Patients with long COVID ‘should not be discouraged from exercising,’ study suggests

Key takeaways:

• Patients with long COVID had roughly similar responses to exercise as those without long COVID, with “no profound symptom exacerbation.”
• However, 62% of those with long COVID showed signs of myopathy.

Patients with long COVID showed no difference in fatigue after exercise vs. those without long COVID, nor did their symptoms significantly worsen, suggesting that “cautious exercise” could help rehabilitation, a randomized study showed.

WHO and other health organizations have advised against intense exercise in those with long COVID, Andrea Tryfonos, PhD, a researcher in the department of laboratory medicine at the Karolinska Institute in Sweden, and colleagues noted.

“However, there is ample evidence that physical inactivity negatively impacts health, including functional impairment within weeks and increased risk of cardiometabolic disease in the long term,” they wrote in JAMA Network Open.

Although long COVID’s wide-ranging symptoms and varying degrees of severity makes it a complex condition to manage, prior research has supported exercise-based interventions for patients with long COVID.

In the study, 31 nonhospitalized patients (mean age, 46 years; 77% women) who had persisting long COVID symptoms for at least 3 months were recruited and compared with 31 age- and sex-matched individuals (mean age, 47 years; 74% women) without long COVID.

Following a comprehensive physiologic assessment, participants completed three exercise trials — including high-intensity interval training (HIIT), moderate-intensity continuous training (MICT) and strength training (ST) — in a random order.

Participants’ symptoms were reported at baseline, immediately after the trials and 48 hours after exercise. Symptoms were assessed with the visual analog scale, or VAS. The researchers also administered a battery of tests, including blood tests, heart ultrasound, spirometry for lung function, neurophysiological tests, and muscle strength tests and biopsies.

They found no significant differences in worsening fatigue between the study groups after any of the exercises. Mean VAS rankings for participants with long COVID and control participants, respectively, were:

• 29.3 and 28.7 for HIIT;
• 31.2 and 24.6 for MICT; and
• 31 and 28.1 for ST.

“What we can generally see is that the post-COVID patients do just as well as the controls, even though they had more symptoms to begin with,” Tryfonos said in a press release. “By equally well, I mean that they did not worsen their symptoms or negatively affect their body during the 48 hours we observed them.”

However, compared with control participants, those with long COVID reported greater exacerbation of muscle pain (P = .04) and joint pain (P = .009) after HIIT and more concentration difficulties (P = .03) after MICT.

Participants with long COVID also spent 43% less time on moderate to vigorous physical activity.

“People with post-COVID had generally lower levels of fitness and muscle strength, which could be due to both the infection and lower activity,” Tryfonos explained. “After 2 years of prolonged symptoms and being discouraged from exercising, it's not surprising that you have lost some of your work capacity.”

Additionally, 62% of participants with long COVID showed signs of myopathy.

“This percentage is far too high to be explained by reduced activity alone,” Tryfonos said. “Therefore, we are currently analyzing the biopsies to see if we can explain the reason behind these muscle changes.”

The study was limited by its small sample size, and the researchers noted that the results should not be generalized to all people with long COVID.

Still, “people with post-COVID should not be discouraged from exercising in general,” Tryfonos said. “Instead, under supervision, they should be encouraged to start with any kind of exercise they enjoy, at an appropriate level of course, and then slowly increase the intensity.”

References:

• Post-COVID not necessarily a barrier to exercise. https://www.eurekalert.org/news-releases/1039996. Published April 4, 2024. Accessed April 4, 2024.
• Tryfonos A, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.4386.