UUntil recently, running was a big part of Emma Zimmerman’s life. The 26-year-old freelance journalist and graduate student was a competitive distance runner in college, and even after graduation, she logged about 50 miles a week. So she tried to return to her running routine about a week after her probable case of COVID-19 in March, doing her best to overcome the malaise that followed her initial allergy-like symptoms. But each time, “I’d be stuck in bed for days, suffering from severe fatigue,” Zimmerman says.
Months later, Zimmerman is still experiencing health problems, including exhaustion, migraines, brain fog, nausea, numbness and sensitivity to screens — a cluster of symptoms that led doctors to diagnose him with prolonged COVID. Although he can’t know for sure, he fears that those workouts early in the recovery process may have worsened his condition.
“I had no idea I should try to rest as much as I needed,” she says.
Stories like Zimmer’s—illness, recovery, exercise, crash—are common in the world of the long COVID. And they’re highlighting what many researchers, patients and advocates say is one of the most powerful tools for managing, and potentially even preventing, prolonged COVID: rest.
The only guaranteed way to avoid long-term COVID is to not get infected with SARS-CoV-2. But when someone gets sick, rest is extremely important to give your body and immune system a chance to fight off an acute infection,” says Dr. Janna Friedly, a post-COVID rehabilitation specialist at the University of Washington who recovered from the illness. Long COVID itself. “People fight it and think it’s going to go away in a few days and they’re going to get better, and that doesn’t really work with COVID.”
Scientists are still learning a lot about long-term COVID, so it’s impossible to say for sure whether rest can really prevent its development or, conversely, whether premature action will cause complications. But anecdotally, Friedly says, many of the long-term COVID patients she sees are working women whose families are in a rush to return as soon as possible. It’s hard to give clear guidelines on how much rest is enough, but Friedly advises anyone recovering from COVID-19 to take at least a few weeks away from high-intensity exercise and avoid fatigue.
For people who have already developed Long COVID, rest may also be helpful to relieve symptoms, including fatigue and post-exertional malaise (PEM), or crashes after physical, mental or emotional exertion. The US Centers for Disease Control and Prevention recommends pacing, an activity management strategy that involves moderating activity and interspersing it with rest to prevent overexertion and worsening symptoms.
In an international study published last year, researchers asked more than 3,700 long-haul drivers about their symptoms. Almost half said they found stimulation to be at least somewhat helpful in managing symptoms. While other researchers surveyed about 500 long-haul drivers for a study published in April, the vast majority said physical activity worsened their symptoms, had no effect, and produced mixed results. Recent research suggests that this may be because long-distance runners have damage to their mitochondria, which generate energy cells can use.
Before Long COVID existed, researchers and patients encouraged rest and pace to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Characteristic symptoms of the condition include PEM and severe, prolonged fatigue—diagnostic criteria that many people with long-term COVID now meet. A January study of more than 200 people with long-term COVID found that 71% had chronic fatigue and nearly 60% had PEM.
For years, doctors have tried to treat ME/CFS patients by gradually increasing their level of physical activity. But since then, this practice has been proven not only ineffective, but often harmful, because people with ME/CFS have a unique and pathogenic response to stress due to cellular dysfunction, explains Jaime Seltzer, the center’s director of scientific and medical outreach. advocacy group MEAction. A 2019 study found that most people with ME/CFS prefer stimulation over exercise-based treatment.
To achieve effective pacing, Seltzer says, people need to learn to notice when they’re overworking and remove ingrained ideas about productivity. “If you’re doing laundry, for example, there’s nothing that says you have to fold every item in one sitting,” she says. Dividing tasks may seem odd, but it can be crucial to saving energy.
People with new, lingering symptoms of COVID should keep a log of their diet, activity, sleep and symptoms for a few weeks to learn about their triggers, Friedly says. For those who can afford it, a fitness tracker or other wearable can also be helpful to gauge how much effort is too much, says Seltzer. Once someone has an idea of the behaviors that improve or worsen symptoms, they can use that information to plan their days and break activities down into manageable chunks.
However, for many people who test positive for COVID-19, even taking a few days off work to isolate is a financial and logistical challenge. Many people have no choice but to return to physically demanding work or responsibilities such as childcare as soon as possible. “Leaving is absolutely socioeconomically and politically weighted advice,” says Seltzer.
People with long-term COVID or ME/CFS may be able to secure employment such as working from home, take on a role that can be done sitting instead of standing, or apply for disability if necessary. Seltzer suggests relying on friends, faith groups, or mutual aid networks for help with some tasks. In addition, Friedly recommends looking for creative ways to use less energy throughout the day. When he was living with long-term symptoms of COVID, he bought several pairs of identical socks so that he would never have to waste time and effort trying to find a match.
Things like that, he says, “may seem small, but when you add them up over the course of a day, they make a big difference in how much energy you spend.”
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