Frequency of post-exertional malaise among individuals with post acute sequelae of sars-cov-2 infection

INTRODUCTION AND AIM Post acute sequelae of SARS-CoV-2 infection (PASC) is a multifaceted disorder with varying symptoms. Fatigue is commonly reported; however, it is unclear if similarities exist between PASC and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We sought to determine the frequency of post-exertional malaise in individuals with PASC; a hallmark symptom of ME/CFS. METHODS 116 participants (Age: 53.4±8.4, 36% Male) were identified to have PASC through medical screening. The Duke Activity Status Index (DASI) subjectively evaluated functional capacity, and participants achieving <100% of age and sex defined norms were eligible for the study. Participants attended one of three sites across Victoria and Tasmania to complete Cardiopulmonary Exercise Testing (CPET). Two days post CPET they were asked to complete the DePaul Symptom Questionnaire (DSQ) post-exertional malaise (PEM). PEM was defined as a score ≥ 2 for frequency and severity on DSQ-PEM items 1-5. A personalised exercise rehabilitation program is currently underway for participants, with results on responses to training to be available at the time of the conference. RESULTS 106 (91%) of the participants who completed a CPET achieved less than 85% of predicted relative VO2peak (21.79±5.72ml.min-1.kg-1). The DSQ-PEM questionnaire was completed in 75% (n=79) of participants. Among these individuals 78% (n=62) met the threshold for PEM. The PEM group were older (53±8 vs 48±8 years, p=0.04), had higher BMI (30.5±7.6 vs 26.7±3.9kg.m2, p=0.02), lower VO2peak (21.6±5.7 vs 25.6±5.4ml.min-1.kg-1, p=0.01) and six-minute walk distance (491±131 vs 583±112m, p=0.02). There was a similar proportion of men and women between both groups. CONCLUSION Like with ME/CFS, PEM is a common symptom in PASC. Additionally, these individuals are more deconditioned than PASC sufferers without PEM. Thus, practitioners should carefully consider the impact of PEM and deconditioning when developing rehabilitation programs.