Too Tired to Move: Long COVID in Clinical and Population Settings - presentation at American College of Sports Medicine's 2024 annual meeting

DESCRIPTION

The emergency phase of the federal COVID-19 response ended in May 2023, but concerns remain about health impacts from post-COVID conditions, or long COVID. According to CDC, in Spring 2023, 4.6% of US adults reported activity limitations from long COVID symptoms, suggesting that nearly 12 million adults perceive long COVID as disrupting daily activity. Clinical research presented at ACSM 2023 supports this: persistent fatigue was predictive of decreased physical activity in former COVID patients. Decreased physical activity among people with long COVID may have important, long-term implications for health. Questions remain about the national epidemiology of long COVID and physical activity, the possible underlying pathophysiology, and the implications for patients, health care providers, and the health care system writ large. The purpose of this session is to highlight the current state of the science around long COVID and physical activity, covering national epidemiology, physiological underpinnings, and health care impacts.

Presenters:

Geoffrey Whitfield. Centers for Disease Control and Prevention, Atlanta, GA.

Beth Glace. Nicholas Institute of Sports Medicine and Athletic Trauma, New York, NY.

Robert Sallis, FACSM. Kaiser Permanente, Fontana, CA.

https://www.abstractsonline.com/pp8/#!/20101/session/185

 

Twitter thread from Dr Mark Faghy from Derby University starts here

Selected quotes from thread

"The third speaker spoke about clinical screening and determination of #LongCOVID, suggesting that treatment approaches should be compartmentalised to target symptom domains... here were some of the shocking recommendations:"

"My jaw was on the floor but it gets worse... as ‘treatments’ suggested to address POTS, ME/CFS and cognitive and neurologic symptoms included hydration strategies, GET and CBT…"

"Both of which are ineffective and can be dangerous, and do not address the underlying pathology, even if they were effective (which they are not) they would be management not treatment strategies…"

"It gets worse. They even called out the @WHO correspondence article that highlights that GET should not be recommended for people with #LongCOVID. Claiming that there is a bias from the ME/CFS population and a “reluctance from a few” to consider the actual benefits of exercise…"

More at link above.

 

Thanks for sharing that link.

The cult of exercise as cure is deeply engrained. Staggering to hear about this so late on.

Sigh.

 

It is disappointing that sports medicine is only interested in touting its own horn instead of understanding post-exertional malaise and its pathophysiology. One would think that such a counter-intuitive response to exertion would pique the scientific curiosity of top doctors and researchers in this field and draw their attention to it, but once again they predictably and unfortunately end up repeating the same harmful messages.

That said, the fact that one of the presenters works for Kaiser Permanente might explain this inclination.

 

May be the "clinical management of COVID-19 - living guideline", p115 of the PDF: "Interventions for rehabilitation based on fixed incremental increases in the time spent being physically active or graded exercise, should not be offered to people experiencing PESE (150)":

Link: https://app.magicapp.org/#/guideline/j1WBYn/rec/LA6lVY
PDF: https://files.magicapp.org/guidelin...06b5694bf575/published_guideline_6915-7_0.pdf

 

That's funny. They recommend pacing and rest for overtraining syndrome, which should be in the domain of their expertise, yet they reach out to LC and then recommend GET. Either Sallis doesn't understand OTS, or he didn't realize ME/CFS portion of LC is pretty much same thing as OTS. I searched for Robert Sallis and found this: Bio_Questions RSallis.pdf (exerciseismedicine.org).

 

@poetinsf - where did you see that part of the presentation?

 

Robert Sallis is a single issue MD, who seems to publish the same "exercise is medicine" article over and over again.

If exercise was medicine, it would be regulated and harms would be recorded, but I think that isn't what Robert Sallis actually wants. He wants medical doctors to promote exercise with no personal consequences if something goes wrong.

 

Additional, from the Dallas Bed rest study. Note this data is L/min, not normalised to body weight.

Participant B was a runner, Participant E was a football star who stopped exercising due to various injuries - note the regression to the mean for those who were athletic compared to the others.



https://academic.oup.com/biomedgerontology/article/64A/2/293/664123

 

The overtraining part? It is a general recommendation by sports medicine, not from the presentation. This from Cleveland Clinic, for example, recommends complete rest and cutting down exercise.