‘I Had Never Felt Worse’: Long Covid Sufferers Are Struggling With Exercise

Dr. Lambert noted that some patients with prolonged Covid are also diagnosed with postural orthostatic tachycardia syndrome (or POTS), a disorder that affects blood flow. In people with POTS, “the nervous system can’t regulate the things it’s supposed to control automatically, like heart rate, blood pressure, sweating, and body temperature,” he said. However, “those are all things that when you exercise need to be properly regulated.”

Some doctors also point to parallels between prolonged Covid patients and those with chronic fatigue syndrome, who have severe fatigue, memory and cognitive problems, and often muscle or joint pain. For decades, doctors advised patients with chronic fatigue that exercise would improve their symptoms, but for many patients, exercise actually made her symptoms worse And now it’s no longer recommended.

In 2021, Dr. Systrom and his team studied 160 patients with chronic fatigue, and found that when they exercised, they experienced many of the same blood vessel problems seen in long-term Covid patients, while control subjects did not. “Basically, we’re finding exactly the same thing” when it comes to potential mechanisms, she said.

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All of this leads to a question: should Covid patients who have problems with exercise continue to increase their physical activity? No one knows, and opinions differ. “There are both patients and doctors who are vehemently against any exercise” because of these issues, Dr. Systrom said. But he also said exercise may be possible, and even beneficial, long after Covid patients receive proper treatment. “If you can get the patient to a better place with medication, then you can embark on a graded exercise program without precipitating accidents,” he said.

Dr. Lambert agreed. “You can’t just start exercising, or you’ll be delayed,” he said, but he should “try to get back into it slowly if it feels better.” He added that prolonged Covid can manifest itself in different ways, so doctors and patients may need to tailor their recommendations to patients’ needs.

“That’s really the story of Covid: that for every patient, prolonged Covid is different,” he said. “There will probably never be a single recommendation for exercise.”

Melinda Wenner Moyer is a science journalist.

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