Are you or someone you know struggling with Long Covid? We can help!

Today, Longevity Exercise Physiology Drummoyne, Edgecliff, Marrickville, Castle Hill, Randwick, Pymble, Balmain, Kingsgrove, Neutral Bay, Coburg – Melbourne, and Barrie, Ontario – Canada  discuss Long Covid and how exercise can help in treating and managing the condition.

COVID-19 pandemic

Initially, the majority of scientific research around the COVID-19 pandemic was geared towards treatment of the acute phase of the condition. Focus within the scientific community has since shifted to the long-term consequences of COVID-19 infection, and the attempt to characterise the extremely varied and “invisible” illness now known as Long-COVID. Over 60 long-term effects of COVID-19 infection have been identified (1), with a reduced exercise capacity, fatigue, “brain fog”, affected sleep, and increased incidence of associated anxiety and depression just some of the debilitating components of Long-COVID syndrome. While so many elements of the condition have been identified, a consistent definition and diagnostic framework still does not exist.

“As a result, the treatment pathway tends to be full of gaslighting and dismissal of symptoms, with patients often feeling they must rely on their own research to identify, understand, and appropriately apply treatments without guidance from healthcare professionals.”

However, one treatment that has shown promising results is Gradual Exercise Therapy, or activity pacing, under the guidance of an Exercise Physiologist.

The PERCEIVE study, out of Victoria and Tasmania, recently highlighted in this ABC article, has shown that even in its pilot form that supervised exercise rehabilitation lead to a 15 percent increase in the amount of exercise participants were able to do.

As such, the initial study has been submitted as part of an inquiry into the treatment of Long-COVID in Australia in the hope of establishing strong, evidence-based guidelines and, hopefully, some more clarity for both patients and practitioners in the treatment process.

“We haven’t even characterised the illness adequately at the moment, so to see some of them showing a significant symptomatic benefit, that’s a great result,”

– Tom Marwick (PERCEIVE study – lead investigator) (2)

What is Activity Pacing?

Pacing, or Gradual Exercise Therapy is a self-management strategy that involves doing less activity than you have energy for, breaking up your activities into smaller items and maximising your time for recovery. It is a term that most every person with Long-COVID has heard, but how to actually ‘pace’, or even who can help you figure out what appropriate pacing means for you, is often still left a question.

Below are some tools that I have found to be effective with all my clients dealing with Long-COVID. Although, given how individual the treatment journey is, the application of each of these ideas, methods, or protocols may look completely different from one treatment plan to another, so it is important to seek help from a professional to individualise these processes.

Learn about your Battery

Your battery is how much energy you have in the tank each day. Each day, especially in earlier phases of treatment, your battery is likely to differ. Understand that activities of all kind, not just structured exercise, have some level of physical, emotional, or mental energy cost.

“The most effective tool to understanding your battery is keeping a diary of activity, symptoms, and mood.”

The most effective tool to understanding your battery is keeping a diary of activity, symptoms, and mood. This diary gives you, and your Exercise Physiologist the chance to identify and discuss trends in your activity that directly relate to managing your symptoms, and will help set the strategy for progression towards your goal. Sharing these journal entries with your Exercise Physiologist can help advice to be given daily, can help to focus on your accomplishments and find the positives even on a day of more severe symptoms. Additionally, the feeling of having someone on your side every day can be an invaluable part of what has been described by many as a lonely treatment journey.

­Barbara*, started working with Longevity after she had been dealing with the symptoms of Long-COVID for 9 months. Initially, Barbara was stuck in a “boom-bust” cycle where one great day of high activity was typically followed by days or weeks of severe symptoms, a very common trend for people dealing with Long-COVID. Her daily entries have become a very valuable part of her treatment and now demonstrate a record of both her progression of activity, as well as changes to her language and attitude around her symptoms.

Set up a Schedule and Prioritise your Energy

Prioritise your week with activities that you derive pleasure and purpose from.

Set activities into 3 groups:

• • Tier 1: Must get done – A mix of physical activity, social activity, work activity (if appropriate), and recovery.
  • Tier 2: Must get done but are very flexible on when they get done and how they get done
    • Can someone else help complete these?
    • Can they be broken down into shorter durations?
  • Tier 3: Great if it gets done, no problem if it doesn’t.

Plan the week

• • • Plan your recovery appropriately so that your battery is replenished ahead of your most important tasks. As much as planning your activity is important, planning your recovery/rest is just as essential.

Pacing

• • Break up your activity/exercise into small portions.
  • Use a maximum daily step count or heart rate that is appropriate for you and progressively increase it week-to-week given there is no significant exacerbation of symptoms throughout the week.

Barbara* chose to prioritise time with her granddaughter 2x/week, her 2x Exercise Physiology sessions/week, 10 minutes of meditation/mindfulness, and a weekly walk to the shops, as well as making sure she could get into the ocean and have a dip most days. We created a weekly schedule that prioritised recovery. We split daily activity into morning and afternoon, kept the schedule flexible, and changed it as her capacity improved and her priorities changed.

Listening to your body/learning to say No

One of the most essential tools to avoiding the boom-bust style of week is learning to avoid doing that little bit extra.

When Barbara* began working with me she couldn’t take 5000 steps in a day without symptoms. We started with 4000 steps a day for the first week with 2x 5-10min walks scheduled in on most days. The agreement was that if she stayed within these limits and had no exacerbation of symptoms, the step count would increase each week, and so would the allowed activity. She now has no step count limit, and is swimming and cycling, strength trains 3x/week, is on the way to returning to work, and has booked an overseas trip she was unsure she would ever be able to do a year ago. Although treatment has not been linear, Barbara’s exercise capacity has increased dramatically, alongside her positive attitude towards managing her condition.

If you, or someone you know is struggling with a reduced exercise capacity, or fatigue following a COVID-19 diagnosis, our team of Exercise Physiologists at Drummoyne, Edgecliff, Marrickville, Castle Hill, Randwick, Pymble, Balmain, Kingsgrove, Neutral Bay, Coburg – Melbourne, and Barrie, Ontario – Canada  are here to help.

Call Longevity Exercise Physiology on 1300 964 002 today!

Written by Nate Sutton

References:

O’Mahoney, L. L., Routen, A., Gillies, C., Ekezie, W., Welford, A., Zhang, A., … & Khunti, K. (2023). The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. EClinicalMedicine, 55, 101762.

https://www.abc.net.au/news/2023-02-20/could-exercise-help-some-long-covid-sufferers/101975206