Can exercise help long covid? - Foxwood Personal Training

Can exercise help with Long Covid? This is a recent question I have been faced with. I have needed to know the answer to this question because I have taken on a few new personal training clients who have been diagnosed with Long Covid.

The symptoms these clients have include extreme breathlessness, loss of muscular strength, and also severely aching joints. Just as with Covid itself, it would appear that the exact symptoms vary from person to person with Long Covid. However, the above-mentioned symptoms do appear to be highly prevalent amongst Long Covid sufferers.

As a personal trainer with a number of new clients suffering from Long Covid, it was important for me to do my research as to whether or not an exercise regimen is able to help with Long Covid symptoms. Additionally, it is important for me to have a thorough understanding of best practice with regards to exercise prescription for clients with Long Covid. So, this article is serving two distinct purposes. Firstly, in doing my research for this article, I am upscaling my own knowledge base regarding how best to serve my clients with Long Covid. Secondly, by putting the article out there in the public domain, I am hopefully creating a resource that will benefit many other individuals suffering from Long Covid and also potentially help other health and fitness professionals working with clients suffering from Long Covid.

So, there are two separate areas that require looking into. Firstly, can exercise help with Long Covid? And then, secondly (and this is assuming that we find, yes, exercise can indeed help with Long Covid), how can we optimise exercise prescription in order to best serve clients with Long Covid?

What is Long Covid?

Let’s not get ahead of ourselves. Before asking whether exercise can help Long Covid, it is worth understanding exactly what Long Covid is.

Long Covid is the used term for Post Covid-19 Syndrome. The NICE guidelines for the management of the long-term effects of Covid-19, define Post Covid-19 Syndrome (Long Covid) as being ‘signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis’.

Long Covid often presents itself as clusters of symptoms, which usually overlap, and may change over time. We also know, with Long Covid, that any system within the body can be affected.

The latest estimates are that 10% to 20% of Covid-19 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis (Jimeno-Almazan, 2021). In other words, up to 20% of symptomatic Covid-19 patients are going on to experience Long Covid.

Can Exercise Help With Long Covid?

To give an evidence based answer to this question I am going to delve into the research on the subject. As a disclaimer here, Long Covid is a very new condition. This means we can expect a much larger body of research to be available on this topic in the future. However, there is already a growing, body of research that is being conducted on the treatment of Long Covid.

Firstly, it is worth noting that exercise programmes and physical activity are well-known modulators of the clinical manifestations and prognosis in many chronic diseases (Jimeno-Almazan, 2021). For this reason alone, it is worth looking into the possible implications of exercise in individuals diagnosed with Long Covid.

Physical inactivity has been associated with a higher risk for severe COVID-19 outcomes (Sallis 2021). High levels of cardiorespiratory fitness are shown to reduce the likelihood of hospitalisation due to COVID-19 (Brawner, 2020). As a result, it has been hypothesised that an optimal exercise prescription would benefit individuals with Long Covid (Jimeno-Almazan, 2021).

Treatment of Long Covid

In terms of research into the treatment of Long Covid itself; most of the current research is focused around the use of drugs or supplements. There is also one known research study, currently ongoing, that is looking into the use of hyperbaric oxygen (Hyperbaric Oxygen Therapy for Post-Covid-19 Syndrome). However, of particular interest, there is a research study, also currently ongoing, into the treatment of Long Covid through a supervised exercise intervention (Rehabilitation for Post-Covid-19 Syndrome Through a Supervised Exercise Intervention). No results from this study have yet been published.

However, a qualitative study into Long Covid and the role of physical activity has been published (Humphreys, 2021). This study highlighted how Long Covid patients struggle, from a psychological perspective, with drastically reduced physical function. This is perhaps an under-considered area. However, it surely adds more weight to the consensus that exercise is likely to have an important role to play in the rehabilitation of individuals with Long Covid.

Optimal Exercise Prescription for Long Covid

We now have a consensus that exercise probably can help with Long Covid (although more research is needed). We now must consider how to optimise exercise prescription for individuals with Long Covid.

The latest recommendations are for the need of symptom-titrated physical activity and tailored exercise in Long Covid rehabilitation (Maxwell, 2021). Of course, a tailored approach to exercise programming is always going to be the approach that offers best results. But, perhaps with Long Covid rehabilitation, we need to particularly stress that a one size fits all approach to exercise prescription is less likely to work.

We acknowledge the need for an individualised approach, based on the severity and nature of an individuals Long Covid symptoms. But it would still be useful to have a framework from which to work. In this regard, it would be logical to look at the details of the exercise prescription being used in the one known currently ongoing research study into the treatment of Long Covid using exercise. In this study (Rehabilitation for Post-Covid-19 Syndrome Through a Supervised Exercise Intervention), the participants in the experimental group are completing 8 weeks of a 3-days-per-week training routine. More specifically, they are completing two days per week of resistance training (involving 10 to 20 working sets and 6-12 receptions per set at a moderate intensity) and one day per week of light intensity continuous exercise (of 30 to 60 minutes duration).

We may need to adjust our recommendations once the results of the above study have been published. We may need to make further adjustments once additional follow up research is carried out. However, until then, the exercise prescription used in the above study can be used as a solid basis upon which to make recommendations for individuals with Long Covid.

Resistance Training and Light Aerobic Activity

In practical terms, it looks like a combination of resistance exercise and light aerobic activity would be best suited to individuals with Long Covid. Logically, this also seems to make sense, since extreme breathlessness as well as muscle weakness appear to be very common symptoms of Long Covid.

In terms of more specific recommendations, I would suggest gentle walking would be the most suitable form of aerobic exercise. This is due to the fatigue and breathlessness that is common amongst individuals with Long Covid. Of course, as symptoms improve, the intensity can be increased by incorporating more strenuous activities. But, in most cases, gentle walking is likely to be the most suitable starting point.

Full Body Strength Training

In terms of the resistance training element, my suggestion is to engage in a full body strength training routine where possible. This is in order to assist in regaining full body strength as much as possible on route to regaining a normal lifestyle. However, it is important to recognise that painful and aching joints is also a common symptom of Long Covid. Additionally, it is possible that certain movements or exercises will just be too exhausting at first. As such, I would recommend individuals with Long Covid to enlist the help of a qualified and experienced exercise professional. This is to ensure the specifics of the resistance training programme are best tailored to the individual needs.

This is about as specific and detailed as it is possible to be, based on the current evidence in relation to exercise and Long Covid. However, I would expect the research to move fast on this topic. I will endeavour to update this page as and when the research and available information develops. If you have any questions on the topic, please do get in touch. I will endeavour to be of help.

Tim Egerton
Egerton’s Garage Gym
Foxwood Personal Training
York, UK

References

Brawner (2020) https://pubmed.ncbi.nlm.nih.gov/33413833/

Hyperbaric Oxygen Therapy for Post-Covid-19 Syndrome Clinical Trials.gov

Jimeno-Almazan (2021) https://pubmed.ncbi.nlm.nih.gov/34067776/

Maxwell (2021) https://scholar.google.com/scholar_lookup?

Rehabilitation for Post-Covid-19 Syndrome Through a Supervised Exercise Intervention
Clinical Trials.gov

Sallis (2021) https://pubmed.ncbi.nlm.nih.gov/33849909/

Rehabilitation for Post-Covid-19 Syndrome Through a Supervised Exercise Intervention
Clinical Trials.gov

Sallis (2021) https://pubmed.ncbi.nlm.nih.gov/33849909/