As we move further into the pandemic, and as more and more people worldwide are infected with COVID 19, we see a rising emergence of people finding it hard to shake that post COVID brain fog and fatigue. (1) This is usually what we refer to as ‘Long COVID’.
Long COVID is typically defined as persisting symptoms 30-90+ days after infection (2,3,4). The long lasting effects of COVID are widespread and include up to 100 symptoms (such as a lingering cough, aches and pains, respiratory symptoms and psychological impairments), with the most common being ongoing fatigue/reduced physical capacity. (3,4)
This ongoing fatigue for some can be debilitating and is often misunderstood. It’s not your typical ‘tired-after-a-long-day-at-work’ kind of fatigue, it can be a seriously debilitating malaise triggered by sometimes very moderate intensity activity that in the past would have been a breeze to do.
As more data continues to emerge from long COVID itself, and as we collate our knowledge and understanding of similar conditions (such as chronic fatigue syndrome, fibromyalgia and other post-viral illnesses) we can see some clear comparisons and some treatment options available. One of the strongest contenders being pacing and graded exposure to activities and exercise. (6)
Management of the Post COVID Malaise – An introduction to Pacing
When it comes to managing ongoing fatigue in any context (not just COVID related), the first thing we need to begin with is finding just how much energy we can afford to use in a given time period safely without triggering significant symptoms. Once we find this baseline, we can control our fatigue symptoms and over time begin to slowly build. This system is called pacing.
For some this might not be much – It could be shaping your day with 3 rest breaks and 5 low energy tasks that are achievable. For others, it might just mean cutting back to some easier exercise then perhaps you’re used to.
Basically, we are learning how much exertion we can handle before we need to rest, so we don’t find ourselves in the position where we have to spend hours or days resting every time we want to get anything done.
Once this is established, we can better understand and control the symptoms and the levels of fatigue.
Progressing forwards – Graded Exposure
From here we can build – This can start with reintroducing household tasks and meaningful activities, or it could be the introduction of specific and tailored types of physical activity (such as short walks, a few exercises to try, or adding a few easy yoga stretches/flows). Adding a little more each day to promote progression is called Graded Exposure.
For some getting to this stage may take a while, and building to be able to tolerate enough exercise to force adaptation and build fitness may take a while and can be limited by the physiology of the condition itself. For others, if exercise can be tolerated early in the piece, better outcomes are predicted. (5)
Either way, exercise is one of the most effective methods for building back energy levels and tolerance to get you through the day and is one of the best ways we have for promoting healthy recovery from long COVID. (6)
Applying Pacing and Graded Exposure:
All the above sounds great in theory. But how do we translate that to practice?
- Prioritise doing bits throughout the day, rather than doing all activity all at once followed by long rest times
- Keep in mind, Malaise or tiredness may come a significant time after a strenuous activity (hours, or even the next day)
- Fatigue on its own is not harmful (it just feels awful), so if you do too much and need to rest, do not feel as though you’ve failed or are making your condition worse. Be kind to yourself, and rest when you feel you need it.
- Start a daily activity journal – Take note of the tasks and rests you take throughout the day and how strenuous each activity felt. See if you find any trends or patterns between your activity and you are most tired.
- Once you find what you can tolerate in a day, try adding a bit in step by step (this could be 2-3 extra minutes on a walk, or an extra light household task added to the list)
- Your recovery will look a bit like the stock market, with lots of ups and downs along the way
- For some recovery may be fast, for others, research suggests recovery could last longer than 1 year (4).
When to seek help:
Finding your own way out of a long COVID rut can be extremely challenging at times. If:
- finding and achievable level of baseline level of activity is difficult
- you keep finding that tolerable level of exercise is hard to calculate
- symptoms do not seem to be manageable
- your progression feels stagnant (or even backwards) for 4+ weeks after attempting to return to activity
Then consider reaching out for help.
A great place to start is your local exercise physiologist, particularly one who focuses on chronic fatigue or chronic pain.
At Tailored Health, we have a team of Exercise Physiologists who can help people in their Post COVID recovery. To learn more for yourself or someone close to you, feel free to contact us via phone or email, or simply book in to see us online under the reference list below.
- Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review. The Journal of Infectious Diseases. 2022 Apr 16.
- Cutler DM. The Costs of Long COVID. InJAMA Health Forum 2022 May 6 (Vol. 3, No. 5, pp. e221809-e221809). American Medical Association.
- Hayes LD, Ingram J, Sculthorpe NF. More than 100 persistent symptoms of SARS-CoV-2 (Long COVID): a scoping review. Frontiers in Medicine. 2021:2028.
- Seeßle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A, Müller B, Merle U. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clinical infectious diseases. 2022 Apr 1;74(7):1191-8.
- Mohamed AA, Alawna M. The effect of aerobic exercise on immune biomarkers and symptoms severity and progression in patients with COVID-19: A randomized control trial. Journal of bodywork and movement therapies. 2021 Oct 1;28:425-32.
- Dotan A, David P, Arnheim D, Shoenfeld Y. The autonomic aspects of the post-COVID19 syndrome. Autoimmunity Reviews. 2022 May 1;21(5):103071.