What is known about the patient:
She has had COVID twice —
and since then, nothing has been the same.
“I can no longer live my life
the way I want to.
I want to be happier.
I am a positive,
cheerful person.
All of that has fallen away.”
She is 58 years old.
She suffers from post-COVID syndrome,
is constantly exhausted,
lacks energy, and becomes short of breath easily.
“I feel resigned.
I no longer have confidence in the future.
Sometimes I think
I can’t cope with all of this anymore
and I’ve reached a point
where I simply don’t know what to do.”
Her physical capacity is
significantly reduced
because she lacks both breath
and strength.
We have the report
from the pulmonary specialist.
It shows
that her inspiratory muscle strength
has been reduced to 60%.
This is
a considerable impairment.
“I have gained weight because
I can no longer move around
the way I would like to.
All of this affects my mood.”
She can barely manage
her part-time office job anymore.
About the Movement Docs
That is about to change
with the help of the Movement Docs.
They treat illnesses
through exercise:
Cardiologist Melanie Hümmelgen,
rehabilitation physician Christian Sturm,
and sports medicine specialist Helge Riepenhof.
The Movement Docs’ Perspective
She avoids physical exertion
and becomes increasingly inactive.
The question for the doctors is:
How much exercise
can Angela Kück tolerate?
Does she experience severe exhaustion
after exertion to the point where she says:
“I completely crash
if I exert myself physically?”
She describes
typical fatigue symptoms.
She has this leaden tiredness
and does not recover well.
However, she does not have
post-exertional malaise (PEM)—
what patients often describe
as a “crash.”
That means worsening symptoms
after physical
or emotional exertion.
So she is allowed to exercise.
In that case,
I would apply for rehabilitation with her.
That will help her
most effectively.
Specifically,
through a holistic post-COVID rehabilitation program
with Melanie Hümmelgen
at the Mühlenberg Clinic in Malente.
Angela begins
the four-week program
with a fitness test.
“You will walk continuously
for six minutes
at your own pace,
as far as you can.
Each time you walk the length
of the hall,
take one marble.
Each marble
represents 50 meters,
which makes counting easier.”
The test begins.
How many meters
can Angela walk
in the allotted six minutes?
325 meters.
“That is a low result
for six minutes.
We typically see distances like this
in patients with heart failure.”
Next comes
a neurological assessment.
Angela must complete
a fatigue questionnaire.
“You scored a total of 58 points.
The average score is 38,
which means the scale indicates
a very pronounced level
of fatigue.”
Additional tests show
that since her COVID infection,
Angela has also been suffering from memory problems
and difficulty concentrating.
These symptoms affect her daily life considerably.
“Sometimes I’m looking for something
or going to get something,
for example in my pantry.
I walk ten steps,
and when I get there,
I have no idea
why I went there.
I can no longer concentrate
on several things at once.
I really have to pull myself together
to stay on top of things.”
It is time
for something to change.
Movement Doc Melanie Hümmelgen
has developed a training program.
Point 1: Train the brain
“Our neuropsychology colleagues
at the neighboring August Bier Clinic
can help.
With computer-based
cognitive training,
we can see
whether it benefits you.”
Point 2:
Improve Angela’s physical capacity
through strength and endurance training.
Point 3:
Breathing exercises.
Pulmonary specialist Sabrina Rottmann
from Grosshansdorf Lung Clinic
consults Angela via video appointment.
“You saw a pulmonologist
back in March 2024.
He noticed that your diaphragm
had been somewhat affected
by the viral illness.
The lungs themselves
are not muscles.
They cannot move on their own.
To expand
and allow air to flow in,
they need assistance
from the muscles.
The diaphragm
is particularly important.
This muscle
pulls the lungs downward.
In post-COVID patients,
the diaphragm can be weakened.”
Angela has only 60%
of normal respiratory muscle strength.
The specialist recommends
a breathing trainer.
Angela should inhale slowly
against resistance.
The small ball rises
and should be kept
within the target zone.
This strengthens the diaphragm.
“You can repeat this
several times,
multiple times per day.”
The rehabilitation program can begin.
The first item on the agenda
is breathing therapy.
“Let the air flow in.
And now slowly breathe out
through pursed lips.”
We repeat the exercise.
The focus
of breathing therapy is:
“We are trying
to train the diaphragm
to encourage deeper breathing
for longer periods
and achieve
a longer exhalation.
This helps people cope better
with resistance or exertion,
such as climbing stairs,
which is often difficult.
If you have limitations,
the goal is to help you withstand them
or manage them more effectively.”
In exercise therapy,
light muscle-building exercises follow.
Physiotherapist Lea Giebelstein
ensures correct technique.
“Keep your shoulders relaxed.
Engage the muscles
between your shoulder blades,
open your chest,
and straighten up.
This strengthens
the muscles in your back
so that you can walk more upright.”
During a break,
Angela uses her breathing trainer.
Time to process
her first impressions
of rehabilitation.
“I’ve never been
to rehab before.
This is completely new territory.
I really like it,
because people understand
what I’m struggling with.”
The next therapy session:
computer-based cognitive training
to address Angela’s forgetfulness.
“This is an exercise
for concentration and attention.
Here is an example image.
I’d like you
to find the picture
that is exactly identical
and tap it.”
Just as with muscles,
the same principle applies
to the brain:
Use it or lose it.
The brain must be challenged,
otherwise it deteriorates.
“It’s difficult because
there are so many details,
so many colors.
The pictures
look very similar.
I think I used to be
faster at this.
This is pretty mean.”
“Good morning!
I wanted to give
a quick update
from my rehabilitation.
I have a full schedule
almost every day.”
The effort pays off.
Day by day,
Angela improves
her strength and endurance.
For four weeks
she trains under supervision.
The challenge will be
continuing at home afterward
and not falling back
into old habits.
Will she succeed?
One month later
Has Angela managed
to integrate the exercise program
into her daily life?
“At home,
it’s difficult
to fit everything in.
You still have to work,
and there simply aren’t enough hours
in the day.”
She has learned
to manage her energy.
“I continue
with my breathing exercises.”
She also does endurance training
several times a week.
Whether in the water...
...or on land.
“I actually enjoy exercise now.
The only thing I don’t enjoy:
I would never go outside
when it’s raining.”
On those days,
she completes her workouts
on a stationary bike.
“When I’ve done it,
I feel satisfied
and proud of myself.”
And she is not only strengthening
her muscles—
she is also training her brain.
“There are various apps
that I use in everyday life.
They focus on memory training,
concentration,
and mental arithmetic.
I practice doing calculations
in my head.
I’m still very motivated.”
Will this help her
gain control over
her post-COVID symptoms?
Two months after rehabilitation
Angela Kück
and Melanie Hümmelgen
meet again.
They discuss
the results
of the final assessment.
“Your cognitive difficulties
caused you a great deal of distress
and uncertainty.
Combined with
the fatigue syndrome,
the exhaustion.”
Three months earlier,
Angela scored
58 points
on the fatigue questionnaire,
which was a poor result.
“Now your score is 28,
which is considered normal.
Normal doesn’t mean zero—
anything below the mid-30s
is considered normal.”
“Wonderful.
I’m very happy about that.”
The cognitive training
was also successful.
“My memory
has improved significantly.
I no longer have to make
unnecessary trips around the house.”
And what about
her physical performance?
Looking back:
Three months earlier,
Angela had managed only
325 meters
in the six-minute walk test.
“At the time,
I explained that 325 meters
was comparable
to a patient
with severe heart failure—
a seriously poor result.
Now your result
is completely normal.
I would expect
a healthy woman
to walk more than 500 meters.
And you walked 513 meters
while chatting at the same time.”
This improvement
is also due to
stronger respiratory muscles.
“Your inspiratory muscle weakness,
which had reduced your capacity
to 60%,
has now returned
to normal lung function.
You now have
normal respiratory muscle strength.”
“That’s sensational.”
“Thank you.”
On top of that,
she has lost
more than ten kilograms.
“I’m extremely satisfied
with the results.
I knew things were
much better
because I can manage
my everyday life so much more easily.
Because I can breathe better.
But I never expected
the results
to be this good.”
Angela has succeeded.
The consequences
of her COVID infection
are now a thing of the past.
www.mecfs.de
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