Story at a glance
- Some people with a COVID-19 infection can have symptoms and health complications after they are no longer infected with the virus.
- This is called long COVID or post-COVID syndrome.
- A small group of participants in rehabilitation program in the UK were able to gradually increase physical activity and reduce long COVID symptoms over six weeks.
A rehabilitation program for long COVID symptoms in the United Kingdom shows “impressive” results, according to a new paper in the Journal of Medical Virology. Participants had fewer episodes of exhaustion after six weeks in the program and their ability to be active and quality of life showed “moderate improvement.”
The rehabilitation program specifically focused on gradual or paced increases in physical activity for long COVID patients. It was administered as part of the long COVID service at Leeds Community Healthcare National Health Service Trust in the U.K.
People who have long COVID, also known as post-COVID syndrome, sometimes experience symptoms for weeks and months after their COVID-19 infection has passed. These can include feeling tiredness or fatigue that interferes with their daily activities, fever and difficulty breathing, according to the Centers for Disease Control and Prevention (CDC). These symptoms can worsen after physical or mental exertion, also called “post-exertional malaise.”
“Post-exertional malaise or post-exertional symptom exacerbation or simply ‘crashes’, as described by patients, is a defining and important symptom of long COVID,” says Manoj Sivan, who is an Associate Clinical Professor in the School of Medicine at the University of Leeds and led this research, in a press release. “When patients get a crash, they experience feelings of complete exhaustion and wipe out and are unable to resume activities for hours or sometimes days.”
Before starting the program, participants had long COVID for an average of 17 months and experienced on average three “crashes” per week where they felt physically, emotionally or cognitively exhausted after mild physical or mental exertion.
Over the course of six weeks, 31 participants followed the World Health Organisation (WHO) CR-10 Borg pacing protocol, which includes five levels of activity. The protocol rates how active a patient is and what level they are at based on a scale of 0 to 10 where 0 is the lowest level of exertion and 10 is the highest. There are suggested activities for different levels like breathing exercises, gentle walking, jogging and resistance exercises. The more rigorous levels included activities like running, swimming and dancing.
Level five, with a score of 8 to 10 on the scale, represents the baseline level of activity where the participant could do their regular exercise and activities pre-COVID infection.
By the end of the six weeks, the average number of crashes patients experienced per week went from 3.4 to 1.1. Participants saw an average decrease of 16 percent in such episodes each week and a reduction in the three types of exertional triggers: physical, cognitive and emotional.
Breathlessness, headache/migraine and palpitations decreased the most rapidly, falling by 20, 21 and 29 percent each week, respectively.
The study administrators met the participants where they were in their long COVID recovery and worked with them at the pace the administrators judged they needed based on consultations. “I had a weekly discussion with my long COVID support worker about my symptoms and how I felt if I had exerted myself,” says health care worker and study participant Elizabeth Bycroft, in the press release. “So, there was the motivation to do more but to keep it within limits, so the long COVID did not get worse. If I was feeling good, I would move onto the next phase.”
Prior to the program, Bycroft had about three crashes per week. That dropped to one by the end of the program. Although not yet fully back to her baseline, she feels better able to manage her long COVID. “A lot of people get very down because they cannot do the things they once did. I have not yet been able to return to exercise although I hope to one day soon,” she continues.
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