","DOI":"10.3389\/fmed.2020.606824","article-title":"Will COVID-19 lead to myalgic encephalomyelitis\/chronic fatigue syndrome?","volume":"1132","author":"Komaroff","year":"2021","journal-title":"Front Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"418","DOI":"10.3390\/medicina57050418","article-title":"Long COVID and myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS)\u2014a systemic review and comparison of clinical presentation and symptomatology","volume":"57","author":"Wong","year":"2021","journal-title":"Medicina."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12967-020-02419-4","article-title":"Epidemiological and clinical factors associated with post-exertional malaise severity in patients with myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"18","author":"Ghali","year":"2020","journal-title":"J Transl Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.3389\/fneur.2020.01025","article-title":"Characterization Of Post\u2013Exertional Malaise In Patients With Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","volume":"11","author":"Stussman","year":"2020","journal-title":"Front Neurol"},{"key":"B8","first-page":"197","volume-title":"Humility and Acceptance: Working Within Our Limits With Long Covid and Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome","author":"D\u00e9cary","year":"2021"},{"key":"B9","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1080\/09638288.2022.2043462","article-title":"Evaluating case diagnostic criteria for myalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS): toward an empirical case definition","volume":"45","author":"Conroy","year":"2023","journal-title":"Disabil Rehabil."},{"key":"B10","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1080\/21641846.2014.978110","article-title":"Test\u2013retest reliability of the DePaul Symptom Questionnaire","volume":"3","author":"Jason","year":"2015","journal-title":"Fatigue."},{"key":"B11","doi-asserted-by":"publisher","first-page":"5442","DOI":"10.1038\/s41598-023-32581-w","article-title":"Sex differences in post-exercise fatigue and function in myalgic encephalomyelitis\/chronic fatigue syndrome","volume":"13","author":"Friedberg","year":"2023","journal-title":"Sci Rep."},{"key":"B12","volume-title":"Beyond Myalgic Encephalomyelitis\/chronic Fatigue Syndrome: Redefining an Illness","author":"Medicine","year":"2015"},{"key":"B13","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1093\/qjmed\/hcn123","article-title":"Postural orthostatic tachycardia syndrome is an under-recognized condition in chronic fatigue syndrome","volume":"101","author":"Hoad","year":"2008","journal-title":"QJM."},{"key":"B14","doi-asserted-by":"publisher","first-page":"73488","DOI":"10.1136\/bmj-2022-073488","article-title":"Orthostatic tachycardia after COVID-19","volume":"380","author":"Espinosa-Gonzalez","year":"2023","journal-title":"BMJ"},{"key":"B15","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1183\/13993003.02197-2020","article-title":"COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force","volume":"56","author":"Spruit","year":"2020","journal-title":"Eur Respir J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"5093","DOI":"10.3390\/ijerph19095093","article-title":"The relationship between physical activity and long COVID: a Cross-Sectional Study","volume":"19","author":"Wright","year":"2022","journal-title":"Int J Environ Res Public Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"898","DOI":"10.3390\/healthcare10050898","article-title":"The updated NICE guidance exposed the serious flaws in CBT and graded exercise therapy trials for ME\/CFS","volume":"10","author":"Vink","year":"2022","journal-title":"Healthcare (Basel)."},{"key":"B18","unstructured":""},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.14293\/PR2199.000467.v1","article-title":"Physical exertion worsens symptoms in patients with post-COVID condition: Post-exertional malaise in patients with post-COVID condition","author":"Breedveld","year":"2023","journal-title":"ScienceOpen [Preprints]."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e28373","DOI":"10.1002\/jmv.28373","article-title":"Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome","volume":"95","author":"Parker","year":"2023","journal-title":"J Med Virol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1032955","DOI":"10.3389\/fpubh.2022.1032955","article-title":"Design and recruitment of a large-scale cohort study on prevalence, risk factors and impact evaluation of post-COVID-19 condition and its wider long-term social, mental, and physical health impact: The PRIME post-COVID study","volume":"10","author":"Pagen","year":"2022","journal-title":"Front Public Health."},{"key":"B22","doi-asserted-by":"publisher","first-page":"66","DOI":"10.3390\/diagnostics8030066","article-title":"A brief questionnaire to assess post-exertional malaise","volume":"8","author":"Cotler","year":"2018","journal-title":"Diagnostics."},{"key":"B23","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1080\/21641846.2019.1653471","article-title":"The DePaul symptom questionnaire-2: a validation study","volume":"7","author":"Bedree","year":"2019","journal-title":"Fatigue."},{"key":"B24","doi-asserted-by":"publisher","first-page":"330","DOI":"10.3389\/fped.2018.00330","article-title":"The development of the DePaul Symptom Questionnaire: Original, expanded, brief, and pediatric versions","volume":"6","author":"Jason","year":"2018","journal-title":"Front Pediatr."},{"key":"B25","doi-asserted-by":"publisher","first-page":"13591053231169191","DOI":"10.1177\/13591053231169191","article-title":"Do diagnostic criteria for ME matter to patient experience with services and interventions? Key results from an online RDS survey targeting fatigue patients in Norway","volume":"2023","author":"Kielland","year":"2023","journal-title":"J Health Psychol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1101\/2023.07.27.23293244","article-title":"Prevalence of long-term symptoms varies by using different post-COVID-19 definitions in positively and negatively tested adults: the PRIME post-COVID study","author":"Pagen","year":"2023","journal-title":"medRxiv [Preprints]."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e056568","DOI":"10.1136\/bmjopen-2021-056568","article-title":"Support after COVID-19 study: a mixed-methods cross-sectional study to develop recommendations for practice","volume":"12","author":"Bulley","year":"2022","journal-title":"BMJ Open."},{"key":"B28","doi-asserted-by":"publisher","first-page":"11093","DOI":"10.3390\/ijerph191711093","article-title":"Post-acute COVID-19 sequelae in a working population at one year follow-up: a wide range of impacts from an Italian sample","volume":"19","author":"Buonsenso","year":"2022","journal-title":"Int J Environ Res Public Health."},{"key":"B29","doi-asserted-by":"publisher","first-page":"5663","DOI":"10.1038\/s41467-022-33415-5","article-title":"Outcomes among confirmed cases and a matched comparison group in the long-COVID in Scotland study","volume":"13","author":"Hastie","year":"2022","journal-title":"Nat Commun."},{"key":"B30","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1097\/CCM.0000000000004817","article-title":"Core outcome measures for trials in people with coronavirus disease 2019: respiratory failure, multiorgan failure, shortness of breath, and recovery","volume":"49","author":"Tong","year":"2021","journal-title":"Crit Care Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.medj.2021.03.003","article-title":"Defining long COVID: going back to the start","volume":"2","author":"Alwan","year":"2021","journal-title":"Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1016\/S2213-2600(21)00383-0","article-title":"Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study","volume":"9","author":"Evans","year":"2021","journal-title":"Lancet Respir Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"pzac005","DOI":"10.1093\/ptj\/pzac005","article-title":"Chronic fatigue and postexertional malaise in people living with long covid: an observational study","volume":"102","author":"Twomey","year":"2022","journal-title":"Phys Ther"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1292446\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,15]],"date-time":"2023-12-15T06:06:53Z","timestamp":1702620413000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2023.1292446\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,15]]},"references-count":33,"alternative-id":["10.3389\/fmed.2023.1292446"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2023.1292446","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.08.17.23294204","asserted-by":"object"}]},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,15]]},"article-number":"1292446"}}