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Nature Reviews Cardiology published (26/1/24) a response to a review by Fedorowski et al. (2024). The authors of the response agree that recognizing cardiovascular autonomic dysfunction (CVAD) is important for managing Long Covid patients. However, they disagree with recommending graded exercise therapy for patients with post-exertional malaise (PEM), a key symptom of Long Covid.
PEM causes disabling symptoms that get worse after physical or cognitive exertion, with a delayed onset and prolonged recovery period. It is a hallmark of syndromes like ME/CFS as well as Long Covid. The evidence does not support graded exercise therapy for PEM.
The authors argue the cited PACE trial claiming exercise benefits for ME/CFS has been discredited due to methodological flaws. Contemporary guidelines no longer recommend graded exercise therapy for ME/CFS.
The authors also argue that studies showing exercise benefits in Long Covid do not properly include or account for PEM. Surveys show most PEM patients deteriorate if they exercise. Recent research has found abnormal physiological responses to exercise in people with Long Covid. Because of this graded exercise should not be recommended for Long Covid patients with PEM. Those without PEM can try exercise approaches while monitoring for PEM onset. Patients with PEM should stay within their ‘energy envelope’ and follow other non-exercise recommendations.
The authors agree with the rest of the review but call for a ‘do no harm’ approach, assessing Long Covid patients for PEM before exercise therapy. Graded exercise should be avoided in those with PEM given the potential for harm.
You can see the full response here.
