Long-COVID and graded exercise, why it’s hard for some to grasp the message of harm?

In my last blog post I highlighted that exercise is definitely not medicine in any shape or form for sufferers of Long-COVID (aka COVID Long Haulers), in fact for some long-COVID sufferers pushing through leads to complete breakdown and profound exhaustion.

Over the weekend I began to reflect on ponder, as the feedback and discussions around my blog developed on SoMe. It became apparent that long time advocates of exercise where finding it difficult to accept that graded exercise wasn’t the answer for long-COVID and played mental gymnastics with definitions of exercise, down to suggesting any activity of any sort was exercise and should be utilised to defend their stance.

Let me just place this in perspective, long-COVID sufferers commonly and almost universally are not suffering from a deficit of exercise, they are not exercise avoiders, they are not deconditioned. Their presentations do mimic deconditioning ie post exertion fatigue, general malaise, tachycardia, breathlessness. BUT, these are not due to deconditioned status they are symptoms of the effects of the the virus and it’s long term effects on cellular activity, chronic inflammation and organ damage, including heart, lungs, kidneys, liver and brain. Watch this video from 60 minute if you are still not convinced here

So why is it hard for clinicians to change their paradigm and accept that exercise is not the answer?

The answer lies in our difficulty to unlearn and relearn new information. I have labeled this “first in best dressed syndrome” meaning what we learn first and believe to be true, is much longer lasting , ingrained and harder to change, than new and conflicting information.

As a young educator I had to learn this the hard way, when I excitedly presented some new, controversial and conflicting ideas at a conference. I was overwhelmed by the negative response of the audience and the almost vitriolic attack on my newly presented knowledge. After the presentation someone gave me this paper as a message of support👇


The paper describes the way we handle conflicting information and highlights the seven different strategies that people adopt. All seven can be seen on SoMe discussing the role of graded exercise in the treatment of Long-COVID, as you will see if you read the paper six ways are used to discount the idea that exercise is not indicated and used to protect their original understanding of “exercise is medicine”

One of the hardest things to do is “unlearn” and then replace the old idea with new learning.

Most of use will try to use the six strategies highlighted in the paper above to maintain or previous notions and in some case appear to have adopted the new information.

in fact in some cases the more information that is provided for in support of the new idea, the greater the push back, which creates a back fire effect.

Unlearning is tough. But I would encourage clinicians to ponder on whose interest they serve, their own, or their patients? Believing that your ideas are sound and should be followed, rather than seeking to understand a new perspective from a patient focused point of view, seems futile.

I am striving for change and understanding, receive your patients narrative, listen to the sufferers of long-COVID, there are links to their stories here These narratives are not only sufferers of long-COVID they are your clinical peers.

There is so much we do not know or understand about the cause, and course of long-COVID, BUT making a change in your understanding and beliefs, doing some unlearning and releasing, listening to the narratives of long-COVID sufferers, may improve their care and journey.

Be part of the solution, not the problem.

As always I suggest Ethos (Gain Trust), Pathos (First seek to understand), Logos (the to be understood)

As always, thanks for reading.

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