“Clearly there is something interfering with that normal response,” said study co-author Stephen Carter, an exercise physiologist at the Indiana University School of Public Health in Bloomington.
Lambert pointed out that some patients with prolonged covid are also diagnosed the postural orthostatic tachycardia syndrome (POTS, for its acronym in English), a disorder that affects blood flow. In people with POTS, “the nervous system can’t regulate what it’s supposed to automatically control, like heart rate, blood pressure, sweating and body temperature,” he said. However, “all those things are what, when exercising, should be properly regulated.”
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Some doctors also point to parallels between patients with prolonged covid and those with chronic fatigue syndrome (also known as myalgic encephalomyelitis or ME/CFS). These patients suffer from severe exhaustion, memory and cognitive problems, and often muscle or joint pain. For decades, doctors have suggested to chronic fatigue syndrome patients that exercise would improve their symptoms, but for many patients, exercise actually made her symptoms worse and now no longer recommended.
In 2021, Systrom and his team studied 160 patients with chronic fatigue syndrome and found that when they exercised, they experienced many of the same blood vessel problems seen in patients with prolonged covid, while control subjects did not. “Essentially, we’re finding exactly the same thing” regarding possible mechanisms, he said.
All this leads us to a question: should patients with prolonged covid who have problems with exercise continue to increase their physical activity? No one knows, and opinions differ. “There are patients and doctors who are strongly opposed to any type of exercise” because of these issues, Systrom said. But he also said exercise may be possible, and even beneficial, following Covid patients receive proper treatment. “If the patient can be made better with medication, then a graded exercise program can be undertaken without precipitating falls,” he said.
Lambert agreed. “You can’t rush into exercise, or you’re going to have a setback,” he said. However, the thing to do is “try to sit up slowly if you feel better.” He added that persistent covid can manifest itself in different ways, so doctors and patients must adjust the recommendations to the needs of each person.
“That is the true story of covid: that persistent covid is different for each patient,” he said. “There will probably never be a one-size-fits-all recommendation when it comes to exercise.”
Melinda Wenner Moyer is a science journalist.
