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University of Minnesota: No need to avoid exercise with Long Covid diagnosis, researchers say

Recommendations that people with long COVID, or post-COVID condition (PCC), should avoid vigorous exercise are probably too strict, according to a new study published in JAMA Network Open from researchers at the Karolinska Institutet in Sweden.

By Stephanie Soucher

Many long-COVID patients are told to avoid activities that exacerbate symptoms such as fatigue, shortness of breath, and pain, and many report exercise intolerance, or a “flare” in symptoms following exercise. 

The study was based on 31 patients with PCC but no other diagnoses. They were matched with healthy controls and monitored while performing three different training sessions of high-intensity interval training (HIIT), moderate-intensity continuous training, and strength training in a randomized order a few weeks apart. 

Seventy-seven percent of the participants with long COVID were women, and the average age was 46.6 years.

Participants were asked to rate symptoms at baseline, immediately after exercise, and 48 hours after exercise. The researchers also gave participants blood tests, heart ultrasound, spirometry for lung function, muscle strength tests, neurophysiologic tests, and muscle biopsies within 2 days of the exercise tests.

The ME Association Comment

It is very disappointing to see that the results from this small study are being used to claim that exercise therapy is now a safe and effective treatment for people with Long Covid – even though the researchers found evidence of viral induced myopathy (muscle damage).

The trial has a number of important defects – especially the failure to recognise that a significant proportion of people with Long Covid have activity-induced fatigue and post-exertional malaise and along with other ME/CFS type symptoms meet diagnostic criteria for ME/CFS.

Having now established that any form of graded exercise therapy (GET) is likely to cause harm to people with ME/CFS, and NICE has cautioned against the use of GET in Long Covid, I hope that these findings will not be used by health professionals to automatically start recommending exercise regimes to their Long Covid patients

The ME Association has produced comprehensive guidance on activity and exercise management for people with ME/CFS. This is also appropriate for people with Long Covid who have activity-induced fatigue and post-exertional malaise.

Dr Charles Shepherd,
Trustee and
Hon. Medical Adviser
to the ME Association.
Member of the 2018-2021 NICE Guideline Committee.
Member of the 2002 Independent Working Group on ME/CFS.

Dr Charles Shepherd
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