Long-COVID is exercise really medicine? Do we need a paradigm shift?

(source google)

Exercise is medicine has become a common mantra across Social Media and in several medical journals. It is well know that exercise has far reaching health benefits and is utilised in rehabilitation to strengthen, condition, also to  improve endurance, aerobic capacity and overall reduce several metabolic health risks from diabetes to heart disease. ( references links: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004757/pdf/cptj0021-0004.pdf https://bjsm.bmj.com/content/43/1/3 )

BUT, is exercise really medicine and should it be recommended for all that troubles us?

First lets define what we mean by exercise. Simply put formal exercise is aimed at challenging bodily structures and systems to a point of controlled overload causing fatigue and or micro failure with the intent of stimulating adaptation of the structure or bodily system. Common types of exercises aim to strengthen muscles, improving flexibility, stimulate cardiovascular changes, improve general bodily endurance. Everyone is familiar with lifting a weigh to muscular fatigue, running until your pant and sweat, doing aerobic classes that make you pant and sweat, long runs and cycling that improve your endurance, climbing steep hill either by running or walking that challenge your heart rate and breathing. All are designed to push you to challenge the muscle or system followed by a period of rest to allow adaptation. Often the periods of effort/challenge followed by rest lead to increasing abilities in strength, power, improved cardiovascular responses and endurance. It is also recognised that these changes take several weeks and require regular challenging exercise and progression of load and intensity.

Yep exercise sounds great and yes it sounds like a great way to be healthy, almost a medicine in it’s self.

We are one year into the global pandemic caused by the SARS-Corona virus-2 commonly referred to as COVID-19. Many people have contracted the virus world wide and have recovered from the acute presentation, but many are still left suffering from the long term effect which present in multiple ways. This has lead to the term Long-COVID to describe the ongoing , often debilitating signs and symptoms, of post COVID infection.

Common Long-COVID presentations 

  • Overwhelming fatigue
  • Bradycardia
  • Tachycardia
  • Palpitations
  • Dysautonomia
  • Heat intolerance
  • Flu-like feeling
  • Headache
  • Altered appetite
  • Diarrhea
  • Sore throat
  • Dyspnea
  • Breathing-pattern disorders
  • Swollen glands
  • Muscle and joint pain
  • Chest wall and mediastinal pain
  • “Brain fog”
  • Executive functioning challenges
  • Short-term memory loss

(Source )

Source google on fatigue

One of the most common reported presentations with Long-COVID is post activity malaise and or extreme bodily fatigue which is immediate but often delayed by 24 hours. It can be unpredictable in nature. Also commonly reported are fluctuations in heart rate including tachycardia, and breathlessness, with minimal to no physical exertion.

The symptoms of Long-COVID seem to mirror those of Chronic Fatigue Syndrome (CFS) although no direct link has yet been shown. 

So the question arises if exercise or even normal daily physical function causes irregular heart and breathing issues, followed by general malaise and or profound fatigue, how can exercise be the solution to long-COVID?

It may be time to adopt some of the strategies developed for the treatment of CFS such as activity pacing, rather than formalised “graded exercise”. It has been suggested that graded activities of daily living are exercise if they cause increased heart rate and fatigue, I would suggest this is not true in te case of long-COVID sufferers or CFS as the changes in heart rate and fatigue and often O2 saturation, are not due to deconditioning, but are unpredictable responses due to the the long post viral infection process, which at this point in time we do not  fully understand. (Ref ) More on CFS and exercise here

So I propose that for long-COVID exercise per se or even graded activity may not be indicated as a therapy and in the case of long-COVID “exercise is NOT medicine.”

If you want to read more and understand the lived experience of many health professionals with long-COVID check out this blog (here)

And this website here

At the current time we need to seek to understand the individual with long-COVID, there individual and unique presentation and give support and advice on management and perhaps pacing based on their own current understanding  of their activity tolerance, triggers and long-COVID crashes. Employers, spouses, partners and society at large may need to be more understanding and accommodating, as people with long-COVID try to recover and restore their pre COVID health and lifestyles.  There is a nice article/blog on pacing with long-COVID “Long covid and self-help pacing groups—getting by with a little help from our friends” found in the BMJ here

In conclusion it may be more important than ever to be a person focused therapist when managing people suffering from long-COVID. Exercise is NOT medicine, self directed activity pacing may be the best initial intervention, support and understanding are essential. Surgeries will have “crashes” we all need to be supportive and understanding. 

As always thanks for reading I hope this was helpful.

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