Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment

Mark A Faghy; Rae Duncan; Emily Hume; Lewis Gough; Clare Roscoe; Deepika Laddu; Ross Arena; Ruth E M Asthon; Caroline Dalton

doi:10.1016/j.pcad.2024.03.003

Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment

Prog Cardiovasc Dis. 2024 Mar-Apr:83:62-70. doi: 10.1016/j.pcad.2024.03.003. Epub 2024 Mar 8.

Authors

Mark A Faghy¹, Rae Duncan², Emily Hume³, Lewis Gough⁴, Clare Roscoe⁵, Deepika Laddu⁶, Ross Arena⁶, Ruth E M Asthon⁷, Caroline Dalton⁸

Affiliations

¹ Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA. Electronic address: M.Faghy@derby.ac.uk.
² Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
³ Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK.
⁴ School of Health Sciences, Birmingham City University, Birmingham, UK.
⁵ Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK.
⁶ Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA; Department of Physical Therapy, University of Illinois at Chicago, Chicago, USA.
⁷ Biomedical and Clinical Exercise Science Research Theme, University of Derby, Derby, UK; Healthy Living for Pandemic Event Protection Network (HL-Pivot), Illinois, Chicago, USA.
⁸ Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.

PMID: 38460898
DOI: 10.1016/j.pcad.2024.03.003

Abstract

The Post Covid-19 Condition (commonly known as Long Covid) has been defined by the World Health Organisation as occurring in individuals with a history of probable or confirmed SARS CoV 2 infection, usually within 3 months from the onset of acute Covid-19 infection with symptoms that last for at least two months which cannot be explained by an alternative diagnosis. Long Covid is associated with over two hundred recognised symptoms and affects tens of millions of people worldwide. Widely reported reductions in quality of life(QoL) and functional status are caused by extremely sensitive and cyclical symptom profiles that are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli. This manifestation prevents millions of people from engaging in routine activities of daily living (ADLs) and has important health and well-being, social and economic impacts. Post-exertional symptom exacerbation (PESE) (also known as post-exertional malaise) is an exacerbation in the severity of fatigue and other symptoms following physical, emotional, orthostatic and cognitive tasks. Typically, this will occur 24-72 h after "over-exertion" and can persist for several days and even weeks. It is a hallmark symptom of Long Covid with a reported prevalence of 86%. The debilitating nature of PESE prevents patients from engaging in physical activity which impacts functional status and QoL. In this review, the authors present an update to the literature relating to PESE in Long Covid and make the case for evidence-based guidelines that support the design and implementation of safe rehabilitation approaches for people with Long Covid. This review also considers the role of objective monitoring to quantify a patient's response to external stimuli which can be used to support the safe management of Long Covid and inform decisions relating to engagement with any stimuli that could prompt an exacerbation of symptoms.

Keywords: COVID; Cardiorespiratory fitness; Exertional fatigue; Long COVID; Physical activity.

Publication types

Review

MeSH terms

COVID-19 / complications
Cardiorespiratory Fitness*
Exercise*
Humans
Post-Acute COVID-19 Syndrome* / diagnosis
Post-Acute COVID-19 Syndrome* / pathology
Post-Acute COVID-19 Syndrome* / therapy
Quality of Life