Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID, 2023, Edward et al

[SNT Gatchaman]

Characteristics and Treatment of Exercise Intolerance in Patients With Long COVID
Edward, Justin A.;Peruri, Adithya;Rudofker, Eric;Shamapant, Nikhil;Parker, Hugh;Cotter, Ryan;Sabin, Katherine;Lawley, Justin;Cornwell, William K. III

The post-acute sequalae of SARS-CoV-2, also known as “Long COVID,” is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. At least 25-30% of individuals impacted by SARS-CoV-2 will go on to experience the Long COVID syndrome, underscoring the detrimental impact this condition has on society. Although efforts are underway to further understand risk factors for Long COVID and identify strategies to prevent disease development entirely, implementation of treatment strategies is warranted to alleviate symptom burden among those affected.

This review provides a rationale for exercise prescriptions tailored to the Long COVID patient based on the pathophysiology underlying this syndrome, as well as the previously demonstrated benefits of exercise training in other similar populations whose clinical manifestations result from cardiac deconditioning. Herein, we discuss methods to tailor exercise protocols, accommodating exercise intolerance and post-exertional malaise that may otherwise limit the ability to participate in a training protocol, as well as data demonstrating that a focused exercise prescription may effectively alleviate symptom burden in these patients.

Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity. Exercise prescriptions tailored to patients with Long COVID may effectively alleviate symptom burden associated with this condition and in the absence of overt contraindications should be considered in management.

Link | PDF (Journal of Cardiopulmonary Rehabilitation and Prevention)

 

[SNT Gatchaman]

Paywalled, but intrigued to read quite how they propose that 20 hours of inactivity -> deconditioning -> Long Covid.

In the meantime: "hah hah hah, no".

 

[Denise]

The authors are at one of the RECOVER sites (though I haven't looked to see if they are in any way part of RECOVER)
@Dakota15 ?

 

[EndME]

I remember when I went from full time working and high level athlete to fully bedbound within one night. I guess I just shouldn't have deconditioned so hard in that one night.

 

[Wyva]

Yep, everyone knows that even healthy people need to work out every day because if they skip even one day, they might risk ending up as reverse Captain America.

And that's if they are lucky and don't get disabled after a super lazy day.

 

[Dakota15]

The authors are at one of the RECOVER sites (though I haven't looked to see if they are in any way part of RECOVER)
@Dakota15 ?

Correct. I'll flag to the 2 CU PI's I've connected with on RECOVER.

 

[Mij]

No thanks. CBT helped me learn to identify, question and change how my thoughts, attitudes and beliefs related to my emotional and behavioural reactions. I'm cured!!

 

[rvallee]

Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity.

Why do they just make stuff up like this? It obviously isn't true, and slight deconditioning obviously doesn't cause this type of illness with such severe symptoms, let alone just a bit of inactivity.

And from as little as 20h? 20h?! Most people meet this criterion, and the vast majority do at least a few times per year, if they take some time off. Almost everyone coming back from vacation would. This is completely unserious.

And then what would it even have to do with COVID? They're genuinely, or pretending to be, aware of the huge number of athletes and very fit people with LC? People who thought they had recovered from the acute illness then resumed their training, or at least regular activity? Even high schoolers are expected to try better than this.

 

[NelliePledge]

20h inactivity could be a fair number of the adult population over a boozy bank holiday

 

[Medfeb]

From the article...
"When considering implementation of an exercise protocol, it is critical to emphasize the importance of a graded increase in exercise duration and intensity, so as to avoid post-exertional malaise that may otherwise limit adherence to the program.54 At the same time, it is equally important to emphasize the potential for such a program to improve symptoms associated with Long COVID, and in the absence of overt contraindications, a tailored exercise prescription should be included in man- agement of these patients."

 

[Trish]

Such ignorance is inexcusable.

 

[Kiwipom]

T

From the article...
"When considering implementation of an exercise protocol, it is critical to emphasize the importance of a graded increase in exercise duration and intensity, so as to avoid post-exertional malaise that may otherwise limit adherence to the program.54 At the same time, it is equally important to emphasize the potential for such a program to improve symptoms associated with Long COVID, and in the absence of overt contraindications, a tailored exercise prescription should be included in man- agement of these patients."

This is very contradictory, it doesn't make any sense. Such bias towards graded exercise even when it's clearly contraindicated. Just be more motivated, tell yourself you are OK. I can't find an eye rolling

I remember when I went from full time working and high level athlete to fully bedbound within one night. I guess I just shouldn't have deconditioned so hard in that one night.

Me too, I went from 1h30 half marathons to unable to walk overnight. Must have been the overnight deconditioning then! Odd that it never improved despite trying exercise as repeatedly told to, in fact made it so much worse that I couldn't even stand. Pretty rapid deconditioning there. Ridiculous.

 

[Ash]

T


This is very contradictory, it doesn't make any sense. Such bias towards graded exercise even when it's clearly contraindicated. Just be more motivated, tell yourself you are OK. I can't find an eye rolling


Me too, I went from 1h30 half marathons to unable to walk overnight. Must have been the overnight deconditioning then! Odd that it never improved despite trying exercise as repeatedly told to, in fact made it so much worse that I couldn't even stand. Pretty rapid deconditioning there. Ridiculous.

Yeah I think this paper is personally tailored and individualised for pre-chronic condition athletes like the both of you. You must be so relieved to be seen and heard. Believed and represented at long last. What good fortune this pandemic has produced increased scrutiny, without which your cohorts would be still out in the cold unaccounted for, even by good standard evidence based phychosomatic modelling.

 

[SNT Gatchaman]

Long COVID results, in large part, from deconditioning, which may result from as little as 20 hr of inactivity.

Paywalled, but intrigued to read quite how they propose that 20 hours of inactivity -> deconditioning -> Long Covid.

The references include Cardiovascular deconditioning produced by 20 hours of bedrest with head-down tilt −5° in middle-aged healthy men (1985).

So this claim would appear to be unsupported.

1. The 1985 paper states: "The results support the concept that cardiovascular deconditioning after bedrest is primarily an adaptation to a postural fluid shift rather than to inactivity"
2. These findings relate to middle-aged men which is not the predominant demographic seen in LC/ME.
3. Nobody outside of some specific physiology study is undergoing "20 hr of inactivity" as bedrest in a 5° head-down position.

 

[rvallee]

I’m a researcher w/expertise in exercise adherence & this stuff drives me nuts. If you know any MDs who want to sign onto a paper I’m working on deflating the fitness myth or hybrid immunity providing full-proof protection of syncytial virus, I’m open to collaborating.

 

[SNT Gatchaman]

Noting: American, European and Russian space agencies routinely investigate zero-g effects and counter-measures with volunteers in 5-6° head-down tilt full time for 2 months. They have done this since the 1960s. Subjects recover fine and there has never been a report of long-term symptoms.

 

[bobbler]

Why do they just make stuff up like this? It obviously isn't true, and slight deconditioning obviously doesn't cause this type of illness with such severe symptoms, let alone just a bit of inactivity.

And from as little as 20h? 20h?! Most people meet this criterion, and the vast majority do at least a few times per year, if they take some time off. Almost everyone coming back from vacation would. This is completely unserious.

And then what would it even have to do with COVID? They're genuinely, or pretending to be, aware of the huge number of athletes and very fit people with LC? People who thought they had recovered from the acute illness then resumed their training, or at least regular activity? Even high schoolers are expected to try better than this.

In fact don’t good training regimes for athletes require rest days

isntvripping of muscles literally that and requires therefore time when you aren’t ripping them in order for them to grow back stronger hence ‘leg days and arm days’

it used to be that if someone got twitchy not being able to work out for a week in holiday they had a problem and now that is being encouraged saying 20hours

I got I’ll when I never had 20 hours off between sports not even Sundays off and often several on the same day even when I was really sick because ‘committment’ and ‘someone has to do this and you aren’t struggling with your grades so we are allowed you’

I was the idiot who even though I was asleep ill 23hrs a day when I had EBV was still doing stuff on that one hour which meant suddenly finding my calves got bone deep aches from driving later certainly wasn’t from those muscles not having been used

yet friends who never did much never got aches or issues and those who just got lazy never had been bed bound or bone deep pain from smallish activities.

how can these people deluded themselves of that sane reality they must also have observed over that same time period that was right in front of their eyes? People who pretend to see what they want to see.

 

[bobbler]

Such ignorance is inexcusable.

They should be required to retrain for saying this nonsense - if you can’t read something without inverting it that’s just not an excuse to keep your job where there is a responsibility to be on top of these things where is the self-respect anymore