A little more than 35% of people with persistent long Covid (also known as post Covid syndrome) reported that they experienced post-exertional malaise or exercise intolerance even in the second year of experiencing other major symptoms, according to a new study. The findings further revealed that 68% or two-thirds of people who were diagnosed with long Covid were grappling with fatigue, cognitive issues, breathlessness, and mental health problems like anxiety, depression, and sleep disturbances.
“In particular, pain syndromes (chest pain, myalgia or burning feet, joint pain, melalgia, and headache), confusion, and dizziness were more often reported by case patients with post-exertional malaise (apart from fatigue and exhaustion). Post-exertional malaise was highly prevalent (>50%) among patients with persistent post-Covid syndrome who reported symptoms from all three dominant clusters (fatigue, neurocognitive disturbances, and chest symptoms),” the researchers highlighted in the study that was published in PLoS Medicine January 23, 2025.
The researchers studied adults with long COVID-19 based in southwestern Germany who were between 18 and 65 years old, along with another 576 participants who did not have long COVID-19. All 982 participants consulted doctors in university health centers to assess their cardiopulmonary and cognitive abilities and detailed laboratory testing. Among the study participants with long COVID-19, 65% were women.
“Most working-age patients with post-Covid syndrome did not recover in the second year of their illness. Patterns of reported symptoms remained essentially similar, non-specific, and dominated by fatigue, exercise intolerance, and cognitive complaints. Despite objective signs of cognitive deficits and reduced exercise capacity, there was no major pathology in laboratory investigations, and our findings do not support viral persistence,” the authors wrote in the study.
“A history of post-exertional malaise was associated with more severe symptoms and more objective signs of disease and might help stratify cases for disease severity,” the authors explained. “Fatigue, neurocognitive disturbance, and chest symptoms were among the predominant symptom clusters in persistent post-Covid syndrome.”
“We observed a large overlap of these three clusters, with a substantial proportion of patients with persistent PCS (26.8%) reporting moderate or severe symptoms in all three main symptom clusters (S4 Fig). The second largest overlap was the combination of fatigue and neurocognitive disturbance (prevalence, 20.1%). One or more of these three main symptom clusters affected the vast majority (90.4%) of participants with persistent post-Covid syndrome,” they added.
The team observed that obesity is a major risk factor. In their study group, most of the participants with persistent long Covid (30.2% compared with 12% in the control group).
According to the Centers for Disease Control and Prevention, post-exertional malaise refers to an increasing severity of symptoms after any type of physical or mental effort or strain that the patient would have previously been able to tolerate without any issues. Most commonly, post-exertional malaise tends to manifest and worsen around 12 to 48 hours after any activity. In some cases, it can last for days or several weeks.
Since late 2019, over 750 million cases of Covid-19 and 6.8 million Covid-related deaths were reported globally. That number is still growing. At least 14% of people who tested positive for Covid-19 in the United States have suffered or are still suffering from long Covid symptoms.
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