August. March 3, 2022 – Joel Fram woke up on the morning of March 12, 2020, knowing exactly why he felt so bad.
He lives in New York, where the first wave of the coronavirus is sweeping the city. “I knew right away,” said the 55-year-old Broadway music director. It’s COVID-19.
What started out as the general feeling of being hit by a truck soon included a sore throat and severe fatigue that he once fell asleep in the middle of texting his sister. The final symptoms are chest tightness and difficulty breathing.
Then he started to feel better. “By mid-April, my body felt basically back to normal,” he said.
So he did what would be smart after almost every other ailment: He started exercising. That didn’t last long. “It felt like someone pulled the rug out from under me,” he recalls. “I walk three blocks without feeling out of breath and tired.”
This is the first sign that Fram has been infected with the new coronavirus for a long time.
At least 7.5 percent of U.S. adults—nearly 20 million people—have long-term COVID symptoms, according to the National Center for Health Statistics. For nearly all of these people, there is growing evidence that exercise makes their symptoms worse.
COVID-19 patients with the most severe illnesses will get back to exercise later, according to a June review by UCSF researchers. But even people with mild symptoms can struggle to regain their previous levels of health.
“We had some participants in our study who had relatively mild acute symptoms but then experienced a very severe decline,” said cardiologists at the University of California, San Francisco School of Medicine. Matt Durstenfeld, lead author of the review.- Yale University researchers showed expected scores on aerobic fitness tests in a study published in August 2021.
“Part of that is due to adaptation,” Durstenfeld said. “You don’t feel well, so you don’t get to where you were before the infection. ”
In a study published in April, people chronically infected with Covid-19 told researchers at the University of Leeds in the United Kingdom that they spent 93% less physical activity than they did before infection.
But multiple studies have found that dissonance isn’t entirely—or even mostly—to blame.
A 2021 study found that 89% of Long-term COVID participants have post-exercise discomfort (PEM), which occurs when a patient’s symptoms worsen after engaging in light physical or mental activity. According to the CDC, post-exercise discomfort can persist for up to 12 years after activity To appear within 48 hours, people can take up to 2 weeks to fully recover.
Unfortunately, the advice patients get from their doctors can sometimes make the problem worse Oops.
How long does COVID ignore simple solutions
Long COVID is a “dynamic disability” that requires health professionals to exit the script when a patient’s symptoms do not respond in a predictable manner NYC’s Mount Sinai Health System’s Says neuroscientist, physical therapist and director of rehabilitation innovation, Dr. David Putrino.
“We’re not very good at dealing with people who, for all intents and purposes, look healthy and unhealthy. – Disabled one day, completely debilitated the next,” he said.
Putrino said more than half of the long-term COVID patients in his clinic told his team that they were at le as the following One of the persistent problems:
And 86% said exercise made their symptoms worse.
These symptoms are similar to what doctors see like lupus, Lyme disease, and chronic fatigue syndrome Symptoms of disease are similar – many experts compare long-term COVID to this disease. Researchers and medical professionals still don’t know how COVID-19 causes these symptoms. But there are some theories.
Potential Causes of Long-Term COVID Symptoms
Putrino said it is possible for the virus to enter a patient’s cell and hijack the mitochondria — the part of the cell that provides energy. It can linger there for weeks or months — that’s called viral persistence.
“Sudden In between, the body gets less and less energy for itself, even though it produces the same or more,” he says. This extra stress on cells has consequences. “Creating energy is not free. You’re producing more waste, which puts your body in a state of oxidative stress,” Putrino said. Oxidative stress damages cells when molecules interact with oxygen in harmful ways.
“Another important mechanism is autonomic dysfunction,” Putrino said. It is characterized by breathing problems, palpitations and other glitches that most healthy people never consider. He said , at Mount Sinai Clinic, approximately 70% of long-term COVID patients have some degree of autonomic dysfunction.
For those with autonomic dysfunction, changing postures like this Basic things trigger a cytokine storm, a chemical messenger that tells the immune system where and how to respond to challenges such as injury or infection.
“All of a sudden, you have this switch,” Putrino said. “You go right into ‘fight or flight’ ,” with an adrenaline rush and a racing heart, “and then back to ‘rest or digest.’ You go from excited to drowsy, unable to open your eyes. “
Patients with persistent virus and those with autonomic dysfunction may have the same negative response to exercise, even though the triggers are completely different.
So how do doctors help long-term COVID patients?
Putrino said the first step is to understand the difference between long-term COVID and long-term recovery from COVID-19 infection.
Many patients in the latter group were infected with 4 Weeks later still had symptoms. “At 4 weeks, yes, they still felt symptoms, but it wasn’t long-term COVID,” he said. “It just took a while to get over the virus. “
For these people, the fitness advice is simple: Relax at first, then gradually increase the amount and intensity of cardio and strength training.
But for people who fit Putrino’s stricter definition of long-term COVID, this advice would be disastrous: “Three to four months from initial infection, they are experiencing severe fatigue, Fatigue symptoms, cognitive symptoms, palpitations, shortness of breath,” he said.
“Our clinic is very cautious about the movement of these patients”, he said.
Based on Putrino’s experience, about 20 to 30 percent of patients experience significant progress after 12 weeks. “They feel more or less like they did before COVID,” he said. “
The unfortunate 10% to 20% won’t make any progress at all. Any type of therapy, even simply moving their legs from a flat position, will make their symptoms worse.
Most people – 50% to 60% – will improve their symptoms in the following areas. But then progress will stop, for reasons researchers still Trying to figure it out.
“My sense is that gradually increasing exercise is still good advice for the vast majority of people,” says UCSF’s Durstenfeld.
Ideally, the exercise will be supervised by someone who has been trained in cardiac, pulmonary and/or autonomic rehabilitation – a specialized treatment designed to resynchronize the autonomic nervous system, control breathing and other involuntary functions, he said. of the nervous system. But these treatments are rarely covered by insurance, which means most long-term COVID patients are on their own.
Durstenfeld says it’s important for patients to keep trying and not give up. “With slow but steady progress, a lot of people get better. “
Fram, who works under careful supervision, said he was getting closer to the life of his predecessor – COVID-19.
But he hasn’t. The chronic coronavirus, he said, “is affecting my life every day. ”
