Post-exertional malaise in pulmonary rehabilitation after COVID-19: Are we not giving enough attention?

Post COVID-19 condition is defined as the illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months. The most common symptoms of people with post-COVID condition are symptoms of fatigue, dyspnea, brain fog and post-exertional malaise (PEM). International guidelines on the management of COVID-19 highlight the importance of screening patients for PEM before rehabilitation interventions and carefully monitoring symptoms in response to physical activity to avoid flare-ups. We sought to determine how PEM is being considered in the context of rehabilitation for COVID-19 by reviewing the published literature and registries of clinical trials.