Publication date: Jul 15, 2026
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in children, young people (CYP) lacks validated diagnostic biomarkers. Post-exertional malaise (PEM) is central to case definitions and is usually assessed by patient report. We evaluated the feasibility and clinical value of handgrip strength (HGS) testing in PEM-reporting CYP referred for suspected ME/CFS. In this prospective observational study at the Munich Chronic Fatigue Center for Young People (November 2022-November 2024), 147 patients (10-25 years) referred for the assessment of ME/CFS with positive DSQ-PEM screening and 83 healthy controls (HC) completed two HGS sessions (10 maximal grips/session; 3-s contraction/5-s rest; 60-minute inter-session break) using a digital dynamometer. We derived maximal force (Fmax), mean force (Fmean), fatigue ratio (FR = Fmax/Fmean), and recovery ratio (RR = Fmean session 2 / session 1). Analyses used repeated-measures ANCOVA, linear regression, partial Spearman correlations (adjusted for sex, age, and BMI), and proportional odds models for group membership (HC, noME/CFS, ME/CFS), reporting accuracy, and the C-statistic. Sensitivity analyses compared noME/CFS with confirmed CCC-ME/CFS. After clinical work-up, 84/147 (57%) patients were classified as ME/CFS (confirmed or probable) and 63/147 (43%) as noME/CFS. HGS test completion rate was high (session 1: 146/147, 99. 3%; session 2: 142/147, 96. 6%). Compared with HC, patients had substantially lower HGS (mean difference -9. 93 kg, 95% CI: -12. 00 to -7. 85), and HGS indices correlated modestly with physical functioning (SF-12 PCS), but not with PEM duration. Both noME/CFS and ME/CFS groups differed from HC in absolute strength indices (Fmean, Fmax) and FR. RR differed between ME/CFS and HC, whereas no HGS index significantly separated noME/CFS from ME/CFS. In proportional odds models, each HGS index improved fit (all p
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| Concepts | Keywords |
|---|---|
| Handgrip strength | |
| ME/CFS | |
| Pediatrics | |
| PEM | |
| Post-COVID | |
| Post-Exertional malaise | |
| Post-Vaccination |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | myalgic encephalomyelitis |
| disease | MESH | fatigue |
| disease | MESH | PCS |
| pathway | REACTOME | Reproduction |
| disease | MESH | included |
| disease | MESH | Infection |
| drug | DRUGBANK | Coenzyme M |