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Dealing with Long COVID-Go at your own PACE!

By, Kaci Quick

Many people are aware of the typical symptoms associated with COVID-19 including fever, cough, nausea, vomiting, diarrhea, loss of taste or smell, and body aches. Most symptoms can range from mild to severe resulting in several dealing with post-COVID conditions. The CDC indicates approximately 1 in 10 people will develop side effects following diagnosis-including shortness of breath, muscle, and chronic fatigue.

One of the many complaints among patients experiencing what is now known as “long COVID” include the inability to exercise. People may experience limitations with basic physical activities such as a sit-to-stand position, walking, and climbing stairs. Post-COVID patients can take on a paradoxical breathing pattern-uncontrolled breathing that reverses the natural pattern where the chest contracts during inspiration and expands during expiration. This can be amplified in individuals with obesity and high blood pressure.

Included in the range of side effects of Long COVID is what is known as post-exertional malaise (PEM). PEM is a physiological response to physical or cognitive exertion that can damage organs such as the heart and lungs. PEM can be triggered by daily activities and physical exercise. The onset of PEM can be delayed 24-72 hours, but followed by severe immune, neurological and cognitive symptoms that could last days, weeks, or permanently.

In November of 2020, Dr. Inderjit Singh, a Pulmonary Medicine physician at Yale New Haven Hospital, conducted a series of invasive cardiopulmonary exercise tests (iCPET) to evaluate exercise limitations in post-COVID patients ( Patients were tested while riding a stationary bike with catheters inserted into the veins of the neck and wrist. The patient’s blood vessels, heart, lung, and skeletal muscle function were monitored and assessed. Results from testing suggested an exercise intolerance-showing that the patient’s muscles were unable to properly release oxygen delivered by the heart and lungs.

Limited studies highlighting the positive effects that exercise can have on post-COVID patients exist. However, many studies suggest the overall benefits of exercise include improvement in cardiovascular function, increased psychological wellbeing, improvement in pulmonary oxygen uptake, quality of life, and enhances immune function (International Journal of Environmental Research and Public Health, 2021). In addition, resistance training provides benefits to the musculoskeletal system by increasing the cross-sectional area of muscle fibers and aids in regulating metabolism.

Many of us have become acquainted with the term “exercise is medicine”. However, it is important that individuals experiencing Long COVID side effects err on the side of caution to prevent overexertion. The truth of the matter is the effects of long COVID may differ from person to person. What one individual may be able to tolerate-another may not be able to. A range of factors can co-exist as the reason why this is the case. Any individual considering returning to exercise should be cleared by a medical professional and given a physical screen to see if participation in exercise is appropriate at that time. An individualized, supervised program should be designed to effectively manage the patient’s condition and modified as needed.

The Journal of Orthopaedic & Sports Physical Therapy recommends a “Stop. Rest. Pace” approach to managing Long COVID (

Stop-involves not pushing your limits-having the awareness that overexertion can have detrimental effects on overall recovery.

Rest-regarded as one of the essential self-management strategies. This also involves listening to your body and taking breaks when needed-not when symptoms arise.

Pace-don't rush your physical and cognitive activities. Give yourself adequate time to complete. This safe approach may help reduce the triggering of symptoms.

Those experiencing mild-moderate COVID symptoms- who have not required hospitalization, and have been cleared by a medical professional to start an exercise routine, may benefit from the following basic/beginner exercises to re-acquaint the body with exercise while encouraging an optimal breathing pattern

  • Warm-up walk (5 min)

  • Pelvic tilts with focused breathing-inhale on the arch, slowly exhale to flatten back to a neutral spine position (5-10 reps)

  • Cat/cow with focused breathing- inhale into cow position, slowly exhale to cat-rounded back position (5-10 reps)

  • Bird dogs with focused breathing-inhale in all 4-position with contracted abdominals, adding a slow exhale with the opposite arm, and leg extension (5-10 reps)

Exercises should be no more than 15 minutes initially, to ensure the safety of the individual performing the exercise, and to prevent over-exertion. Experts recommend a slow progression over an extended period of time. It may be helpful to keep a journal log of the exercises performed that includes reps, sets, and rest intervals. As you are able to effectively perform each exercise without exhaustion or adverse reaction, you may safely be able to increase reps or sets by 1-2 initially, then gradually increase from that point. Always apply the Stop, Rest, Pace formula during exercise.

Also, jot down any notes about how you are feeling. Make a list of current challenges; identify and set short-term obtainable goals that can inspire you and keep you motivated.

Don't forget that sleep and nutrition are also important for recovery and go hand in hand with exercise and optimal performance. Follow recommended nutritional, and sleep guidelines by your medical professional.

Contact your primary care physician if any new or concerning symptoms arise at any point in time during your return to health journey!

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