There is clearly a huge problem with defining what rehabilitation even means, because it only applies in exceptional cases here, the vast majority of people suffering from any set of LC symptoms have no need for any type of rehabilitation, most of the time the patients know better than the therapists anyway, and I don't know of a single bit of professional-grade insight or skill that professionals can add beyond what patients can learn in 15 minutes.
Stratification of patients by POTS or PEM status allows for tailored rehabilitation plans, prioritising breathing exercises, low-intensity activities and pacing strategies for those experiencing PEM.
"Tailored rehabilitation plans" is way too vague and broad, there is no actual evidence that such 'plans' offer any meaningful benefits, breathing exercises have very little relevance, and what is even the point of "low-intensity activities"? Who needs that?! No one needs professionally-coached "low-intensity activities" because we are not children whose time needs to be managed, or whatever. And "pacing strategies" is not really a thing, pacing is not rehabilitation, it's convalescence, which is basically the opposite of rehabilitation.
Our professional allies will really need to stop pretending like any of this is valid if they ever want to help us. The only valid reason to do this kind of exertional rehabilitation is from severe deconditioning, and even at that most people don't need any such coaching because normal activities of daily living are more than sufficient, and people can do the rest all on their own. I'd be surprised if anything more than 1-2% ever need that, and I genuinely don't think outcomes would be meaningfully worse if no one did.
This kind of stuff is frankly just insulting in a "you people need to learn how to adult" way. The entire premise is that we are idiots suffering from weird phobias and ended up deconditioning ourselves because we stopped doing everything even though we were always capable of it, or whatever, and all of it is junk, there is no need to pretend that the lies have any relevance here.
They even do those mistakes in the paper:
While prolonged rest may initially seem beneficial for symptom management, extended periods of daytime lying or bed rest can induce cardiovascular and skeletal muscle deconditioning.
Almost no one needs to hear that, because almost no one does that, and the vast majority of those who do wouldn't do that in the first place if they weren't neglected and gaslighted in the first place, this is a wholly medicine-manufactured problem that could be eliminated by tomorrow if the motivation was there. Most severe patients who significantly improve manage it on their own anyway, and it's not as if any such coaching would change much, in about 99.9% of cases those people would benefit far more from at-home help, financial support and similar things.
Incorporating PEM into a new conceptual model of long covid cardiac rehabilitation programmes is essential to clinically distinguish it from cardiovascular deconditioning and to safeguard patients from unintended harm.
And again, cardiovascular deconditioning isn't even a secondary problem here, it's even less important than that, and the whole rehabilitation ideology is built around the belief that it's the only thing. Because of all those issues papers like this end up being more harmful than useful, they perpetuate the old debunked myths when we need health care that is based on fact and evidence, not myths and suspension of disbelief.
This is a political problem where messaging is crucial and this whole "my opponent is right about x" when actually they are not is just bad politics. We need better than this, the whole approach is wrong and it needs to be said out loud, defiantly.
