Long COVID affects about 10% of people who are infected with COVID-19. It leads to months of extreme fatigue, and “crashes” of severe exhaustion hours or days after activity known as Post-exertional symptom exacerbation or PESE. For people living with this condition, simple activities like walking, taking a shower, or grocery shopping can leave them exhausted for hours or days.
Early in the pandemic, therapists started seeing people with these symptoms. They noticed these patients were different from others who had COVID-19. They also noticed that some of the symptoms people were describing overlapped with conditions they had treated before.
Specifically, Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) also caused severe fatigue and delayed symptoms after activity. This overlap led them to use techniques they knew worked to manage these diseases.
The first strategy PTs started to use was pacing. This is simply doing less activity than you have energy for. By keeping bouts of activity short with lots of breaks, pacing can help avoid severe fatigue immediately after activity. It can also avoid the delayed “crash” of PESE. A useful metaphor is to think of your energy level as a battery. When you do activities, you drain your battery. When you rest, you charge it back up a little bit. Physical therapists helped teach patients how much energy was in their “battery” and how to conserve it. This began to help patients with Long COVID accomplish more with less fatigue.
Another strategy from ME and CFS management that helped Long COVID patients was heart rate monitoring. With the huge number of wearable devices that monitor heart rate, this is an easier strategy to use than ever. Heart rate monitoring uses your heart rate as a gauge of how hard your body is working. It’s based on your resting heart rate. The goal is to keep your heart rate within 15 beats of your RHR while you’re doing activities. This minimizes how much lactic acid your muscles produce. Build up of lactic acid is what gives you “the burn” when you’re working out really hard. It also causes your muscles to fatigue more quickly – by keeping activity light enough to avoid lactic acid, heart rate monitoring reduces fatigue.
What about exercise? That’s the treatment most people associate with PTs. Some therapists tried starting a gradual exercise program for patients with Long COVID, but they found it made them worse. Just like people who have CFS, or ME, “toughing it out” or “pushing through it” doesn’t make them stronger. It costs them days of their lives – leaving them barely enough energy to get out of bed or complete basic tasks. Using pacing, heart rate monitoring and other strategies like breathing exercises can stop the fatigue cycle and start to get the body responding to activity more normally. Only then can exercise be gradually and cautiously introduced.
As we learn more about the pathology behind Long COVID’s symptoms, rehabilitation will surely change and improve. But people who are living with Long COVID can’t afford to wait until science figures everything out about their disease. Fortunately, physical therapists have
training and strategies that can help improve their lives right now.
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Cite: The Private Practice Section of the American Physical Therapy Association. For more information, please visit www.ppsapta.org.