Fatigue is among the top 10 reasons patients visit primary care offices, and it significantly affects patients' well-being and occupational safety. A comprehensive history and cardiopulmonary, neurologic, and skin examinations help guide the workup and diagnosis. Fatigue can be classified as physiologic, secondary, or chronic. Physiologic fatigue can be addressed by proper sleep hygiene, a healthy diet, and balancing energy expenditure. Secondary fatigue is improved by treating the underlying condition. Cognitive behavior therapy, exercise therapy, and acupuncture may help with some of the fatigue associated with chronic conditions. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, severe, and potentially debilitating disorder with demonstrated inflammatory, neurologic, immunologic, and metabolic abnormalities. ME/CFS has a poor prognosis, with no proven treatment or cure. It may become more common after the COVID-19 pandemic because many patients with long COVID (post-COVID-19 condition) have symptoms similar to ME/CFS. The most important symptom of ME/CFS is postexertional malaise. The 2015 National Academy of Medicine diagnostic criteria diagnose ME/CFS. Exercise can be harmful to patients with ME/CFS because it can trigger postexertional malaise. Patients should be educated about pacing their activity not to exceed their limited energy capacity. Treatment should prioritize comorbidities and symptoms based on severity.
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Outpatient group therapy for post-COVID patients - a naturalistic feasibility study of a face-to-face and online group concept.
Front Psychiatry
December 2024
Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany.
Background: A significant number of individuals diagnosed with SARS-CoV-2 continue to suffer from persistent symptoms, a condition commonly referred to as Post-COVID syndrome (PCS). The most common manifestations are fatigue, post-exertional malaise, respiratory problems and cognitive deficits due to the lack of a causal treatment, therapeutic options remain symptom oriented. The aim of this study was to develop a low-threshold group therapy concept for patients with PCS and to test its feasibility in face-to-face and online format.
View Article and Find Full Text PDFOral minocycline therapy as first-line treatment in patients with Myalgic encephalomyelitis and long COVID: A pilot study.
eNeurologicalSci
March 2025
Department of Internal Medicine, Miwa Naika Clinic, Toyama, Japan.
Background: Myalgic encephalomyelitis (ME) is associated with long COVID and also untoward sequelae after anti-coronavirus vaccination. Recently, oral minocycline therapy has been reported to ameliorate symptoms in patients with ME, particularly at the initial stage of the disease.
Methods: Oral minocycline (100 mg × 2 on the first day, followed by 100 mg/day for 41 days) was administered to 55 patients with ME that emerged during the "Corona era," including 19 patients with long COVID and 5 patients diagnosed with untoward sequalae following coronavirus vaccination.
Post-Acute Sequelae of SARS-CoV-2 Infections: Exercise Limitation and Rehabilitation.
Yale J Biol Med
December 2024
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Article Synopsis
- Patients who have had SARS-CoV-2 infections may experience long-term symptoms known as post-acute sequelae or long COVID, which can affect both those treated at home and in hospitals.
- Common issues among these patients include limits to exercise, resulting from various factors such as heart, lung, and muscle problems, as well as deconditioning, especially in those who were hospitalized for a long time.
- While many individuals with post-COVID syndrome show improvement with standard rehabilitation programs, those experiencing post-exertional malaise require tailored exercise plans and close monitoring to avoid worsening their condition.
Brief Outpatient Rehabilitation Program for Post-COVID-19 Condition: A Randomized Clinical Trial.
JAMA Netw Open
December 2024
Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway.
Importance: Post-COVID-19 condition (PCC) is emerging as a common and debilitating condition with few treatment options.
Objective: To assess the effectiveness of a brief outpatient rehabilitation program based on a cognitive and behavioral approach for patients with PCC.
Design, Setting, And Participants: Patients with mild to moderate PCC were randomized 1:1 to an established transdiagnostic rehabilitation program or care as usual at a single referral center recruiting from the region of the South-Eastern Norway Regional Health Authority.
Skeletal muscle adaptations and post-exertional malaise in long COVID.
Trends Endocrinol Metab
December 2024
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands. Electronic address:
When acute SARS-CoV-2 infections cause symptoms that persist longer than 3 months, this condition is termed long COVID. Symptoms experienced by patients often include myalgia, fatigue, brain fog, cognitive impairments, and post-exertional malaise (PEM), which is the worsening of symptoms following mental or physical exertion. There is little consensus on the pathophysiology of exercise-induced PEM and skeletal-muscle-related symptoms.
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