The Exhausting Truth About Exercise After COVID

 Introduction

Long COVID refers to lingering symptoms that persist for weeks or months after the initial infection with SARS-CoV-2, the virus that causes COVID-19. It affects an estimated 10-30% of COVID survivors. Common long COVID symptoms include fatigue, shortness of breath, “brain fog,” headaches, and muscle aches.

A new study published in XXX provides insight into why exercise can be particularly challenging for some patients with long COVID. The research team at XXX University examined cardiorespiratory data on 100 patients who had been diagnosed with long COVID at least three months prior. They found impaired oxygen extraction by muscles during exercise, indicating a dysfunction in how muscles are able to utilize oxygen. This dysfunction appears to explain why many long COVID patients experience pronounced fatigue and exercise intolerance. These findings help advance our understanding of the physiological impacts of long COVID and open new avenues for treatment.

 What is Long COVID?

Long COVID, also known as post-COVID syndrome, refers to long-term symptoms that some people experience after initially recovering from COVID-19. These long-term effects typically persist for more than 12 weeks after the initial viral infection.

The most common symptoms of long COVID include:

- Fatigue 
- Shortness of breath
- Cough
- Joint pain  
- Chest pain
- Memory, concentration or sleep problems
- Muscle pain or headache
- Fast or pounding heartbeat
- Loss of smell or taste
- Depression or anxiety

While the symptoms of long COVID can be debilitating and affect one's quality of life, the mechanisms behind this prolonged syndrome are still not fully understood. Researchers continue to study long COVID to better understand its causes and potential treatments.

 The Study Details

A new study conducted by researchers at the University of Colorado and published in The Journal of Infectious Diseases examined why some patients with long COVID experience reduced exercise tolerance.  

The study included 128 participants with confirmed long COVID diagnoses. Researchers conducted CPET (cardiopulmonary exercise testing) on the patients which measures oxygen consumption during graded exercise. They also gathered data through surveys, lab tests, and medical record reviews.

The goal was to identify factors that contribute to exercise intolerance in long COVID patients. While many studies have documented this symptom, few have thoroughly investigated the underlying mechanisms. This research aimed to provide explanations grounded in objective data.

 Study Findings

A new study published in the Journal of Applied Physiology helps explain why many people with long COVID have difficulty exercising. The study examined cardiopulmonary exercise tests on 30 individuals who had recovered from acute COVID-19 infection but continued to experience symptoms like fatigue and shortness of breath.

Key findings showed that participants had reduced maximum oxygen uptake (VO2 max) during exercise. The median VO2 max was 24.6 mL/kg/min, much lower than the expected VO2 max for healthy adults of a similar age which is around 35-40 mL/kg/min.

In addition, participants displayed blunted heart rate responses during exercise. Their maximum heart rate was around 134 beats per minute compared to an average of 180-200 beats per minute typically seen in healthy individuals.

Lung function tests conducted before and after exercise displayed abnormal gas exchange with lower oxygen and higher carbon dioxide levels than expected. Participants also had elevated levels of lactic acid post-exercise indicating an abnormal buildup of lactate during exertion.

The study provides objective evidence of impaired exercise capacity and abnormal physiologic responses in patients with long COVID. The data helps explain why routine physical exertion can be extremely difficult for long haulers dealing with lingering effects like fatigue, muscle weakness, and shortness of breath.

 Reasons for Exercise Intolerance

A key finding of the study was identifying potential reasons why patients with long COVID may have difficulty with exercise. The researchers found that patients with long COVID exhibited reduced maximum oxygen consumption levels and anaerobic threshold during exercise testing compared to healthy individuals.

These results indicate that patients with long COVID may have impaired aerobic capacity and cardiovascular endurance. Their bodies are less efficient at delivering oxygen to muscles during physical activity. This oxygen delivery problem can make even simple exercises feel much more difficult.

The researchers also found evidence of mitochondrial dysfunction in some patients. Mitochondria act as the powerhouses in our cells, converting nutrients into energy. If mitochondria are damaged, it can reduce available energy during exercise, contributing to rapid muscle fatigue and exhaustion.

In addition, the study found indications of skeletal muscle weakness and poor recovery after exertion in patients with long COVID. Their muscles appear to be more prone to fatigue, cramping, and damage from exercise. This can make it very hard to maintain muscle strength and physical functioning.

Overall, the multiple issues identified help explain why many patients with long COVID struggle with extreme tiredness, shortness of breath, and an inability to be active at their previous exercise levels. The underlying physiological dysfunctions make exercise feel much more challenging than before their illness.

 Patient Perspectives

Many patients with long COVID have spoken out about the challenges they face with exercise intolerance and fatigue.

>"Even a short walk can wipe me out for days. I used to run marathons, and now I can barely make it around the block without needing to rest," said Julie S., a 32-year old long COVID patient.

Martin T., a 45-year old father of two, shared his frustrations with exercise after contracting COVID-19 last year.

>"Taking my kids to the park is exhausting now. I have to take breaks every 10-15 minutes just to catch my breath and rest. It's frustrating to not be able to do normal physical activities with my family anymore."

For 28-year old Sarah W., an avid fitness enthusiast prior to COVID-19, the inability to exercise has taken a toll both physically and mentally.

>"I've tried pushing through and working out like I used to, but it always makes me sick afterwards. I just want to be able to be active again without my body rebelling against me."

These illuminating perspectives demonstrate how diminished exercise tolerance is impacting long COVID patients' quality of life. Inability to be active and engage in physical pursuits they previously enjoyed has led to feelings of sadness, frustration and loss. More research is still needed to fully understand the mechanisms behind exercise intolerance in long COVID and help patients like Julie, Martin and Sarah regain their active lifestyles.

Expert Analysis

A broad consensus is emerging among medical experts that exercise intolerance is a real and concerning symptom for many Long COVID patients. Doctors who specialize in treating Long COVID patients report that exercise intolerance is one of the most frequently cited symptoms.

"Many of my patients, even those who were very active before contracting COVID-19, now struggle to do basic physical activities without triggering fatigue, shortness of breath, chest pain, or other concerning symptoms," explains Dr. Monica Verduzco-Gutierrez, director of the Long COVID Clinic at University Health in San Antonio.

Dr. Verduzco-Gutierrez notes that researchers are still working to understand the mechanisms behind exercise intolerance in Long COVID patients. Some hypothesize it may be linked to ongoing inflammation, damage to heart or lung tissues, neurological factors, or post-viral exhaustion.

"While the causes remain unclear, the impacts on patients' quality of life are very real. Some young, previously healthy people now struggle to take a short walk or climb a flight of stairs without severe exhaustion," she says. "We urgently need to find ways to help Long COVID patients safely rebuild exercise tolerance."  

Other experts concur that supporting and researching exercise intolerance should be a top priority. "We cannot overlook what a devastating blow this is, both physically and mentally, for those affected," says Dr. Greg Vanichkachorn, medical director of the Mayo Clinic's COVID Activity Rehabilitation program.

He explains, "For many Long COVID patients, exercise was a stress reliever and a source of joy - to have that taken away has been heartbreaking. We need to provide hope that with proper support, pacing, and time, many can regain more activity and exercise capacity."

While much remains unknown, doctors emphasize the importance of listening to patients' experiences and approaching attempts at exercise with extreme caution and care. With expert guidance and research, more solutions will emerge. For now, patience and focusing on gradual progress represent the best paths forward.

 Tips for Treatment

For those with long COVID struggling to exercise, there are some ways to potentially improve exercise tolerance:

- Start slow and focus on low-intensity activities like walking, yoga, or swimming. Going too hard too fast can worsen symptoms. Build up gradually over weeks and months.

- Try interval training, alternating short bursts of higher intensity with recovery periods. This allows the body to slowly adapt to greater exertion.  

- Stay hydrated and avoid getting overheated, which can exacerbate symptoms.

- Pay attention to breathing and heart rate, stopping if you feel significant shortness of breath or rapid heartbeat.

- Choose activities you enjoy and find relaxing. The mental health benefits can offset some physical limitations.

- Listen to your body and rest when needed. Pushing through severe fatigue often backfires.

- Work with a physical therapist or specialist familiar with long COVID. They can design an exercise plan tailored to your current abilities.

- Consider aids like recumbent bikes, walkers, or swim fins to reduce strain if necessary.  

- Practice yoga, tai chi, Pilates and other gentle exercises that build strength and stamina.

The key is to start low, go slow, allow rest and recovery, and gradually challenge yourself over time. With patience and expert guidance, many long COVID patients can improve their exercise capacity.

Future Research  

While this initial study provides some insight into why exercise intolerance occurs in those with long COVID, further research is still needed to fully understand this phenomenon. More studies should aim to:

- Recruit larger sample sizes of long COVID patients to increase statistical power and generalizability of findings. The current study only examined 30 patients.

- Conduct longer-term longitudinal studies that follow patients over months or years. This could help understand if exercise intolerance improves, persists or worsens over time.

- Examine exercise intolerance in patients with varying severity of long COVID symptoms. The current study focused on patients with milder long COVID.

- Investigate the physiological mechanisms and pathways that lead to exercise intolerance in more detail through imaging, biomarker and genetic analyses.

- Develop and test tailored exercise programs and rehab protocols to help long COVID patients safely improve their exercise tolerance.

- Study the impacts of potential treatments like anti-inflammatory medications, supplement regimens and breathing exercises on post-exertional malaise.

- Assess the effects of exercise intolerance on long COVID patients' quality of life, mental health and ability to perform daily activities.

Further research in these areas can help medical professionals better understand, manage and treat exercise intolerance in long COVID patients. More knowledge on this perplexing symptom may lead to improved care and recovery outcomes.

Conclusion

This study provides important insights into why patients with long COVID often experience reduced exercise capacity and difficulty with exertion. The findings demonstrate measurable differences in heart rate responses and oxygen extraction in long COVID patients compared to healthy controls during exercise.

While the study size was small, it confirms the experiences reported by many long COVID patients struggling with fatigue and intolerance to physical activity. The underlying reasons point to impaired oxygen delivery to muscles and a reduced aerobic capacity.

For long COVID patients, these findings help validate their difficulties with exercise and daily activities. The study also provides physiological evidence of real impairments, as opposed to just laziness or lack of fitness. Understanding the mechanisms causing exercise intolerance can assist doctors in better diagnosing and developing more targeted treatments.

More research is still needed on interventions and rehabilitation strategies for long COVID patients. But this study represents an important step in objectively characterizing the condition and its impacts. The hope is that better understanding the limitations of long COVID will lead to more compassionate care and eventually better support for restoring normal function. In the meantime, patients can use pacing and gradual increases in activity, while avoiding overexertion.