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

SNT Gatchaman

SNT Gatchaman

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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]
 
abstract said:
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.
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abstract said:
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.
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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:

Screenshot 2025-07-01 at 5.14.39 pm.png
i.e. get off the sofa! (but exercise should start out being recumbent, and should not produce PEM).
 
Hutan said:
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).
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Off the sofa and healthy enough to shuffle along. I’m surprised he’s not jogging.
 
Hutan said:
If that is too technical for its clinician audience, the authors have provided a picture:

Screenshot 2025-07-01 at 5.14.39 pm.png

i.e. get off the sofa! (but exercise should start out being recumbent, and should not produce PEM).
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If rowing worked for everyone, I would not be lying here now. Spent 18 months doing it after covid, only made me worse..
 
The paper said:
However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms.
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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.
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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.

cir.0000000000001348.fig04.jpg
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"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.
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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.
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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
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Again this makes no sense, ignores reality. What causes the reduction in physical activity?!

9z29jk.jpg
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rvallee said:
"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.
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rvallee said:
Again this makes no sense, ignores reality. What causes the reduction in physical activity?!
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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.
 
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.
 
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.
 
Remarkable that they are actually aware of asymptomatic acute infection —

Among patients with Long COVID (N=367), the diffusion capacity of the lungs for carbon monoxide was lower among individuals with a more severe index infection (diffusion capacity of the lungs for carbon monoxide for asymptomatic infection, symptomatic infection, and infection requiring hospitalization: 95.2±14.3%, 90.3±14.2%, and 79.6±19.3%, respectively). 11 In this cohort, exercise tolerance, as determined by the 6-minute walk test, correlated with diffusion capacity of the lungs for carbon monoxide.11
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And yet conclude —

Long COVID is a devastating syndrome, affecting up to 25% of individuals previously infected with SARSCoV-2. Although multiple factors contribute to development of this syndrome, there is accumulating evidence that cardiovascular deconditioning is a central component of the pathophysiology. This deconditioning results from a relative reduction in physical activity in the setting of the index infection and its quarantine/confinement and leads to cardiac atrophy, a reduction in ventricular distensibility, and steepening of the Frank-Starling curve. Clinically, this phenomenon results in symptoms such as lightheadedness and orthostatic intolerance, brain fog/ confusion, tachycardia with minimal effort, palpitations, dyspnea on exertion, and severe fatigue/exhaustion. Reductions in VO2 observed among individuals with Long COVID are comparable to reductions observed among individuals with cardiovascular deconditioning as a result of bed rest.
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As with rvallee's meme-goose above I would like to know "What causes this cardiovascular deconditioning in acutely asymptomatic cases?"
 
Plus there is zero evidence about deconditioning. Straight up none. It's literally as textbook post hoc fallacy as it gets. There are many imaginable examples of post hoc fallacy that are as blatant as this, but none that are more straightforward. This claim is as ridiculous as the idea of someone raising themselves by their own bootstraps, it defies all the laws of nature, reason and common sense in the most insulting way.

Is it just medicine that is uniquely bad? What I've seen over the years is beyond bad, it's disastrous. Generally, you see discussions about research with all sorts of comments like "have they thought about X?" and always there are multiple replies of "they're scientists, of course they thought about obvious things like X, it's their whole job to think about these things" and then you realize that, actually, no, not even close, and not some of the time, but easily over half the time. Sometimes it's as straight up nonsense as knowing about something that invalidates their hypothesis, and, still, they just can't help themselves. Which is basically everything biopsychosocial.

I haven't read too many academic papers about computer science, I was more on the engineering side of things and never grad school level, but even random blogs about programming rarely ever got anything this wrong.

Because then that's really the main explanation for why progress in medicine is so slow. It really isn't just that it's hard. It is, but the slow pace is mostly explained by... whatever the hell is going on with this kind of failed reasoning. Maybe something about most of biology and health not making any sense, that it can't be reasoned, you need to know all the pieces and how they all fit but there is no way to intuitively understand any of it through reasoning.

And it's always worse in context, and the more context you add the worse it is. It's not just bad, it's disastrously bad, catastrophically bad. So much it can't be real.
 
rvallee said:
Because then that's really the main explanation for why progress in medicine is so slow. It really isn't just that it's hard. It is, but the slow pace is mostly explained by... whatever the hell is going on with this kind of failed reasoning. Maybe something about most of biology and health not making any sense, that it can't be reasoned, you need to know all the pieces and how they all fit but there is no way to intuitively understand any of it through reasoning.
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I don't think it's anything much to do with biology, because we don't see that in other industries based around biology. I think it is that there aren't a lot of consequences related to not achieving what we care about - better health outcomes. If a doctor kills someone through incompetence, they might feel bad, but the system typically learns little. If rates of death on a neonatal ward are higher than usual, it seems that there's no rapid response, beyond perhaps blaming an individual scapegoat.

For instance, how does the American Heart Association suffer by putting this nonsense out? We might think less of them, but we don't matter. There are no checks, no consequences. The senior people in the AHA aren't ridiculed by their peers. Cadiologists don't suddenly have no patients to treat. And, too often, this sort of stuff that serves to reduce short term costs to the health system but creates major despair in patients, actually gets rewarded.

There are few signals to improve the system. And I think that's partly because things that matter don't get measured, and reported, and analysed and acted on.
 
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