‘Bouncing’ Back from Long Covid

Covid, ahh Covid… It has been a topic hot on everyone’s lips since its emergence back in 2019. As much as we don’t want to believe it, Covid doesn’t seem to be going anywhere anytime soon! And the number of people who have personally been infected by Covid continues to rise as new waves move through the community.

Unfortunately, for some of these people, research is suggesting that the symptoms don’t resolve completely as they recover from the virus. Coined ‘long Covid’ for obvious reasons, these individuals can experience ongoing fatigue (physical and cognitive), respiratory problems, cardiovascular problems, chest pain, muscle aches, and mental health implications such as anxiety and depression. To be considered as ‘long Covid’, they need to have experienced these symptoms for 12 weeks after their initial infection. It is estimated that 10-20% of those infected will experience long Covid (1).

Researchers have been busy trying to find solutions for a virus that is still so new on the scene, but a lot of the research efforts have been directed to acute recovery as opposed to long Covid recovery. There are still a lot of unknowns and question marks!

We (as always), have been keeping a keen eye on the literature to figure out what is being acknowledged as the best practice, exercise-wise.

To Exercise or Not to Exercise?

“Physical inactivity is associated with a higher risk for severe COVID-19 outcomes.” (2)

Let’s step back first and foremost. The benefits of exercise for immunity and general wellbeing are well documented. This analysis of 48,440 adult patients with Covid19 showed that being physically active is protective for Covid outcomes – making them less likely to be hospitalised, go to ICU, or die from the virus. Doing some exercise, even if not enough to meet the physical activity recommendations, was still superior to no exercise at all! So for the sake of preventing re-infection, exercise is a good strategy.

“Exercise is important for recovery for patients with COVID-19 but must be done gradually and safely” (3)

This article put out by the Australasian College of Sport and Exercise Physicians suggests a graded return to exercise “once the patient is symptom-free for seven days and no analgesia [pain relief medication] is required.” Not suuuper helpful for long Covid, considering that the basis of the problem is in unresolved symptoms! It does however raise a good point – that exercise is a vital method for combating some of the other implications of Covid 19 – such as the damage that can occur to the heart and respiratory symptoms.

As exercise physiologists, exercise takes center stage for cardiovascular and pulmonary rehabilitation. For mental health recovery too! So considering the prevalence of these conditions in long Covid, it makes sense that, when the timing is right, exercise should be gently phased back into that individual’s life. The emphasis here being on ‘when the timing is right’!! Exercise physiologists are the ideal professionals to ensure that the return to exercise is safe.

What About Fatigue Symptoms?

If you’re asking this question, then you’re probably pretty clued up in the fatigue management space! This article (4) published in the British Medical Journal describes the cautions made by N.I.C.E. (National Institute for Health and Care Excellence) against using graded exercise therapy in individuals suffering from post-viral fatigue resulting from Covid 19. This is due to a phenomenon known as ‘post exertional malaise’ – where any increased exertion can result in a significant exacerbation of fatigue.

Is this sounding familiar? We’ve written another article about the draft N.I.C.E. recommendations for managing chronic fatigue!

When it comes to managing chronic fatigue; it appears that graded exercise therapy is out, pacing and activity management is in. We are still exercise physiologists, admittedly… So we still want to introduce exercise in the long term to get all those benefits mentioned above! But when post-Covid fatigue is the primary concern, we take a chronic fatigue approach first. Once these fatigue symptoms stabilise, we can start to build exercise capacity.

Our Bounce program has been specifically designed, in line with the draft N.I.C.E. recommendations, for individuals affected by post-viral fatigue – making it the perfect fit for individuals affected by long Covid.

Author: Yolanda van Vugt 
Clinical Exercise Physiologist and Content Creator at Specialised Health

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