Exercise Intolerance and Response to Training in Patients With Postacute Sequelae of SARS-CoV2 Long COVID…, 2025, Cornwell et al.

[SNT Gatchaman]

Exercise Intolerance and Response to Training in Patients With Postacute Sequelae of SARS-CoV2 Long COVID: A Scientific Statement From the American Heart Association
William K. Cornwell; Benjamin D. Levine; Diane Baptiste; Nicole Bhave; Sarika Desai; Elizabeth Dineen; Matthew Durstenfeld; Justin Edward; Mu Huang; Roni Jacobsen; Jonathan H. Kim; Erica Spatz; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council

The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance.

Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest. Concern has been raised about the use of exercise training as part of the management strategy for patients with Long COVID. However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms.

This American Heart Association scientific statement provides a concise yet comprehensive overview of mechanisms contributing to development of Long COVID and methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life. In addition, methods of reintroducing exercise and return to play among athletes affected by COVID-19 are discussed.

Link | PDF | Circulation [Open Access]

 

[Hutan]

This American Heart Association scientific statement provides a concise yet comprehensive overview of mechanisms contributing to development of Long COVID and methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life.

Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest.

Yet another in the long line of people and organisations who have Long Covid all worked out - and in a 'concise and comprehensive' way. Silly us, our problem is mostly just cardiovascular deconditioning.

If that is too technical for its clinician audience, the authors have provided a picture:


i.e. get off the sofa! (but exercise should start out being recumbent, and should not produce PEM).

 

[Turtle]

Recumbent rowing? No muscle damage as seen by Wüst and co? Picking and choosing?
Cardiologists starting late in research, maybe they need some catching up first.

 

[Midnattsol]

Yet another in the long line of people and organisations who have Long Covid all worked out - and in a 'concise and comprehensive' way. Silly us, our problem is mostly just cardiovascular deconditioning.

If that is too technical for its clinician audience, the authors have provided a picture:

View attachment 26814
i.e. get off the sofa! (but exercise should start out being recumbent, and should not produce PEM).

Off the sofa and healthy enough to shuffle along. I’m surprised he’s not jogging.

 

[Utsikt]

If that is too technical for its clinician audience, the authors have provided a picture:

i.e. get off the sofa! (but exercise should start out being recumbent, and should not produce PEM).

If rowing worked for everyone, I would not be lying here now. Spent 18 months doing it after covid, only made me worse..

 

[rvallee]

However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms.

Again, the mindless nonsense of saying this as if 1) no one had thought of this before, 2) no one had tried it, 3) let alone specifically for this, 4) definitely not for several years, or 5) for very similar illnesses for decades before that. What the hell is up with this Dr Magoo bullshit going on in medicine? Where everyone pretends like neither past nor present exist, and the thing that is literally the most over-utilized thing, to obvious and widespread failure, just hasn't been considered yet? They all know it's BS, they're smart enough to know this.

If someone presented this in a film people would walk out in anger at "stupid useless characters being stupid as a plot device", something known as the idiot plot, where there wouldn't even be a problem if everyone involved weren't so stupid. Except everyone in this profession is technically smart, so this is all pretense. A distinction without a difference.

First, the exercise protocol must incorporate low-duration, low-intensity exercise early to minimize or avoid the risk of postexertional malaise.

They have no clue what PEM is. They don't pay attention, they don't listen to the people experiencing it. This is like advising the poorest people in the world how to manage an upper middle class budget: don't do an expensive kitchen modeling, keep expensive vacations to at most twice per year, and so on. Not a damn clue.

"Increase as tolerated". OK, and what if it's not tolerated? Then what? Because that's literally what PEM is. They just completely ignore reality and can't be bothered to care. I have a recumbent bike they show in the graph above. I've been using it for two years, as tolerated. My capacity has grown by about 200-300%, which still leaves it as far less than what my 79 year-old father can do. This is ridiculous delusional fantasy stuff.

Emerging data indicate that exercise training programs improve key outcomes in Long COVID, including peak V̇o2,47–50 6-minute walk distance,47,49 and metrics of fatigue, dyspnea, or quality of life.

It's been 5 years. None of this is emerging, it's a massive failure, but they reject reality and substitute their own. Always forever promising, never actually delivering, always has fake delivered for years.

Multidisciplinary clinics have emerged to provide comprehensive management strategies to patients with Long COVID.

Hundreds have literally come and gone. Emerging was 5 years ago. Most have closed down, because this is all they did, and it's a massive failure. But in their fantasy universe, where time is not relevant, this is emerging stuff.

This deconditioning results from a relative reduction in physical activity

Again this makes no sense, ignores reality. What causes the reduction in physical activity?!

 

[Sean]

"Increase as tolerated". OK, and what if it's not tolerated? Then what? Because that's literally what PEM is. They just completely ignore reality and can't be bothered to care.

Again this makes no sense, ignores reality. What causes the reduction in physical activity?!

Exactly.

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Multidisciplinary clinics have emerged to provide comprehensive management strategies to patients with Long COVID.

Based on absolutely no robust evidence whatsoever that these clinics either understand or have any helpful advice to offer.

 

[Hutan]

Multidisciplinary clinics have emerged to provide comprehensive management strategies to patients with Long COVID.

To which I reply - see this study of the impact of a multidisciplinary clinic by Meagher, Nacul et al. These clinics are essentially useless, at least for the ME/CFS flavour of Long Covid.

 

[hackorbee]

Unless I am missing something, I'm surprised that I don't see any references to any exercise studies on ME/CFS and when it talks "about the safety of exercise training" with PEM it references "other populations with similar symptoms" then lists studies of people after bedrest/space flight, and POTS patients.

 

[Trish]

It seems from the abstract that they are blinkered by their theoretical model of exercise therapy intolerance caused by cardiovascular deconditioning, so the immediate effect of exercise on that model might be breathlessness and fatigue, which of course can be fixed with graded exercise programs.
From the abstract it seems they are even aware of the existence of PEM.

 

[Jonathan Edwards]

Like the quote about the answer to a question headline always being no I think there is a rule that any abstract that cites 'Emerging evidence' is going to be garbage. It really just means 'everyone else is jumping on this bandwagon so we will too'.

 

[Jaybee00]

Maybe David Systrom could respond to this? Or maybe @dave30th might be interested.