Gradual return to exercise can be effective treatment for long COVID

By Alice Clifford via SWNS

A gradual return to exercise could be an effective treatment for long Covid, suggests new research.

A new long Covid rehab program has shown that a steady increase in physical activity can improve sufferers’ quality of life.

Doctors say the initiative can reduce fatigue, breathlessness and headaches while also boosting people’s ability to be active.

The pacing program was run by the long Covid service at Leeds Community Healthcare NHS Trust, UK, and evaluated by clinicians and scientists at the University of Leeds and Leeds Beckett University.

Before each patient started the six-week program they reported having an average of three "crashes" a week.

The crashes refer to times they were left physically, emotionally or cognitively exhausted after mild physical or mental exertion.

At the end of the program, the patients reported only having an average of one crash a week.

They also experienced a “moderate improvement” in their quality of life and in their ability to be active.

A total of 31 people with long Covid took part in the six-week study. On average, they had been experiencing the debilitating effects of long Covid for around 17 months.

Each person suffered from a range of symptoms including fatigue, brain fog, breathlessness, headaches and palpitations.

Their rehabilitation was centered around gradually returning to physical activity.

The program, called the World Health Organisation CR-10 Borg pacing protocol, took each person through five levels of activity.

The first phase involved breathing exercises and gentle stretching, while the fifth included the activities the patients were doing before they got ill, such as sports and regular exercise.

During the process, each patient had weekly phone calls with their clinician to check their progress.

They also filled out questionnaires to show their exertion levels and the number of crashes they had each week.

These questionnaires indicated whether they could move to the next level or not.

The patients stayed at each level for at least seven days in order to not overexert themselves.

Project supervisor Professor Manoj Sivan said: “Long Covid affects around two million people in the UK, and it has an impact on their quality of life and, in some cases, their ability to work. It is distressing and disabling.

“Post-exertional malaise or post-exertional symptom exacerbation or simply 'crashes,' as described by patients, is a defining and important symptom of long Covid.

“When patients get a crash, they experience feelings of complete exhaustion and wipe out and are unable to resume activities for hours or sometimes days.

“The findings of this research are exciting because this is the first time that crashing episodes have been used as a marker for the condition and a structured pacing program has now been shown to substantially reduce symptoms and improve quality of life."

Patient testimony: treatment for long COVID

Elizabeth Bycroft has suffered from long Covid since she became ill with the virus in March 2020.

When she contracted the virus she experienced headaches, a high temperature and breathlessness. She even felt like she was dying.

As a healthcare worker, Ms. Bycroft was able to monitor her own blood oxygen levels. She found they were plummeting to worryingly low levels.

She was admitted to the hospital and put on oxygen. After a week in the hospital and a week recuperating at home, she returned to work.

The 52-year-old from Leeds said: “With hindsight, I probably went back to work too soon. I was still suffering from breathlessness and in August, I suffered a relapse.

“I had a range of symptoms. The breathlessness was still affecting me, but I was also feeling exhausted, and I had chest pains.

“I used to walk miles with my dogs, and attend fitness classes, and I would normally run up the stairs.

“After COVID, all that stopped. I could no longer do the everyday things that had been a part of my life. If I walked up the stairs at home I would have to go into one of the bedrooms and sit down to catch my breath.”

In November 2021, Ms. Bycroft became part of the trial.

She said: “It involved me gradually increasing my physical activity. I had a weekly discussion with my long Covid support worker about my symptoms and how I felt if I had exerted myself.

"So, there was the motivation to do more but to keep it within limits so the long Covid did not get worse. If I was feeling good, I would move on to the next phase.”

At the start of the trial, Bycroft experienced around three crashes a week. This number dropped to around one a week by the end of the program.

She added: “I am not doing too badly now. I am still unable to do some of the things I used to do pre-Covid but I can go out walking again, although I do still get breathless at times.

"And there are days when I feel completely exhausted, but those days are becoming fewer and fewer.

“I think I am now able to better manage long Covid.

“A lot of people get very down because they cannot do the things they once did. I have not yet been able to return to exercise although I hope to one day soon.”

According to data from the Office of National Statistics, almost two million people in the UK have long Covid, with symptoms that have lasted for more than four weeks.

The crash or exhaustion that people feel after exerting themselves can start 12 to 48 hours after activity and can last for days. In some rare cases, it can even last weeks.

Yet despite many people suffering from long Covid, researchers stress that there remains a lack of awareness among clinicians and the general public about how to support sufferers.

Sivan added: “This study adds to the current understanding by demonstrating the potential of a structured pacing protocol to gradually improve activity levels.

“Yet, current advice on safely returning to physical activity without worsening their symptoms is unclear, with patients reporting receiving differing advice from health care professionals.”

The researchers are now conducting a major UK-wide study called Locomotion, with the aim of developing a "gold standard" of care for long Covid patients.

The findings were published in the Journal of Medical Virology.