Long COVID & Post-Viral Syndromes ECHO: When Exercise Doesn't Help (BHC educational video)

[Dolphin]

Bateman Horne Center
12 Dec 2023
Long COVID & Post-Viral Syndromes ECHO

When Exercise Doesn't Help

Bateman Horne Center and the University of Utah Health ECHO teams join forces once again to provide a case-based learning series illuminating strategies for assessment and management of Long COVID (PASC), ME/CFS, and related comorbid conditions.

Occupational therapist, Amy Mooney, MS, OTR/L, and physical therapist, Clayton Powers, DPT address the importance of screening for PEM and redefine "exercise" in patients with PEM/PESE.

Powers and Mooney address:

- Research data on CPET testing as it relates to patients with PEM

-How dysfunction in aerobic metabolism pushes patients into the anaerobic system at lower heart rates when compared to pre-illness.

-Cerebral under perfusion

-Screening for PEM

-Energy conservation tips

-Graded exercise protocols like the Levine or CHOP protocols are contraindicated, and exercise can be detrimental for patients experiencing PEM

-Heart rate biofeedback pacing

-Pacing upright activity

-Case examples from a physical and occupational therapy perspective

-Goal of OT: Improve quality of life through participation in meaningful and purposeful activities

-Working with Frames of Reference (FOR) to therapeutically support strengths and deficits Identify/determine immediate & delayed symptoms
● Prioritize/analyze activity within PEM limitations
● Manage pre-emptive and recuperative rest

-The most effective treatments for PEM are:
○ Education
○ Activity pacing
○ Energy conservation

Note to community members: We advise viewers to always speak with their medical care team prior to making any adjustments or changes to their current regimen.

Bateman Horne Center’s involvement in this program is made possible with the additional support of the Open Medicine Foundation.

https://twitter.com/user/status/1736749085363675202

https://twitter.com/user/status/1736751067482714316

 

[Hutan]

Occupational therapist, Amy Mooney, MS, OTR/L, and physical therapist, Clayton Powers, DPT address the importance of screening for PEM and redefine "exercise" in patients with PEM/PESE.

Perhaps it is churlish of me, but noting that exercise is contraindicated in people with post-viral symptoms seems to me to be only part of the story. Where's the evidence that exercise helps fix anyone with post-viral symptoms?

Near the start: Amy Mooney: "I have focussed my treatment approach for people that have post-exertional malaise who have ME and who are seeking help regaining the life they used to live and restoring their occupations of daily living."
What makes Amy Mooney think that she can help people with post-exertional malaise regain the life they used to have?

There's a lot of good stuff. There's some brave stepping into the science of ME/CFS physiology, with statements made much more assertively than the current evidence warrants. For example, if it was an unassailable fact that PEM is the result of a build up of lactic acid that could be measured in the blood, I think we'd have much of ME/CFS solved.

But there's always this underlying belief that exercise can fix everyone who isn't found to have PEM.
e.g. at 11 minutes:

Rehab providers need to screen for PEM on a regular basis
If the patient has PEM, exercise therapists need to provide an alternative treatment approach
Graded exercise protocols like the Levine or CHOP protocols are contraindicated and exercise can be detrimental for patients experiencing PEM.

And there seems to be a belief that patients with PEM are going to be fixed by pacing and education, even though it is going to take a long time.

At 22 minutes, despite all the earlier good stuff about there being no point adding exercise if activities of daily living aren't being accomplished without PEM, there's the suggestion that some people with PEM should follow a programme with recumbent exercise.

At 23 minutes, there's the recommendation of an intervention that involves setting a timer to "lie down or move every hour". That seems like just adding more restrictions into someone's life - where's the evidence?

 

[Hutan]

The ambiguity of the messages continues. e.g. at 23/24 minutes on one slide:
"People tend to naturally increase their physical activity when they feel better"
"Exercise can be harmful to some patients with dysautonomia and should be prescribed by a health care provider that understands the complexities and complications of neuroimmune conditions and PEM"