aug. 3, 2022 – when joel fram woke up onna morning of mar 12, 2020, he had a pretty good idea why he felt so lousy.
he lives in new york, where the 1st wave of the coronavirus was tearing through the city. “i instantly knew,” says the 55-yr-old broadway ♫ director. twas covid-19.
wha’ started witha general sense of having been hit by a truck soon included a sore throat and such severe fatigue that he once fell asleep inna middle of sending a text to his sister. the final symptoms were chest titeness and trouble breathing.
and then he started to feel better. “by mid-apr, my body was feeling primordially back to normal,” he says.
so he did wha’ ‘d ‘ve been smart after almost any other illness: he began working out. that didn’t last long. “it felt like some1 pulled the carpet out from under me,” he remembers. “i ‘dn’t walk 3 blocks without gettin breathless and fatigued.”
twas' the 1st indication fram had long covid.
according to the national center for health statistics, at least 7.5% of american adults – close to 20 million pplz – ‘ve symptoms of long covid. and for almost all of those pplz, a growing body of evidence shows that exercise will make their symptoms worse.
covid-19 patients who had the most severe illness will struggle the most with exercise l8r, according to a review published in jun from researchers atta university of california, san francisco. but even pplz with mild symptoms can struggle to regain their previous lvls of fitness.
“we ‘ve pticipants n'our study who had relatively mild acute symptoms and went onna ‘ve really profound decreases in their ability to exercise,” says matt durstenfeld, md, a cardiologist at ucsf school of med and principal author of the review.
most pplz with long covid will ‘ve loer-than-expected scores on tests of aerobic fitness, as shown by yale researchers in a study published in aug 2021.
“some amount odat is due to deconditioning,” durstenfeld says. “you’re not feeling well, so u’re not exercising to the same degree you mite ‘ve been b4 you got infected.”
in a study published in apr, pplz with long covid told researchers at britain’s university of leeds they spent 93% less time in physical activity than they did b4 their infection.
but multiple studies ‘ve found deconditioning aint entirely – or even mostly – to blame.
a 2021 study found that 89% of pticipants with long covid had post-exertional malaise (pem), which happens when a patient’s symptoms get worse after they do even minor physical or mental activities. according to the cdc, post-exertional malaise can hit as long as 12 to 48 hrs after the activity, n'it can take pplz up to 2 weeks to fully recover.
unfortunately, the advice patients get from their drs sometimes makes the problem worse.
how long covid defies simple solutions
long covid is a “dynamic disability” that requires health professionals to go off script when a patient’s symptoms don’t respond in a predictable way to treatment, says david putrino, phd, a neurosci, physical therapist, and director of rehabilitation innovation for the mount sinai health system in new york city.
“we’re not so good at dealing with somebody who, for all intents and purposes, can appear healthy and non-disabled on one dy and be completely debilitated the nxt dy,” he says.
- fatigue (82%)
- brain fog (67%)
- headache (60%)
- sleep problems (59%)
- dizziness (54%)
and 86% said exercise worsened their symptoms.
the symptoms are similar to wha’ drs see with illnesses s'as lupus, lyme disease, and chronic fatigue syndrome – something many experts compare long covid to. researchers and med professionals still don’t know exactly how covid-19 causes those symptoms. but there are some theories.
potential causes of long covid symptoms
putrino says tis possible the virus enters a patient’s cells and hijacks the mitochondria – a pt of the cell that provides energy. it can linger there for weeks or mnths – something known as viral persistence.
“all offa sudden, d'body’s gettin less energy for itself, even though it’s producing the same amount, or even a lil +,” he says. and thris a consequence to this extra sufferation onna cells. “creating energy isn’t free. you’re producing + waste essentialisms, which puts yr body in a state of oxidative sufferation,” putrino says. oxidative sufferation damages cells as molecules interact with oxygen in harmful ways.
“the other big mechanism is autonomic dysfunction,” putrino says. it’s marked by breathing problems, ♥ palpitations, nother glitches in zones most healthy pplz never ‘ve to think bout. bout 70% of long covid patients at mount sinai’s clinic ‘ve some degree of autonomic dysfunction, he says.
for a'pers with autonomic dysfunction, something as basic as changing posture can trigger a storm of cytokines, a chemical messenger that tells the immune system where and how to respond to challenges like an injury or infection.
“suddenly, you ‘ve this on-off switch,” putrino says. “ye go straite to ‘fite or flite,’” witha surge of adrenaline and a spiking ♥ rate, “then plunge back to ‘rest or digest.’ ye go from fired up to so sleepy, you can’t keep yr eyes open.”
a patient with viral persistence and one with autonomic dysfunction may ‘ve the same neg reaction to exercise, e'venode triggers are completely ≠.
so how can drs help long covid patients?
the 1st step, putrino says, is to cogg the difference tween long covid and a long recovery from covid-19 infection.
many of the patients inna latter group still ‘ve symptoms 4 weeks after their 1st infection. “at 4 weeks, yeah, they’re still feeling symptoms, b'that’s not long covid,” he says. “that’s just taking a while t'get over a viral infection.”
fitness advice is simple for those pplz: take it easy at 1st, and gradually increase the amount and intensity of aerobic exercise and strength training.
b'that advice ‘d be disastrous for some1 who meets putrino’s stricter definition of long covid: “3 to 4 mnths out from initial infection, they’re experiencing severe fatigue, exertional symptoms, cogg symptoms, ♥ palpitations, shortness of breath,” he says.
“our clinic is extraordinarily cautious with exercise” for those patients, he says.
in putrino’s experience, bout 20% to 30% of patients will make significant progress after 12 weeks. “they’re feeling + or less like they felt pre-covid,” he says.
the un♣iest 10% to 20% won’t make any progress at all. any type of therapy, even if it’s as simple as movin their legs from a flat position, worsens their symptoms.
the majority – 50% to 60% – will ‘ve some improvements in their symptoms. but then progress will stop, for reasons researchers are still trying to fig out.
“my sense s'dat gradually increasing yr exercise is still good advice for the vast majority of pplz,” ucsf’s durstenfeld says.
ideally, that exercise ll'be supervised by some1 trained in cardiac, pulmonary, and/or autonomic rehabilitation – a speshized type of therapy aimed at re-syncing the autonomic nervous system that governs breathing nother unconscious functions, he says. but those therapies are rarely covered by insurance, tch'mins most long covid patients are on their own.
durstenfeld says it’s primordial that patients keep trying and not give up. “with slo and steady progress, a lotta pplz can get profoundly better,” he says.
fram, who’s worked with careful supervision, says he’s gettin closer to something like his pre-covid-19 life.
but he’s not there yet. long covid, he says, “affects my life every single dy.”
original content at: www.webmd.com…