In a landmark study published in Nature Communications, researchers have unveiled promising findings regarding persistent fatigue, physical and mental setbacks of long COVID. A defining feature of long COVID following physical activity is called Post Exertion Symptom Exacerbation (PESE) – characterised by debilitating exhaustion, pain related symptoms and cognitive impairment.
This is similar to complex illnesses like chronic fatigue syndrome. People told to “hit the gym” to improve symptoms, may in fact be worsening them. Individuals may be incapacitated for days to weeks following exercise, with symptoms ranging from muscle pain to cognitive issues, commonly referred to as “brain fog”.
The study, comparing long COVID patients to fully recovered individuals, revealed impaired oxygen uptake in muscle tissue, indicating a deeper issue beyond just heart or lung function. Lead author Braeden Charlton of Vrije University in Amsterdam highlights the profound and notable observations made: compromised mitochondria (the cellular powerhouses responsible for energy production), severe muscle damage, and microclot buildup, hinting at an altered immune response to exercise. Respirometry techniques confirmed mitochondrial dysfunction, leading to reduced energy production and premature lactate accumulation during exercise.
Additionally, the presence of microclots in muscle tissue underscores the complexity of long COVID pathology and its potential impact on vascular health.
As the medical community still grapples with the enigmatic nature of long COVID, this research serves as a critical step towards understanding the intricacies of post-exertional malaise and redefining rehabilitation strategies to better support affected individuals.
Returning to Exercise:
The research found some health care professionals were recommending patients increase their physical activity levels, but the researchers warn this could result in symptoms getting worse. Instead of the blanket recommendation of exercise for long COVID management, academics say patients should be encouraged to “pace” their return to exercise, doing enough to stay within their energy reserves so as not to cause a flare-up of symptoms.
To help reduce the effects on long COVID, each person should be individually assessed by a experienced Physiotherapist for a nuanced approach considering individual symptoms and underlying biological factors.
A tailored method called Autonomic Conditioning Therapy (ACT) prioritises energy conservation over exertion and has been found to improve symptoms of PESE in individuals. ACT consists of Physiotherapist-supervised breathwork coaching and graded progressive exercise with three distinct phases of rehabilitation. These are prescribed and carried out according to the patient’s tolerance.
For example, Phase 1a exercises start in supine (lying down) for 30 second intervals, at a self-selected speed. These include active range of motion open chain knee flexion heel slides, hip abduction, concentric quadriceps activation via straight leg raise, and concentric closed chain hip extension bridges. Pacing is very important in ACT when returning to exercise. When recovering from any serious illness most people will experience ups and downs with their symptoms for a variety of reasons.
People tend to use these symptoms to decide how much they do. ‘Good days’ may mean they do more, and very often overdo it. This can result in experiencing a “bad day” or ‘relapse’ when they might experience more symptoms, feel low and are able to do very little. This is called the ‘boom and bust pattern’ and is detrimental to recovery. It is important to remember that all activity takes energy, whether it is physical, mental or emotional.
Physiotherapists use objective markers to determine and keep patient exertion within the upper and lower lines to prevent the ‘busting’ which can lead to PESE. If patients are coping with a phase well, they progress onto the next phase.
Each patient is individual and needs their own assessment and will progress through each phase at their own pace. It is also important to look at other factors, such as nutrition, sleep, relaxation and any emotional impact they may be experiencing. If you have been interested in this blog, and feel you or your patients could benefit from a Physiotherapy assessment and treatment, please get in touch with Synergy Chiropractic and Physiotherapy
