Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Oncology Letters
      • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Biomedical Reports
      • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • Information for Authors
    • Information for Reviewers
    • Information for Librarians
    • Information for Advertisers
    • Conferences
  • Language Editing
Spandidos Publications Logo
  • About
    • About Spandidos
    • Aims and Scopes
    • Abstracting and Indexing
    • Editorial Policies
    • Reprints and Permissions
    • Job Opportunities
    • Terms and Conditions
    • Contact
  • Journals
    • All Journals
    • Biomedical Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Experimental and Therapeutic Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Epigenetics
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Functional Nutrition
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Molecular Medicine
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • International Journal of Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Medicine International
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular and Clinical Oncology
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Molecular Medicine Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Letters
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • Oncology Reports
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
    • World Academy of Sciences Journal
      • Information for Authors
      • Editorial Policies
      • Editorial Board
      • Aims and Scope
      • Abstracting and Indexing
      • Bibliographic Information
      • Archive
  • Articles
  • Information
    • For Authors
    • For Reviewers
    • For Librarians
    • For Advertisers
    • Conferences
  • Language Editing
Login Register Submit
  • This site uses cookies
  • You can change your cookie settings at any time by following the instructions in our Cookie Policy. To find out more, you may read our Privacy Policy.

    I agree
Search articles by DOI, keyword, author or affiliation
Search
Advanced Search
presentation
Experimental and Therapeutic Medicine
Join Editorial Board Propose a Special Issue
Print ISSN: 1792-0981 Online ISSN: 1792-1015
Journal Cover
April-2026 Volume 31 Issue 4

Full Size Image

Sign up for eToc alerts
Recommend to Library

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

Medicine International

An International Open Access Journal Devoted to General Medicine.

Journal Cover
April-2026 Volume 31 Issue 4

Full Size Image

Sign up for eToc alerts
Recommend to Library

  • Article
  • Citations
    • Cite This Article
    • Download Citation
    • Create Citation Alert
    • Remove Citation Alert
    • Cited By
  • Similar Articles
    • Related Articles (in Spandidos Publications)
    • Similar Articles (Google Scholar)
    • Similar Articles (PubMed)
  • Download PDF
  • Download XML
  • View XML
Review Open Access

Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)

  • Authors:
    • Hong Zhou
    • Wenwen Yu
    • Jiaming Lei
    • Runzhi Chang
    • Yingjia Cheng
    • Guorui Wang
    • Li Lin
  • View Affiliations / Copyright

    Affiliations: Key Laboratory of Environmental Related Diseases and One Health, School of Basic Medical Sciences, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei 437100, P.R. China, Shenzhen Mindray Bio‑Medical Electronics Co., Ltd., Shenzhen, Guangdong 51500, P.R. China
    Copyright: © Zhou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 91
    |
    Published online on: February 3, 2026
       https://doi.org/10.3892/etm.2026.13086
  • Expand metrics +
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )
Cited By (CrossRef): 0 citations Loading Articles...

This article is mentioned in:


Abstract

Fatigue is a common clinical symptom, and its complex pathophysiological mechanisms markedly affect the quality of life and social function of patients. With the advancement of omics technologies and artificial intelligence applications, the ability to understand the mechanisms of fatigue has been notably enhanced. Fatigue is a complex process involving the interaction of multiple systems and factors. The occurrence of fatigue involves multilevel regulation of energy metabolism, neuroendocrine and immune systems. Based on omics and molecular biology, abnormal energy metabolism, oxidative stress and mitochondrial dysfunction serve a central role in the pathogenesis of fatigue. Disorders in the neuro‑endocrine‑immune network and dysfunction of the microbiome‑gut‑brain axis constitute key systemic integration mechanisms. Clinically, numerous diseases, including chronic fatigue syndrome and endocrine, neurological and autoimmune disease, can manifest as fatigue symptoms. In terms of treatment, individualized, multidisciplinary collaborative comprehensive management models have become nursing standards. In addition, the application of telemedicine technology has markedly improved the accessibility and compliance of fatigue management. The present review aimed to examine the conceptual framework, physiological mechanisms, clinical manifestations and management strategies of fatigue to provide reference for clinical diagnosis and treatment practice. Future research should focus on strengthening the exploration and translational application of molecular mechanisms, developing novel intervention targets, establishing effective fatigue assessment models and optimizing management strategies to provide strong evidence‑based support for clinical practice.

View Figures

Figure 1

Mitochondria in fatigue.
Mitochondrial dysfunction causes cell damage and energy deficiency
through multiple pathways, leading to fatigue. These pathways
involve the release of mitochondrial DAMPs, including mtDNA,
cardiolipin and N-formyl peptide, which activate inflammasomes such
as NLRP3 and trigger the release of IL-1β, IL-18 and IL-33.
Additionally, mtROS participate in the dysregulation of immune
signaling. Meanwhile, disruptions in metabolic processes such as
the TCA cycle and fatty acid oxidation impact immunometabolism. For
example, metabolites such as acetyl-CoA are involved in DNA and
histone modification, epigenetic reprogramming, and the activation
of AMPK signaling via the ATP/ADP ratio. AMPK, AMP-activated
protein kinase; mtROS, mitochondrial reactive oxygen species; MAVS,
mitochondrial antiviral signaling protein; TCA, tricarboxylic acid;
RLR, RIG-I-like receptor; DAMP, damage-associated molecular
pattern; TLR, toll-like receptor; NLR, NOD-like receptor.

Figure 2

Role of abnormal immune inflammation
in fatigue. Cancer, surgery, chemotherapy or radiation activate
leukocytes, leading to increased expression of the transcription
factor NF-κB, which in turn promotes the release of inflammatory
factors such as IL-6, TNF-α and IFN-γ. These inflammatory factors
induce fatigue manifestations through multiple pathways: They
upregulate IDO and downregulate BH4. IDO promotes the conversion of
Trp to kynurenine, the metabolites (3-hydroxy kynurenine and
quinolinic acid) of which act on the central nervous system. BH4
deficiency leads to reduced levels of DA, NE and 5-HT. Meanwhile,
GCR signaling is impaired due to decreased cortisol, further
amplifying inflammatory responses. In the central nervous system,
microglia and astrocytes are activated by inflammatory factors,
affecting oligodendrocyte function, while the
hypothalamic-pituitary-adrenal axis (involving CRH, the anterior
pituitary and adrenal cortex) is dysregulated, collectively
contributing to fatigue via abnormal immune inflammation and
neurochemical imbalance. GCR, glucocorticoid receptor; BH4,
tetrahydrobiopterin; GABA, glutamate and γ-aminobutyric acid; DA,
dopamine; NE, norepinephrine; 5-HT, serotonin; CRH,
corticotropin-releasing hormone; IDO, indoleamine 2,3-dioxygenase;
Trp, tryptophan.

Figure 3

Intestinal flora is involved in the
mechanism of fatigue. Dysbiosis causes adverse consequences by
affecting host metabolism and immunity. Specifically, gut microbes
influence the production of SCFAs and neurotransmitters (GABA,
dopamine, serotonin and NPY), as well as tryptophan metabolism.
These molecules enter the circulation and act on the brain via the
vagus nerve or systemic transport. Meanwhile, the intestinal flora
modulates immune cells (monocytes, B cells and NK cells) and
cytokines, which interact with the hypothalamic-pituitary-adrenal
axis (involving ACTH and glucocorticoid/catecholamine release from
the adrenal gland). Additionally, enteroendocrine cells secrete
5-HT, which participates in this gut-brain communication network,
collectively contributing to fatigue when the intestinal flora is
imbalanced. ACTH, adrenocorticotropic hormone; NK, natural killer;
5-HT, serotonin; SCFA, short chain fatty acid; NPY, neuropeptide
Y.
View References

1 

Lim EJ and Son CG: Review of case definitions for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Transl Med. 18(289)2020.PubMed/NCBI View Article : Google Scholar

2 

Mueller C, Lin JC, Sheriff S, Maudsley AA and Younger JW: Evidence of widespread metabolite abnormalities in Myalgic encephalomyelitis/chronic fatigue syndrome: Assessment with whole-brain magnetic resonance spectroscopy. Brain Imaging Behav. 14:562–572. 2020.PubMed/NCBI View Article : Google Scholar

3 

Bateman L, Bested AC, Bonilla HF, Chheda BV, Chu L, Curtin JM, Dempsey TT, Dimmock ME, Dowell TG, Felsenstein D, et al: Myalgic encephalomyelitis/chronic fatigue syndrome: Essentials of diagnosis and management. Mayo Clin Proc. 96:2861–2878. 2021.PubMed/NCBI View Article : Google Scholar

4 

Nalbandian A, Desai AD and Wan EY: Post-COVID-19 condition. Annu Rev Med. 74:55–64. 2023.PubMed/NCBI View Article : Google Scholar

5 

Kobayashi Y, Fujiwara N, Murakami Y, Ishida S, Kinguchi S, Haze T, Azushima K, Fujiwara A, Wakui H, Sakakura M, et al: Visualizing fatigue mechanisms in non-communicable diseases: An integrative approach with multi-omics and machine learning. BMC Med Inform Decis Mak. 25(204)2025.PubMed/NCBI View Article : Google Scholar

6 

Sun Y, Zhang Z, Qiao Q, Zou Y, Wang L, Wang T, Lou B, Li G, Xu M, Wang Y, et al: Immunometabolic changes and potential biomarkers in CFS peripheral immune cells revealed by single-cell RNA sequencing. J Transl Med. 22(925)2024.PubMed/NCBI View Article : Google Scholar

7 

Lizyness K and Dewald O: BRASH Syndrome. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island, FL, 2025.

8 

Kakhi K, Jagatheesaperumal SK, Khosravi A, Alizadehsani R and Acharya UR: Fatigue monitoring using wearables and AI: Trends, challenges, and future opportunities. Comput Biol Med. 195(110461)2025.PubMed/NCBI View Article : Google Scholar

9 

Toljan K, Aboseif A and Amin M: Efficacy of pharmacologic treatments for fatigue in multiple sclerosis: A systematic review and meta-analysis. Mult Scler Relat Disord. 96(106352)2025.PubMed/NCBI View Article : Google Scholar

10 

Zhang Y, Zhang Z, Yu Q, Jiang Y, Fei C, Wu F and Li F: Mapping fatigue: Discovering brain regions and genes linked to fatigue susceptibility. J Transl Med. 23(293)2025.PubMed/NCBI View Article : Google Scholar

11 

Gandevia SC: Spinal and supraspinal factors in human muscle fatigue. Physiol Rev. 81:1725–1789. 2001.PubMed/NCBI View Article : Google Scholar

12 

Chaudhuri A and Behan PO: Fatigue in neurological disorders. Lancet. 363:978–988. 2004.PubMed/NCBI View Article : Google Scholar

13 

Manjaly ZM, Harrison NA, Critchley HD, Do CT, Stefanics G, Wenderoth N, Lutterotti A, Müller A and Stephan KE: Pathophysiological and cognitive mechanisms of fatigue in multiple sclerosis. J Neurol Neurosurg Psychiatry. 90:642–651. 2019.PubMed/NCBI View Article : Google Scholar

14 

Rupp TL, Garbarino S, Guglielmi O and Lanteri P: Concepts of fatigue, sleepiness, and Alertness. In: Reference Module in Neuroscience and Biobehavioral Psychology. Elsevier, 2017.

15 

Palotai M, Nazeri A, Cavallari M, Healy BC, Glanz B, Gold SM, Weiner HL, Chitnis T and Guttmann CRG: History of fatigue in multiple sclerosis is associated with grey matter atrophy. Sci Rep. 9(14781)2019.PubMed/NCBI View Article : Google Scholar

16 

Lee JS, Jeon YJ, Park SY and Son CG: An adrenalectomy mouse model reflecting clinical features for chronic fatigue syndrome. Biomolecules. 10(71)2020.PubMed/NCBI View Article : Google Scholar

17 

Siciliano M, Trojano L, Santangelo G, De Micco R, Tedeschi G and Tessitore A: Fatigue in Parkinson's disease: A systematic review and meta-analysis. Mov Disord. 33:1712–1723. 2018.PubMed/NCBI View Article : Google Scholar

18 

Boissoneault J, Sevel L, Robinson ME and Staud R: Functional brain connectivity of remembered fatigue or happiness in healthy adults: Use of arterial spin labeling. J Clin Exp Neuropsychol. 40:224–233. 2018.PubMed/NCBI View Article : Google Scholar

19 

Tschopp R, König RS, Rejmer P and Paris DH: Health system support among patients with ME/CFS in Switzerland. J Taibah Univ Med Sci. 18:876–885. 2023.PubMed/NCBI View Article : Google Scholar

20 

Prajjwal P, Kalluru PKR, Marsool MD, Inban P, Gadam S, Al-Ezzi SMS, Marsool AD, Al-Ibraheem AMT, Al-Tuaama AZH, Amir O and Arunachalam SP: Association of multiple sclerosis with chronic fatigue syndrome, restless legs syndrome, and various sleep disorders, along with the recent updates. Ann Med Surg (Lond). 85:2821–2832. 2023.PubMed/NCBI View Article : Google Scholar

21 

Rasa-Dzelzkaleja S, Krumina A, Capenko S, Nora-Krukle Z, Gravelsina S, Vilmane A, Ievina L, Shoenfeld Y and Murovska M: VirA project. The persistent viral infections in the development and severity of myalgic encephalomyelitis/chronic fatigue syndrome. J Transl Med. 21(33)2023.PubMed/NCBI View Article : Google Scholar

22 

Clarke SA, Abbara A and Dhillo WS: Impact of COVID-19 on the endocrine system: A mini-review. Endocrinology. 163(bqab203)2022.PubMed/NCBI View Article : Google Scholar

23 

Paragliola RM and Corsello SM: Secondary adrenal insufficiency: From the physiopathology to the possible role of modified-release hydrocortisone treatment. Minerva Endocrinol. 43:183–197. 2018.PubMed/NCBI View Article : Google Scholar

24 

Husebye ES, Pearce SH, Krone NP and Kämpe O: Adrenal insufficiency. Lancet. 397:613–629. 2021.PubMed/NCBI View Article : Google Scholar

25 

Mandarano AH, Maya J, Giloteaux L, Peterson DL, Maynard M, Gottschalk CG and Hanson MR: Myalgic encephalomyelitis/chronic fatigue syndrome patients exhibit altered T cell metabolism and cytokine associations. J Clin Invest. 130:1491–1505. 2020.PubMed/NCBI View Article : Google Scholar

26 

Chu L, Valencia IJ, Garvert DW and Montoya JG: Onset patterns and course of myalgic encephalomyelitis/chronic fatigue syndrome. Front Pediatr. 7(12)2019.PubMed/NCBI View Article : Google Scholar

27 

Mertz P, Schlencker A, Schneider M, Gavand PE, Martin T and Arnaud L: Towards a practical management of fatigue in systemic lupus erythematosus. Lupus Sci Med. 7(e000441)2020.PubMed/NCBI View Article : Google Scholar

28 

Pope JE: Management of fatigue in rheumatoid arthritis. RMD Open. 6(e001084)2020.PubMed/NCBI View Article : Google Scholar

29 

Prasad P, Verma S, Surbhi Ganguly NK, Chaturvedi V and Mittal SA: Rheumatoid arthritis: Advances in treatment strategies. Mol Cell Biochem. 478:69–88. 2023.PubMed/NCBI View Article : Google Scholar

30 

Polukchi TV, Abuova GN and Slavko YA: The neuropsychiatric aspect of the chronic viral hepatitis. Prague Med Rep. 124:94–107. 2023.PubMed/NCBI View Article : Google Scholar

31 

Arron HE, Marsh BD, Kell DB, Khan MA, Jaeger BR and Pretorius E: Myalgic encephalomyelitis/chronic fatigue syndrome: The biology of a neglected disease. Front Immunol. 15(1386607)2024.PubMed/NCBI View Article : Google Scholar

32 

Nasserie T, Hittle M and Goodman SN: Assessment of the frequency and variety of persistent symptoms among patients with COVID-19. JAMA Netw Open. 4(e2111417)2021.PubMed/NCBI View Article : Google Scholar

33 

Zheng R, Xie S, Lu X, Sun L, Zhou Y, Zhang Y and Wang K: A systematic review and meta-analysis of epidemiology and clinical manifestations of human brucellosis in China. Biomed Res Int. 2018:1–10. 2018.PubMed/NCBI View Article : Google Scholar

34 

Long B, MacDonald A, Liang SY, Brady WJ, Koyfman A, Gottlieb M and Chavez S: Malaria: A focused review for the emergency medicine clinician. Am J Emerg Med. 77:7–16. 2024.PubMed/NCBI View Article : Google Scholar

35 

Yang TY, Lin CL, Yao WC, Lio CF, Chiang WP, Lin K, Kuo CF and Tsai SY: How mycobacterium tuberculosis infection could lead to the increasing risks of chronic fatigue syndrome and the potential immunological effects: A population-based retrospective cohort study. J Transl Med. 20(99)2022.PubMed/NCBI View Article : Google Scholar

36 

Thong MSY, van Noorden CJF, Steindorf K and Arndt V: Correction to: Cancer-related fatigue: Causes and current treatment options. Curr Treat Options Oncol. 23:450–451. 2022.PubMed/NCBI View Article : Google Scholar

37 

Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F, Weis J, Jordan K and Ripamonti CI: ESMO Guidelines Committee. Electronic address: Clinicalguidelines@esmo.org. Cancer-related fatigue: ESMO clinical practice guidelines for diagnosis and treatment. Ann Oncol. 31:713–723. 2020.PubMed/NCBI View Article : Google Scholar

38 

Ma Y, He B, Jiang M, Yang Y, Wang C, Huang C and Han L: Prevalence and risk factors of cancer-related fatigue: A systematic review and meta-analysis. Int J Nurs Stud. 111(103707)2020.PubMed/NCBI View Article : Google Scholar

39 

Kang YE, Yoon JH, Park N, Ahn YC, Lee EJ and Son CG: Prevalence of cancer-related fatigue based on severity: A systematic review and meta-analysis. Sci Rep. 13(12815)2023.PubMed/NCBI View Article : Google Scholar

40 

AlSaeed S, Aljouee T, Alkhawajah NM, Alarieh R, AlGarni H, Aljarallah S, Ayyash M and Abu-Shaheen A: Fatigue, depression, and anxiety among ambulating multiple sclerosis patients. Front Immunol. 13(844461)2022.PubMed/NCBI View Article : Google Scholar

41 

Zigmond AS and Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 67:361–370. 1983.PubMed/NCBI View Article : Google Scholar

42 

Holden S, Maksoud R, Eaton-Fitch N, Cabanas H, Staines D and Marshall-Gradisnik S: Correction to: A systematic review of mitochondrial abnormalities in myalgic encephalomyelitis/chronic fatigue syndrome/systemic exertion intolerance disease. J Transl Med. 18(407)2020.PubMed/NCBI View Article : Google Scholar

43 

Yamauchi N, Ashida Y, Naito A, Tokuda N, Niibori A, Motohashi N, Aoki Y and Yamada T: Fatigue resistance and mitochondrial adaptations to isometric interval training in dystrophin-deficient muscle: Role of contractile load. FASEB J. 39(e70631)2025.PubMed/NCBI View Article : Google Scholar

44 

Toogood PL, Clauw DJ, Phadke S and Hoffman D: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Where will the drugs come from? Pharmacol Res. 165(105465)2021.PubMed/NCBI View Article : Google Scholar

45 

Wehling-Henricks M, Oltmann M, Rinaldi C, Myung KH and Tidball JG: Loss of positive allosteric interactions between neuronal nitric oxide synthase and phosphofructokinase contributes to defects in glycolysis and increased fatigability in muscular dystrophy. Hum Mol Genet. 18:3439–3451. 2009.PubMed/NCBI View Article : Google Scholar

46 

Shankar V, Wilhelmy J, Curtis EJ, Michael B, Cervantes L, Mallajosyula V, Davis RW, Snyder M, Younis S, Robinson WH, et al: Oxidative stress is a shared characteristic of ME/CFS and Long COVID. Proc Natl Acad Sci USA. 122(e2426564122)2025.PubMed/NCBI View Article : Google Scholar

47 

Sweetman E, Noble A, Edgar C, Mackay A, Helliwell A, Vallings R, Ryan M and Tate W: Current research provides insight into the biological basis and diagnostic potential for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Diagnostics (Basel). 9(73)2019.PubMed/NCBI View Article : Google Scholar

48 

Iu DS, Maya J, Vu LT, Fogarty EA, McNairn AJ, Ahmed F, Franconi CJ, Munn PR, Grenier JK, Hanson MR and Grimson A: Transcriptional reprogramming primes CD8+ T cells toward exhaustion in Myalgic encephalomyelitis/chronic fatigue syndrome. Proc Natl Acad Sci USA. 121(e2415119121)2024.PubMed/NCBI View Article : Google Scholar

49 

Provenzano D, Washington SD and Baraniuk JN: A machine learning approach to the differentiation of functional magnetic resonance imaging data of chronic fatigue syndrome (CFS) from a sedentary control. Front Comput Neurosci. 14(2)2020.PubMed/NCBI View Article : Google Scholar

50 

Maksoud R, du Preez S, Eaton-Fitch N, Thapaliya K, Barnden L, Cabanas H, Staines D and Marshall-Gradisnik S: A systematic review of neurological impairments in myalgic encephalomyelitis/chronic fatigue syndrome using neuroimaging techniques. PLoS One. 15(e0232475)2020.PubMed/NCBI View Article : Google Scholar

51 

Shan ZY, Barnden LR, Kwiatek RA, Bhuta S, Hermens DF and Lagopoulos J: Neuroimaging characteristics of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A systematic review. J Transl Med. 18(335)2020.PubMed/NCBI View Article : Google Scholar

52 

Soffritti I, Gravelsina S, D'Accolti M, Bini F, Mazziga E, Vilmane A, Rasa-Dzelzkaleja S, Nora-Krukle Z, Krumina A, Murovska M and Caselli E: Circulating miRNAs expression in myalgic encephalomyelitis/chronic fatigue syndrome. Int J Mol Sci. 24(10582)2023.PubMed/NCBI View Article : Google Scholar

53 

Luo C, Wei X, Song J, Xu X, Huang H, Fan S, Zhang D, Han L and Lin J: Interactions between gut microbiota and polyphenols: New insights into the treatment of fatigue. Molecules. 27(7377)2022.PubMed/NCBI View Article : Google Scholar

54 

König RS, Albrich WC, Kahlert CR, Bahr LS, Löber U, Vernazza P, Scheibenbogen C and Forslund SK: The gut microbiome in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS). Front Immunol. 12(628741)2022.PubMed/NCBI View Article : Google Scholar

55 

Jason LA, Islam MF, Conroy K, Cotler J, Torres C, Johnson M and Mabie B: COVID-19 symptoms over time: comparing long-haulers to ME/CFS. Fatigue. 9:59–68. 2021.PubMed/NCBI View Article : Google Scholar

56 

Vaes AW, Van Herck M, Deng Q, Delbressine JM, Jason LA and Spruit MA: Symptom-based clusters in people with ME/CFS: An illustration of clinical variety in a cross-sectional cohort. J Transl Med. 21(112)2023.PubMed/NCBI View Article : Google Scholar

57 

Zerón-Rugerio MF, Zaragozá MC, Domingo JC, Sanmartín-Sentañes R, Alegre-Martin J, Castro-Marrero J and Cambras T: Sleep and circadian rhythm alterations in myalgic encephalomyelitis/chronic fatigue syndrome and post-COVID fatigue syndrome and its association with cardiovascular risk factors: A prospective cohort study. Chronobiol Int. 41:1104–1115. 2024.PubMed/NCBI View Article : Google Scholar

58 

van Campen CL, Rowe PC and Visser FC: Worsening symptoms is associated with larger cerebral blood flow abnormalities during tilt-testing in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Medicina (Kaunas). 59(2153)2023.PubMed/NCBI View Article : Google Scholar

59 

Montoya JG, Holmes TH, Anderson JN, Maecker HT, Rosenberg-Hasson Y, Valencia IJ, Chu L, Younger JW, Tato CM and Davis MM: Cytokine signature associated with disease severity in chronic fatigue syndrome patients. Proc Natl Acad Sci USA. 114:E7150–E7158. 2017.PubMed/NCBI View Article : Google Scholar

60 

Krupp LB, LaRocca NG, Muir-Nash J and Steinberg AD: The fatigue severity scale. Arch Neurol. 46:1121–1123. 1989.PubMed/NCBI View Article : Google Scholar

61 

Smets EMA, Garssen B, Bonke B and De Haes JCJM: The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 39:315–325. 1995.PubMed/NCBI View Article : Google Scholar

62 

Bakalidou D, Krommydas G, Abdimioti T, Theodorou P, Doskas T and Fillopoulos E: The dimensionality of the multidimensional fatigue inventory (MFI-20) derived from healthy adults and patient subpopulations: A challenge for clinicians. Cureus. 14(e26344)2022.PubMed/NCBI View Article : Google Scholar

63 

Fisk JD, Pontefract A, Ritvo PG, Archibald CJ and Murray TJ: The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci. 21:9–14. 1994.PubMed/NCBI

64 

Schwartz JE, Jandorf L and Krupp LB: The measurement of fatigue: A new instrument. J Psychosom Res. 37:753–762. 1993.PubMed/NCBI View Article : Google Scholar

65 

Świątczak M, Raczak A, Świątczak A, Młodziński K, Sikorska K, Jaźwińska A, Kaufmann D and Daniłowicz-Szymanowicz L: Fatigue assessment in patients with hereditary hemochromatosis: First use of the popular diagnostic tools. J Clin Med. 13(5544)2024.PubMed/NCBI View Article : Google Scholar

66 

Broadbent DE, Cooper PF, FitzGerald P and Parkes KR: The cognitive failures questionnaire (CFQ) and its correlates. Br J Clin Psychol. 21:1–16. 1982.PubMed/NCBI View Article : Google Scholar

67 

Lee KA, Hicks G and Nino-Murcia G: Validity and reliability of a scale to assess fatigue. Psychiatry Res. 36:291–298. 1991.PubMed/NCBI View Article : Google Scholar

68 

Hewlett S, Dures E and Almeida C: Measures of fatigue: Bristol rheumatoid arthritis fatigue multi-dimensional questionnaire (BRAF MDQ), bristol rheumatoid arthritis fatigue numerical rating scales (BRAF NRS) for severity, effect, and coping, chalder fatigue questionnaire (CFQ), checklist individual strength (CIS20R and CIS8R), fatigue severity scale (FSS), functional assessment chronic illness therapy (Fatigue) (FACIT-F), multi-dimensional assessment of fatigue (MAF), multi-dimensional fatigue inventory (MFI). Arthritis Care Res (Hoboken). 63:S263–S286. 2011.PubMed/NCBI View Article : Google Scholar

69 

Nelson MJ, Buckley JD, Thomson RL, Clark D, Kwiatek R and Davison K: Diagnostic sensitivity of 2-day cardiopulmonary exercise testing in Myalgic Encephalomyelitis/Chronic fatigue syndrome. J Transl Med. 17(80)2019.PubMed/NCBI View Article : Google Scholar

70 

Escorihuela RM, Capdevila L, Castro JR, Zaragozà MC, Maurel S, Alegre J and Castro-Marrero J: Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis. J Transl Med. 18(4)2020.PubMed/NCBI View Article : Google Scholar

71 

Sebaiti MA, Hainselin M, Gounden Y, Sirbu CA, Sekulic S, Lorusso L, Nacul L and Authier FJ: Systematic review and meta-analysis of cognitive impairment in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Sci Rep. 12(2157)2022.PubMed/NCBI View Article : Google Scholar

72 

Sabahi Z, Farhoudi M, Naseri A and Talebi M: Working memory assessment using cambridge neuropsychological test automated battery can help in the diagnosis of mild cognitive impairment: A systematic review and meta-analysis. Dement Neuropsychol. 16:444–456. 2022.PubMed/NCBI View Article : Google Scholar

73 

Missailidis D, Sanislav O, Allan CY, Annesley SJ and Fisher PR: Cell-based blood biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome. Int J Mol Sci. 21(1142)2020.PubMed/NCBI View Article : Google Scholar

74 

Lee Y, Lee Y, Kim S, Kim S and Yoo S: contactless fatigue level diagnosis system through multimodal sensor data. Bioengineering (Basel). 12(116)2025.PubMed/NCBI View Article : Google Scholar

75 

Xiong R, Aiken E, Caldwell R, Vernon SD, Kozhaya L, Gunter C, Bateman L, Unutmaz D and Oh J: AI-driven multi-omics modeling of myalgic encephalomyelitis/chronic fatigue syndrome. Nat Med. 31:2991–3001. 2025.PubMed/NCBI View Article : Google Scholar

76 

Schuster M and Paliwal KK: Bidirectional recurrent neural networks. IEEE Transactions on Signal Processing. 45:2673–2681. 1997.

77 

Ahmadzadeh E, Kim H, Jeong O, Kim N and Moon I: A deep bidirectional LSTM-GRU network model for automated ciphertext classification. IEEE Access. 10:3228–3237. 2022.

78 

Palani P, Panigrahi S, Renganathan G, Kurita Y and Thondiyath A: Empirical classification of fatigue-induced physiological tremor in robot-assisted manipulation tasks using BiLSTM-GRU network. Front Rehab Sci. 6(1474203)2025.PubMed/NCBI View Article : Google Scholar

79 

Tang X, Qi Y, Zhang J, Liu K, Tian Y and Gao X: Enhancing EEG and sEMG fusion decoding using a multi-scale parallel convolutional network with attention mechanism. IEEE Trans Neural Syst Rehabil Eng. 32:212–222. 2024.PubMed/NCBI View Article : Google Scholar

80 

He L, Zhang L, Sun Q and Lin X: A generative adaptive convolutional neural network with attention mechanism for driver fatigue detection with class-imbalanced and insufficient data. Behav Brain Res. 464(114898)2024.PubMed/NCBI View Article : Google Scholar

81 

Mu D, Wang J, Li F, Hu W and Chen R: Multilevel attention mechanism for motion fatigue recognition based on sEMG and ACC signal fusion. PLoS One. 19(e0310035)2024.PubMed/NCBI View Article : Google Scholar

82 

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P and Schünemann HJ: GRADE Working Group. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 336:924–926. 2008.PubMed/NCBI View Article : Google Scholar

83 

Nourbakhsh B, Revirajan N, Morris B, Cordano C, Creasman J, Manguinao M, Krysko K, Rutatangwa A, Auvray C, Aljarallah S, et al: Safety and efficacy of amantadine, modafinil, and methylphenidate for fatigue in multiple sclerosis: A randomised, placebo-controlled, crossover, double-blind trial. Lancet Neurol. 20:38–48. 2021.PubMed/NCBI View Article : Google Scholar

84 

Wisor J: Modafinil as a Catecholaminergic agent: Empirical evidence and unanswered questions. Front Neurol. 4(139)2013.PubMed/NCBI View Article : Google Scholar

85 

Shellenberg TP, Stoops WW, Lile JA and Rush CR: An update on the clinical pharmacology of methylphenidate: Therapeutic efficacy, abuse potential and future considerations. Expert Rev Clin Pharmacol. 13:825–833. 2020.PubMed/NCBI View Article : Google Scholar

86 

Bahji A and Mesbah-Oskui L: Comparative efficacy and safety of stimulant-type medications for depression: A systematic review and network meta-analysis. J Affect Disord. 292:416–423. 2021.PubMed/NCBI View Article : Google Scholar

87 

Yousefi F, Kamyab P, Fakhraei B, Farjam M, Rezaei S, Mahmoudi SS, Karimimoghadam Z, Tabrizi R and Jaafari N: The effects of selective serotonin reuptake inhibitors on neurological and depressive symptoms in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. Galen Med J. 12(e3153)2023.PubMed/NCBI View Article : Google Scholar

88 

Gil-Sanchez A, Canudes M, Valcheva P, Nogueras L, González-Mingot C, Hervás JV, Peralta S, Solana M and Brieva L: Effects of vortioxetine on cognition and fatigue in patients with multiple sclerosis and depression: A case series study. CNS Neurol Disord Drug Targets. 23:395–401. 2024.PubMed/NCBI View Article : Google Scholar

89 

Fluge Ø, Rekeland IG, Lien K, Thürmer H, Borchgrevink PC, Schäfer C, Sørland K, Aßmus J, Ktoridou-Valen I, Herder I, et al: B-lymphocyte depletion in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 170:585–593. 2019.PubMed/NCBI View Article : Google Scholar

90 

Bolton MJ, Chapman BP and Van Marwijk H: Low-dose naltrexone as a treatment for chronic fatigue syndrome. BMJ Case Rep. 13(e232502)2020.PubMed/NCBI View Article : Google Scholar

91 

Soomro M, Lyons S, Bravo R, McBeth J, Lunt M, Dixon WG and Jani M: Use of over-the-counter supplements, sleep aids and analgesic medicines in rheumatology: Results of a cross-sectional survey. Rheumatol Adv Pract. 8(rkae129)2024.PubMed/NCBI View Article : Google Scholar

92 

Bian Z and Wei L: The role of coenzyme Q10 in exercise tolerance and muscle strength. Arch Physiol Biochem. 131:1–20. 2025.PubMed/NCBI View Article : Google Scholar

93 

Salekzamani S, Pakkhesal S, Babaei M, Mirzaaghazadeh E, Mosaddeghi-Heris R, Talebi M, Sanaie S and Naseri A: Coenzyme Q10 supplementation in multiple sclerosis; A systematic review. Mult Scler Relat Disord. 93(106212)2025.PubMed/NCBI View Article : Google Scholar

94 

Castro-Marrero J, Sáez-Francàs N, Santillo D and Alegre J: Treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis: All roads lead to Rome. Br J Pharmacol. 174:345–369. 2017.PubMed/NCBI View Article : Google Scholar

95 

Bozzini S, Albergati A, Capelli E, Lorusso L, Gazzaruso C, Pelissero G and Falcone C: Cardiovascular characteristics of chronic fatigue syndrome. Biomed Rep. 8:26–30. 2017.PubMed/NCBI View Article : Google Scholar

96 

Scheibenbogen C and Wirth KJ: Key Pathophysiological role of skeletal muscle disturbance in post COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Accumulated evidence. J Cachexia Sarcopenia Muscle. 16(e13669)2025.PubMed/NCBI View Article : Google Scholar

97 

Woods PC, Swank DM and Miller MS: Stretch activation combats force loss from fatigue in fast-contracting mouse skeletal muscle fibers. J Gen Physiol. 157(e202413679)2025.PubMed/NCBI View Article : Google Scholar

98 

Allen DG, Lee JA and Westerblad H: Intracellular calcium and tension during fatigue in isolated single muscle fibres from Xenopus laevis. J Physiol. 415:433–458. 1989.PubMed/NCBI View Article : Google Scholar

99 

Zhang N, Jiang P, Fan S, Wang W and Liu F: Current status and determinants of fatigue in Chinese older adults receiving maintenance hemodialysis: A multicentre cross-sectional study. Clin Interv Aging Volume. 20:1847–1860. 2025.PubMed/NCBI View Article : Google Scholar

100 

Tardy AL, Bois De Fer B, Cañigueral S, Kennedy D, Scholey A, Hitier S, Aran A and Pouteau E: Reduced self-perception of fatigue after intake of panax ginseng root extract (G115®) formulated with vitamins and minerals-an open-label study. Int J Environ Res Public Health. 18(6257)2021.PubMed/NCBI View Article : Google Scholar

101 

Tardy AL, Pouteau E, Marquez D, Yilmaz C and Scholey A: Vitamins and minerals for energy, fatigue and cognition: A narrative review of the biochemical and clinical evidence. Nutrients. 12(228)2020.PubMed/NCBI View Article : Google Scholar

102 

Larun L, Brurberg KG, Odgaard-Jensen J and Price JR: Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 12(CD003200)2017.PubMed/NCBI View Article : Google Scholar

103 

Gerland L and Baumann FT: Sport and exercise therapy for burnout and fatigue-a narrative review. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 67:1288–1294. 2024.PubMed/NCBI View Article : Google Scholar : (In German).

104 

Dong B, Qi Y, Lin L, Liu T, Wang S, Zhang Y, Yuan Y, Cheng H, Chen Q, Fang Q, et al: Which exercise approaches work for relieving cancer-related fatigue? a network meta-analysis. J Orthop Sports Phys Ther. 53:343–352. 2023.PubMed/NCBI View Article : Google Scholar

105 

Corbitt M, Eaton-Fitch N, Staines D, Cabanas H and Marshall-Gradisnik S: A systematic review of cytokines in chronic fatigue syndrome/myalgic encephalomyelitis/systemic exertion intolerance disease (CFS/ME/SEID). BMC Neurol. 19(207)2019.PubMed/NCBI View Article : Google Scholar

106 

Loy BD, O'Connor PJ and Dishman RK: Effect of acute exercise on fatigue in people with ME/CFS/SEID. Med Sci Sports Exerc. 48:2003–2012. 2016.PubMed/NCBI View Article : Google Scholar

107 

Kuut TA, Buffart LM, Braamse AMJ, Csorba I, Bleijenberg G, Nieuwkerk P, Moss-Morris R, Müller F and Knoop H: Does the effect of cognitive behavior therapy for chronic fatigue syndrome (ME/CFS) vary by patient characteristics? A systematic review and individual patient data meta-analysis. Psychol Med. 54:447–456. 2024.PubMed/NCBI View Article : Google Scholar

108 

Janse A, Worm-Smeitink M, Bleijenberg G, Donders R and Knoop H: Efficacy of web-based cognitive-behavioural therapy for chronic fatigue syndrome: Randomised controlled trial. Br J Psychiatry. 212:112–118. 2018.PubMed/NCBI View Article : Google Scholar

109 

Chayadi E, Baes N and Kiropoulos L: The effects of mindfulness-based interventions on symptoms of depression, anxiety, and cancer-related fatigue in oncology patients: A systematic review and meta-analysis. PLoS One. 17(e0269519)2022.PubMed/NCBI View Article : Google Scholar

110 

Chen Y, Wang R, Yu J, Zhu L, Lu Y and Deng X: Effects of MBSR therapy on negative emotions, fatigue, and sleep quality in ‘post-ICU patients’. Medicine (Baltimore). 101(e28331)2022.PubMed/NCBI View Article : Google Scholar

111 

Leodori G, Mancuso M, Maccarrone D, Tartaglia M, Ianniello A, Certo F, Baione V, Ferrazzano G, Malimpensa L, Belvisi D, et al: Neural bases of motor fatigue in multiple sclerosis: A multimodal approach using neuromuscular assessment and TMS-EEG. Neurobiol Dis. 180(106073)2023.PubMed/NCBI View Article : Google Scholar

112 

Hirata K, Shiozaki D, Yamada K, Miyokawa Y, Yajima Y and Akagi R: Cryotherapy with carbon dioxide hydrate enhances immediate recovery of muscle function from neuromuscular fatigue. J Sports Sci. 42:2103–2114. 2024.PubMed/NCBI View Article : Google Scholar

113 

Dauksaite G, Eimantas N, Solianik R, Daniuseviciute-Brazaite L, Malciene L and Brazaitis M: Head-neck cooling effects on central and peripheral fatigue, motor accuracy, and blood markers of stress in men with multiple sclerosis and healthy men: A randomized crossover study. Mult Scler Relat Disord. 90(105840)2024.PubMed/NCBI View Article : Google Scholar

114 

Arc-Chagnaud C, Dupuy O, Garcia M, Bosquet L, Bouzigon R and Pla R: D-Day Consortium. Dugué B: Effects of repeated cryostimulation exposures on sleep and wellness in healthy young adults. Cryobiology. 117(104948)2024.PubMed/NCBI View Article : Google Scholar

115 

Vitenet M, Tubez F, Marreiro A, Polidori G, Taiar R, Legrand F and Boyer FC: Corrigendum to ‘Effect of whole body cryotherapy interventions on health-related quality of life in fibromyalgia patients: A randomized controlled trial’. Complement Ther Med 36 (2018) 6-8]. Complement Ther Med. 38:92–93. 2018.PubMed/NCBI View Article : Google Scholar

116 

Kujawski S, Słomko J, Godlewska BR, Cudnoch-Jędrzejewska A, Murovska M, Newton JL, Sokołowski Ł and Zalewski P: Combination of whole body cryotherapy with static stretching exercises reduces fatigue and improves functioning of the autonomic nervous system in chronic fatigue syndrome. J Transl Med. 20(273)2022.PubMed/NCBI View Article : Google Scholar

117 

Kujawski S, Zalewski P, Godlewska BR, Cudnoch-Jędrzejewska A, Murovska M, Newton JL, Sokołowski Ł and Słomko J: Effects of whole-body cryotherapy and static stretching are maintained 4 weeks after treatment in most patients with chronic fatigue syndrome. Cryobiology. 112(104546)2023.PubMed/NCBI View Article : Google Scholar

118 

Rivera J, Tercero MJ, Salas JS, Gimeno JH and Alejo JS: The effect of cryotherapy on fibromyalgia: A randomised clinical trial carried out in a cryosauna cabin. Rheumatol Int. 38:2243–2250. 2018.PubMed/NCBI View Article : Google Scholar

119 

Yeh SW, Hong CH, Shih MC, Tam KW, Huang YH and Kuan YC: Low-level laser therapy for fibromyalgia: A systematic review and meta-analysis. Pain Physician. 22:241–254. 2019.PubMed/NCBI

120 

Couturaud V, Le Fur M, Pelletier M and Granotier F: Reverse skin aging signs by red light photobiomodulation. Skin Res Technol. 29(e13391)2023.PubMed/NCBI View Article : Google Scholar

121 

Cichoń N, Bijak M, Miller E and Saluk J: Extremely low frequency electromagnetic field (ELF-EMF) reduces oxidative stress and improves functional and psychological status in ischemic stroke patients. Bioelectromagnetics. 38:386–396. 2017.PubMed/NCBI View Article : Google Scholar

122 

Tedeschi R: ‘Transcranial direct current stimulation for chronic foot pain: A comprehensive review.’. eNeurologicalSci. 35(100498)2024.PubMed/NCBI View Article : Google Scholar

123 

Zeng J, Wu Q, Meng XD and Wang J: Systematic review of Buzhong Yiqi method in alleviating cancer-related fatigue: A meta-analysis and exploratory network pharmacology approach. Front Pharmacol. 15(1451773)2024.PubMed/NCBI View Article : Google Scholar

124 

Liu T, Sun W, Guo S, Chen T, Zhu M, Yuan Z, Li B, Lu J, Shao Y, Qu Y, et al: Research progress on pathogenesis of chronic fatigue syndrome and treatment of traditional Chinese and Western medicine. Auton Neurosci. 255(103198)2024.PubMed/NCBI View Article : Google Scholar

125 

Wang R, Liu Y, Jiang Y, Zhang Y, Zhang Y, Wang B, Lu H, Su H, Liao W, Liu L, et al: Shenling Baizhu San alleviates central fatigue through SIRT1-PGC-1α-Mediated mitochondrial biogenesis. J Ethnopharmacol. 339(119110)2025.PubMed/NCBI View Article : Google Scholar

126 

Yang J, Li Y, Chau CI, Shi J, Chen X, Hu H and Ung COL: Efficacy and safety of traditional Chinese medicine for cancer-related fatigue: A systematic literature review of randomized controlled trials. Chin Med. 18(142)2023.PubMed/NCBI View Article : Google Scholar

127 

Lu G, Chen F, Guo C and Wu J: Acupuncture for senile insomnia: A systematic review of acupuncture point. Arch Gerontol Geriatr. 127(105586)2024.PubMed/NCBI View Article : Google Scholar

128 

Zhang Q, Gong J, Dong H, Xu S, Wang W and Huang G: Acupuncture for chronic fatigue syndrome: A systematic review and meta-analysis. Acupunct Med. 37:211–222. 2019.PubMed/NCBI View Article : Google Scholar

129 

Hersche R, Roser K, Weise A, Michel G and Barbero M: Fatigue self-management education in persons with disease-related fatigue: A comprehensive review of the effectiveness on fatigue and quality of life. Patient Educ Couns. 105:1362–1378. 2022.PubMed/NCBI View Article : Google Scholar

130 

Rozich JJ, Holmer A and Singh S: Effect of lifestyle factors on outcomes in patients with inflammatory bowel diseases. Am J Gastroenterol. 115:832–840. 2020.PubMed/NCBI View Article : Google Scholar

131 

Jafarnezhadgero A, Moradzadeh N, Mirzang EF, Sajedi H, Dixon S and Akrami M: Influence of a fatiguing exercise on lower limb electromyographic activities and co-contraction in overweight females during running. PLoS One. 20(e0322167)2025.PubMed/NCBI View Article : Google Scholar

132 

Al-Naamani Z, Gormley K, Noble H, Santin O, Al Omari O, Al-Noumani H and Madkhali N: Navigating strategies used to manage fatigue by patients undergoing hemodialysis: A qualitative exploratory design. BMC Nephrol. 26(226)2025.PubMed/NCBI View Article : Google Scholar

133 

Lim S and Chia S: The prevalence of fatigue and associated health and safety risk factors among taxi drivers in Singapore. Singapore Med J. 56:92–97. 2015.PubMed/NCBI View Article : Google Scholar

134 

Huang K, Lidbury BA, Thomas N, Gooley PR and Armstrong CW: Machine learning and multi-omics in precision medicine for ME/CFS. J Transl Med. 23(68)2025.PubMed/NCBI View Article : Google Scholar

135 

Kendler KS, Rosmalen JGM, Ohlsson H, Sundquist J and Sundquist K: A distinctive profile of family genetic risk scores in a Swedish national sample of cases of fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome compared to rheumatoid arthritis and major depression. Psychol Med. 53:3879–3886. 2023.PubMed/NCBI View Article : Google Scholar

136 

Das S, Taylor K, Kozubek J, Sardell J and Gardner S: Genetic risk factors for ME/CFS identified using combinatorial analysis. J Transl Med. 20(598)2022.PubMed/NCBI View Article : Google Scholar

137 

Yang CA, Bauer S, Ho YC, Sotzny F, Chang JG and Scheibenbogen C: The expression signature of very long non-coding RNA in myalgic encephalomyelitis/chronic fatigue syndrome. J Transl Med. 16(231)2018.PubMed/NCBI View Article : Google Scholar

138 

Yang X, Li F, Ma J, Liu Y, Wang X, Wang R, Zhang Y, Zhang W, He Q, Song D and Yu J: Study on the relationship between the miRNA-centered ceRNA regulatory network and fatigue. J Mol Neurosci. 71:1967–1974. 2021.PubMed/NCBI View Article : Google Scholar

139 

Vu LT, Ahmed F, Zhu H, Iu DSH, Fogarty EA, Kwak Y, Chen W, Franconi CJ, Munn PR, Tate AE, et al: Single-cell transcriptomics of the immune system in ME/CFS at baseline and following symptom provocation. Cell Rep Med. 5(101373)2024.PubMed/NCBI View Article : Google Scholar

140 

Xiong R, Aiken E, Caldwell R, Vernon SD, Kozhaya L, Gunter C, Bateman L, Unutmaz D and Oh J: BioMapAI: Artificial intelligence multi-omics modeling of myalgic encephalomyelitis/chronic fatigue syndrome. bioRxiv: doi: 10.1101/2024.06.24.600378.

141 

Castro-Marrero J, Cordero MD, Segundo MJ, Sáez-Francàs N, Calvo N, Román-Malo L, Aliste L, Fernández de Sevilla T and Alegre J: Does oral coenzyme Q 10 Plus NADH supplementation improve fatigue and biochemical parameters in chronic fatigue syndrome? Antioxid Redox Signal. 22:679–685. 2015.PubMed/NCBI View Article : Google Scholar

142 

Lee YJ, Cho WJ, Kim JK and Lee DC: Effects of coenzyme Q 10 on arterial stiffness, metabolic parameters, and fatigue in obese subjects: A double-blind randomized controlled study. J Med Food. 14:386–390. 2011.PubMed/NCBI View Article : Google Scholar

143 

Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, O'Connor L, Leavy D, O'Brien K, Dowds J, et al: Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One. 15(e0240784)2020.PubMed/NCBI View Article : Google Scholar

144 

Bileviciute-Ljungar I, Norrefalk JR and Borg K: Pain burden in post-COVID-19 syndrome following mild COVID-19 infection. J Clin Med. 11(771)2022.PubMed/NCBI View Article : Google Scholar

145 

Wong TL and Weitzer DJ: Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)-A systemic review and comparison of clinical presentation and symptomatology. Medicina (B Aires). 57(418)2021.PubMed/NCBI View Article : Google Scholar

146 

Morris G, Maes M, Berk M and Puri BK: Myalgic encephalomyelitis or chronic fatigue syndrome: How could the illness develop? Metab Brain Dis. 34:385–415. 2019.PubMed/NCBI View Article : Google Scholar

147 

Braley TJ, Ehde DM, Alschuler KN, Little R, Ng YT, Zhai Y, von Geldern G, Chervin RD, Conroy D, Valentine TR, et al: Comparative effectiveness of cognitive behavioural therapy, modafinil, and their combination for treating fatigue in multiple sclerosis (COMBO-MS): A randomised, statistician-blinded, parallel-arm trial. Lancet Neurol. 23:1108–1118. 2024.PubMed/NCBI View Article : Google Scholar

148 

Zhang G, Yang B, Zan P and Zhang D: Multilevel assessment of exercise fatigue utilizing multiple attention and convolution network (MACNet) based on surface electromyography. IEEE Trans Neural Syst Rehabil Eng. 33:243–254. 2025.PubMed/NCBI View Article : Google Scholar

Related Articles

  • Abstract
  • View
  • Download
  • Twitter
Copy and paste a formatted citation
Spandidos Publications style
Zhou H, Yu W, Lei J, Chang R, Cheng Y, Wang G and Lin L: <p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>. Exp Ther Med 31: 91, 2026.
APA
Zhou, H., Yu, W., Lei, J., Chang, R., Cheng, Y., Wang, G., & Lin, L. (2026). <p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>. Experimental and Therapeutic Medicine, 31, 91. https://doi.org/10.3892/etm.2026.13086
MLA
Zhou, H., Yu, W., Lei, J., Chang, R., Cheng, Y., Wang, G., Lin, L."<p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>". Experimental and Therapeutic Medicine 31.4 (2026): 91.
Chicago
Zhou, H., Yu, W., Lei, J., Chang, R., Cheng, Y., Wang, G., Lin, L."<p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>". Experimental and Therapeutic Medicine 31, no. 4 (2026): 91. https://doi.org/10.3892/etm.2026.13086
Copy and paste a formatted citation
x
Spandidos Publications style
Zhou H, Yu W, Lei J, Chang R, Cheng Y, Wang G and Lin L: <p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>. Exp Ther Med 31: 91, 2026.
APA
Zhou, H., Yu, W., Lei, J., Chang, R., Cheng, Y., Wang, G., & Lin, L. (2026). <p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>. Experimental and Therapeutic Medicine, 31, 91. https://doi.org/10.3892/etm.2026.13086
MLA
Zhou, H., Yu, W., Lei, J., Chang, R., Cheng, Y., Wang, G., Lin, L."<p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>". Experimental and Therapeutic Medicine 31.4 (2026): 91.
Chicago
Zhou, H., Yu, W., Lei, J., Chang, R., Cheng, Y., Wang, G., Lin, L."<p>Pathophysiological mechanisms of fatigue and multidisciplinary management strategies (Review)</p>". Experimental and Therapeutic Medicine 31, no. 4 (2026): 91. https://doi.org/10.3892/etm.2026.13086
Follow us
  • Twitter
  • LinkedIn
  • Facebook
About
  • Spandidos Publications
  • Careers
  • Cookie Policy
  • Privacy Policy
How can we help?
  • Help
  • Live Chat
  • Contact
  • Email to our Support Team