UUntil recently, running was a major part of Emma Zimmerman’s life. The 26-year-old freelance journalist and student was a competitive distance runner in college, and even after graduating, she logged about 50 miles a week. So she tentatively 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. Each time, however, “I would stay in bed for days with a severe level of crippling fatigue,” says Zimmerman.
Months later, Zimmerman is still experiencing health problems, including exhaustion, migraines, brain fog, nausea, numbness and sensitivity to screens — a constellation of symptoms that led doctors to diagnosed her with long covid. Although she can’t know for sure, she fears that those workouts early in the recovery process may have worsened her condition.
“I had no idea I had to try to rest as hard as I needed to,” she says.
Stories like Zimmernan’s—illness, recovery, exercise, disaster—are common the world of long covid. And they highlight what many researchers, patients and advocates say is one of the most powerful tools for managing and potentially even preventing long-term COVID: rest.
The only guaranteed way to avoid Long COVID is to not contract SARS-CoV-2. But if someone does get sick, “Rest is extremely important to give your body and immune system a chance to fight off the acute infection,” says Dr. Janna Friedley, a post-COVID rehabilitation specialist at the University of Washington who recovered from long COVID myself. “People fight it and think it’s going to go away in a few days and they’ll be fine, and that doesn’t really work with COVID.”
Researchers are still learning a lot about Long COVID, so it is impossible to say for sure whether rest can really prevent its development – or, conversely, whether premature activity causes complications. But anecdotally, Friedley says many of the Long COVID patients she sees are working women with families who are in a rush to get back to normal as soon as possible. It’s hard to give universal guidelines for how much rest is enough, but Friedly recommends that anyone recovering from COVID-19 stay away from high-intensity exercise for at least a few weeks and avoid overcoming fatigue.
For people who have already developed a long COVID, rest can also be helpful for managing symptoms, including fatigue and post-exertion malaise (PEM), or crashes after physical, mental or emotional exertion. US Centers for Disease Control and Prevention recommends “the pace,” an activity management strategy that involves spacing out activity and interspersing it with rest to avoid overexertion and worsening symptoms.
in international survey published last year, researchers asked more than 3,700 long-haul carriers about their symptoms. Almost half said pacing was at least somewhat helpful in managing symptoms. Meanwhile, when other researchers surveyed about 500 long-haul carriers for study published in April, the vast majority said that physical activity worsened their symptoms, had no effect, or had mixed results. This may be because long-distance travelers have damage to their mitochondria, which generate energy that cells can use, recent research shows.
Before Long COVID existed, researchers and patients encouraged rest and pacing for treatment of 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 COVID already meet. Research of more than 200 people with Long COVID published in January found that 71% had chronic fatigue and almost 60% had PEM.
For years, clinicians have tried to treat ME/CFS patients by gradually increasing physical activity levels. But this practice has since been proven not only ineffective, but often harmful, because people with ME/CFS “have a unique and pathogenic stress response” due to cellular dysfunction, explains Jaime Seltzer, director of scientific and medical work at the advocacy group MEAction. Most people with ME/CFS prefer pacing to exercise-based therapy, found one 2019 study.
To move effectively, people need to learn to pick up on cues that they’re overdoing it and let go of ingrained ideas about performance, says Seltzer. “If you’re doing laundry, for example, there’s nothing that says you have to fold every single item at once,” she says. Dividing tasks may seem strange, but it can be crucial to conserving energy.
People with new Long COVID symptoms should keep a log of their diet, activity, sleep and symptoms for several weeks to learn their triggers, Friedley says. For those who can afford it, a fitness tracker or other wearable device can also be useful for assessing how much effort is too much, says Seltzer. Once someone has an idea of behaviors that improve or worsen symptoms, they can use that information to plan their days and break activities into manageable chunks.
For many people who test positive for COVID-19, however, even taking a few days off work to self-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. “The break is absolutely advice that’s weighted socioeconomically and politically,” says Seltzer.
People with long-term COVID or ME/CFS may be able to provide workplace accommodationsuch as working from home, taking on a role that can be performed sitting instead of standing, or applying for disability if necessary. Seltzer also suggests relying on friends, religious groups, or support networks for help with some tasks. Additionally, Friedly recommends looking for creative ways to use less energy throughout the day. When she was living with Long COVID symptoms, she bought many pairs of matching socks so she would never waste time and effort looking for a match.
Things like that “may seem small,” she says, “but if you add them up throughout the day, they make a big difference in how much energy you expend.”
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