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Study: Long COVID can erase decade of aerobic fitness

By Kristin Emery for The Observer-Reporter newsroom@observer-Reporter.Com 5 min read
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Pulmonary rehabilitation therapy is becoming a cornerstone for recovery among long COVID patients, says Dr. Briana DiSilvio, pulmonary and critical care specialist and director of the Allegheny Health Network Post-COVID-19 Recovery Clinic. “Regularly scheduled physical activity under medical supervision has been shown to shorten the duration of long-haul symptoms.”

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Courtesy of Washington Health System

Dr. Mark Sperry

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Courtesy of Allegheny Health Network

Dr. Briana DiSilvio: “Unfortunately, exercise intolerance and shortness of breath with minimal activity are some of the most common symptoms experienced by long COVID sufferers, occurring in roughly 30% of patients six months after infection.”

The lingering effects of long COVID can be debilitating: lack of energy, frequent headaches, brain fog and joint pain are among the growing list of symptoms. Now, a study shows the long-lasting respiratory impact can rob some patients of nearly a decade of aerobic fitness. The study was published in JAMA Network Open and shows people with long COVID frequently find exercise much more difficult and have lower endurance capacity compared to people of similar ages who also developed COVID but recovered.

Dr. Briana DiSilvio, pulmonary and critical care specialist and director of the Allegheny Health Network Post-COVID-19 Recovery Clinic, says she sees evidence of this in some of the more than 1,500 patients the clinic has treated.

“We see many patients who, prior to their COVID infection, were very active and physically fit,” says DiSilvio. “Unfortunately, exercise intolerance and shortness of breath with minimal activity are some of the most common symptoms experienced by long COVID sufferers, occurring in roughly 30% of patients six months after infection. In those who experienced either no symptoms or mild symptoms during the acute phase of COVID illness, it can be particularly frustrating to get short of breath doing such simple activities such as walking the dog, climbing a flight of stairs, or carrying a laundry basket.”

How common is it?

Long COVID affects millions of Americans, with one study showing as many as 1 in 20 COVID patients will develop long COVID. The question remains whether this exercise deconditioning is merely a side effect of being bedridden or inactive for weeks or months while suffering from COVID or whether it’s a long-lasting separate symptom.

Dr. Mark Sperry with Washington Health System’s Department of Pulmonary and Critical Care Medicine, says that’s the unanswered question.

“Most patients will see gradual improvement over time and some benefit from an inhaler,” says Sperry. “Unfortunately, there are no good medical therapies right now for long COVID. However, I always tell patients that the most important thing that they can do is to exercise and watch their weight. Long COVID sufferers are often too tired to exercise and tend to get out of shape.”

Sperry says patients who take time to walk and do low intensity upper body exercise every day tend to feel much better and have better lung function. The JAMA Network Open study showed patients who had recovered from COVID showed normal exercise capacity for their age while those with long COVID had the stamina of a person 10 years older.

What causes it?

Other studies are trying to determine the exact cause of long COVID. “We know that long COVID is likely caused by inflammation that persists after the initial infection resolves,” Sperry explains. “This inflammation can occur in the heart, lungs, or nervous system, which can cause fatigue and impaired ability to exercise as seen in the study.”

He adds that patients who were vaccinated against COVID-19 have less inflammation and therefore are less likely to have symptoms of long COVID. Patients with diabetes and heart disease are also more likely to suffer from persistent symptoms, but younger people without any history of health problems can also suffer from long COVID.

“As the virus mutates, we are starting to see differences in long COVID symptoms.” Sperry admits the situation can be frustrating for patients but that many do gradually improve. “Some of my patients benefit from an inhaler, and most see improvement over the first three to six months,” he adds. “Rarely, we see patients who have persistent symptoms, and at that time we usually perform additional heart and lung testing.”

DiSilvio has also seen many long COVID patients improve over the course of six months to one year.

“Treatment of long COVID symptoms becomes more challenging when initial testing fails to yield an obvious cause of shortness of breath and exercise limitation,” she says. In those cases, she digs deeper. “In cases in which pulmonary and cardiac evaluations are normal, there is emerging literature which points to the roles of dysfunctional breathing patterns, severe muscular deconditioning, skeletal muscle mitochondrial dysfunction and chronic thromboembolic disease.” Highly specialized tests like cardiopulmonary exercise testing (CPET) can monitor several pulmonary, cardiac, and circulatory parameters while the patient is on a bicycle or treadmill.

How do you treat it?

Once those results are known, DiSilvio can formulate a plan. “The first step is to rule out any of the common and well-known causes of exercise intolerance which may be rooted in a cardiovascular or pulmonary disease,” she says. “A physician will be able to recommend the appropriate testing to determine if you have a pulmonary or cardiac condition which is directly attributable to COVID infection or possibly a previously undiagnosed disease that might have been triggered by COVID.”

Such tests may include pulmonary function testing, CT chest imaging, transthoracic echocardiogram and/or a cardiac stress test. While there are no simple answers or quick remedies, DiSilvio says there are some treatments that can help. “Pulmonary rehabilitation therapy is becoming a cornerstone for recovery among long COVID patients,” she says. “Regularly scheduled physical activity under medical supervision has been shown to shorten the duration of long-haul symptoms.”

Finally, one area of interest among researchers right now is whether a COVID-19 booster vaccine for patients experiencing long COVID symptoms can shorten the duration or severity of their symptoms.

“While the related data is conflicting thus far,” says Dr. DiSilvio, “what we do know is that vaccinated patients who have breakthrough COVID-19 infections are far less likely to suffer from long COVID than those who are unvaccinated and contract COVID.”

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