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Can exercise attenuate the negative effects of long COVID syndrome on brain health? 2022 Teo and Goodwill

Discussion in 'Long Covid research' started by Andy, Oct 4, 2022.

  1. Andy

    Andy Committee Member

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    The impetus for many governments globally to treat the novel coronavirus (COVID-19) as an endemic warrant more research into the prevention, and management of long COVID syndrome (LCS). Whilst the data on LCS remains scarce, reports suggest a large proportion of recovered individuals will experience ongoing neuropsychological symptoms, even with mild disease severity. The pathophysiology underlying LCS is multifaceted. Evidence suggests that altered inflammatory, neurotrophic, and neurotransmitter pathways within the brain contribute to neuropsychological symptoms reported following COVID-19. Exercise or regular physical activity has long been shown to have positive effects on brain health and cognition through exerting positive effects on inflammatory markers, neurotransmitters, and neurotropic factors analogous to the neurophysiological pathways proposed to be disrupted by COVID-19 infection. Thus, exercise may serve as an important lifestyle behavior in the management of LCS.

    In this opinion article, we present the evidence to support the positive role of exercise in the management of cognitive symptom that manifest with LCS and discuss important considerations and interactions with cardiorespiratory and exercise tolerance complications that often present for individuals experiencing LCS. We highlight the need for more research and training of sports medicine practitioners and clinical exercise physiologists in the management of LCS with exercise and call for further research to understand the optimal dose-responses and exercise prescription guidelines for cognitive benefits and minimizing other complications.

    Open access, https://www.frontiersin.org/articles/10.3389/fimmu.2022.986950/full
     
    Hutan, Ariel, DokaGirl and 2 others like this.
  2. bobbler

    bobbler Senior Member (Voting Rights)

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    So it does look like we've got a roll it all in together issue.

    Are they not at all intrigued by why in the older and less fit (averaging again, as those who are fit can get the horrid cytokine storm and probably other awful things) who ended up acute in hospital seem to have a very different condition to those whose illness almost insidiously (pernicious?) crept up after a 'mild' home-managed bout into 'long covid'? Or have they not really being doing enough study to even notice this and either way there is the same issue of lump and dump.

    Besides, in general, older patients might be pretty motivated but they are in a position to and life-experienced enough to know how to play the game on 'doing what works best for them' and the appropriate method chosen of suggesting something that clearly isn't working shoves off - whereas youngers will be in the middle of a crisis needing the old letters that validate them etc. and more committments they can't avoid. So the treatment won't be the same.

    What quite do they think they mean by theoretical knowledge and what actually does theoretical knowledge mean here too? Concerning that the most important lesson that I think should have been hammered home for the ME/CFS guidelines was longitudinal - yes the '135 day rule' that drove certain individuals bonkers. But the realisation of the impending workforce crisis is perhaps wagging the dog on studies. Yet again.

    We have issues with industries that should be required to report on 1,3,5,10yrs for people being allowed to be hit and run and all their KPIs and thinking being based around this

    No conflict technically - but it seems certain depts can't envisage a cure that isn't based on what they do best, and you've a turkeys not voting for xmas issue (perhaps even inadvertent/un self-aware due to the meld of politics, norms and personal beliefs and looking for what you look for).
     
  3. RedFox

    RedFox Senior Member (Voting Rights)

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    I mean, hey, if you don't have PEM, knock yourself out. But I doubt it will be curative. Lifestyle changes like exercise tend to be about managing, not curing, a chronic illness.

    Disappointingly, this paper doesn't explicitly say PEM is a contraindication for exercise. But they're at least aware of PEM, and implying you shouldn't exercise or need to be very careful if you get severe symptoms:
    We're seeing a trend of papers on long Covid and exercise taking a nuanced view, that exercise can be beneficial in the absence of PEM. This is a dramatic U-turn from earlier papers blatantly recommending CBT/GET and blaming LC on deconditioning.
     
  4. Mij

    Mij Senior Member (Voting Rights)

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    There is a fine line between PEM and post exercise symptoms during the early years. Making broad statements as to what to look out for isn't clear. My first "PEM" after exercise experience when I first became ill was quite different from what I experience now with autonomic symptoms mixed in.
     
  5. RedFox

    RedFox Senior Member (Voting Rights)

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    My PEM may have changed too, but it's hard to say if it's a difference in what symptoms I had, or a difference in what I noticed. But in the first few months of my illness, it was odd neuro symptoms. My mind was "jittery" or "glitching". It sort of felt like I was trying to think, but I was constantly about to forget what I was thinking about. My vision did the same thing, where it felt like there was a slight delay in my brain interpreting what my eyes saw. Over time, I stopped having that, and my PEM shifted being so exhausted I could barely think or move. This shift happened early in my illness, in the first year or so.
     
  6. V.R.T.

    V.R.T. Senior Member (Voting Rights)

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    Yes I worry about that. I could not tell the difference when mild and undiagnosed and jogged/worked myself into a moderate and largely housebound state, which declined to severe after Covid months later. I had had ME for over three years at that point so it concerns me when pwLC think they can return to running etc.
     
    Ariel, BrightCandle, Mij and 3 others like this.
  7. Mij

    Mij Senior Member (Voting Rights)

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    It's a pretty good indication that we shouldn't be exercising when our cognitive impairment becomes worse after exercise The tricky part is that it can take years to even realize this.

    I developed cognitive impairment (never had issues for the 11 years of M.E) when my health improved and I started running again. Took a while to convince myself that even though I felt really good during and right after exercise that I was going downhill with delayed PEM.
     
    Sean, oldtimer, RedFox and 5 others like this.
  8. ukxmrv

    ukxmrv Senior Member (Voting Rights)

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    I'm noticing on the LC groups that people who feel that exercise is important for their mental health are particularly resistant to warnings about PEM. I'm not sure what other avenues are open to them. They used exercise previously to try and cope with stress in their lives and may have already been dealing with previous experience of depression.

    It's not something I have any experience with so keep quiet.

    Making a connection to symptoms hours or days after exercise, if they are feeling better straight after, is not something they can accept.
     
    Art Vandelay, Sean, bobbler and 4 others like this.
  9. BrightCandle

    BrightCandle Senior Member (Voting Rights)

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    Quite a few long haulers seem to be going through the "great, bad, great, bad" cycle day after day and never recognising they are causing this boom and bust due to PEM. You can tell them what is happening but they have internalised deeply that Long Covid is not ME/CFS and they don't have that Psychological disease and its just worse some days. Not a lot you can do for them really, they will learn but only once they put themselves in a wheelchair and bed most of the time. I always try and take the abuse because I feel its important at least one person tells them what is happening and what they need to do differently just on the chance they heed it or it starts this process of concern within them that leads to progress or monitoring of the triggers across days. Its sad really the grip and impact that exercise therapy continues to have on the 140 million sufferers of Long Covid around the world.
     
  10. BrightCandle

    BrightCandle Senior Member (Voting Rights)

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    I hate being part of a group that knows its a conspiracy. Up until October 2021 we were all conspiracy theorists. Now we aren't quite the same but we definitely don't have mainstream acceptance. If you think about Youtube's guidelines our position is one of conspiracy and hence would/should be banned for misinformation. I am getting mighty disheartened by just how little effect truth and science is having on resolving this situation when so many new ME/CFS patients have been created by Covid in the past couple of years. We are loosing this information battle, the Psychologists remain trusted and completely in control of the situation despite being completely and utterly wrong and they are still harming people in their millions.
     
    oldtimer and Peter Trewhitt like this.
  11. bobbler

    bobbler Senior Member (Voting Rights)

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    I guess I didn’t spot this as such a move forward so it’s interesting to have this pointed out. I do think that if they mean it regarding PEM then there needs to be methodology to pick it out - the patterns aren’t as obvious for even the person themselves to pick up (maybe feel better right after then crawling round more but you don’t put it down to that if it isn’t flagged what to look for).

    And checks over the longer term as hope etc means you could be ‘slowly’ getting worse. Or robbing other activities to do your exercise etc.

    I think I was dissuaded
    Indeed - the word 'fluctuating' is another one that needs some more definitive vocab assigned to it. It feels the use of only that word represents more the disinterest we should be happy to accept of anyone without the condition. That all others need to know is that our condition and ability will vary. Half-justified by the line used of 'it's different for everyone'. But there are some broad themes that would take it out of this 'mystery box' and that are already known for many other conditions - or are just magnitudes on themes they experience (like getting a virus, overdoing it etc).

    I'm still shocked we don't have a big old diagram where a load of patients sat down and managed to come up with what stage-by-stage happens and is experienced and give each of these straight-forward 'does what it says on the tin' names. It's a tough enough illness to get others to describe without ending up starting a sentence and by the 4th word you realise you have to explain it, or note it doesn't mean what you'd think it would. I'm a broken record I know on that one.:laugh:
     
    RedFox likes this.
  12. RedFox

    RedFox Senior Member (Voting Rights)

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    Yes. This how I imagine the progress of research into post-infectious conditions:
    "You need to stop collecting welfare and go back to work. Nothing's medically wrong with you"
    "Your symptoms are real but due to deconditioning. Gentle exercise might help."
    "If you have PEM, be very careful about physical activity. You're ill, but we're clueless why." <--You are here
    "If you have PEM, exercise might make you more ill. You have a serious medical issue we don't understand."
    "You have a serious medical issue we're working hard to unravel"
    *Definitively discovers some aspect of ME pathology* "Wow, how are you still alive?!"
     
    bobbler, Trish and Sean like this.

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