Long COVID, or Just Deconditioning?

Photo by Pixabay: https://www.pexels.com/photo/person-lying-on-bed-covering-white-blanket-271897/

About a month ago, I came down with COVID for the first time (or at least the first time with significant symptoms). It hit me pretty hard, and I didn’t get out of bed much for a few days. But as soon as I could stand up without feeling like I was going to fall down, I made myself be as physically active as I could.

After testing negative, I went back to work 10 days after initially getting sick, and as a chiropractor, I have a somewhat physically demanding job. It was a tough week, but I made it through.

By the end of the second week after the onset of symptoms, despite still not having much energy, I resumed my long-time exercise regimen, toned down for the first few sessions. Even toned down though, they were a struggle!

Now, I realize this goes against the conventional wisdom to rest when you’re sick. And to be clear, I still had to rest a fair amount once I started increasing my activity, but I was definitely pushing myself beyond what I really felt like doing and my exercise sessions really sucked to get through!

So why would I torture myself like that?

Well, many years ago, I had a bad case of the flu. I mostly stayed in bed for a full week, and it seemed like it was taking me forever to get better. With all the time in bed, my back started to get very stiff and uncomfortable.

Trying to loosen up, I decided to use my wife-at-the-time’s “health rider” machine. If you don’t know what that is, it had a bicycle seat and had handles that you pulled and pedals that you pushed to raise the seat, essentially go from a sitting to a semi-standing position, before lowering yourself back down again. I only did it for about 5 minutes. But when I was finished, not only did my back feel better, but I felt significantly better overall. So, after a short rest, I did it again. In all, I probably did 5 or 6 sessions of about 5 minutes each that first day, feeling better each time.

The next day, I was remarkably better – after having had minimal improvement for the preceding week up to that point. Now, that could have been a coincidence. Maybe the flu had finally run its course and I would have been better anyway, but it was such a dramatic change that the experience stayed in my mind. I suspected that the increased circulation probably helped my lymphatic and immune system to accelerate my recovery.

Since that first experience, whenever I’ve been sick, I’ve made it a point to be as physically active as possible, as soon as possible. And over the years, while by no means scientific, I’ve had multiple opportunities to compare my recovery to the recovery of friends and family who got sick with at least similar symptoms around the same time as I did.

Over the last 25 years or so, the overwhelming trend is that I’ve recovered from my illnesses significantly faster than those around me suffering with similar maladies.

The recovery from COVID is highly variable, but I was pretty much back to my normal energy level by the end of the third week post-onset. By comparison, I know two people about my age who got COVID with similar symptoms to mine about a week before I got sick, who are still struggling significantly with fatigue.

This brings me to the title of this article. First, let me be clear that I believe Long COVID is a real illness unto itself, with a variety of symptoms that can last indefinitely.

But I also think there’s probably a lot of people who have chronic, persistent post-viral fatigue who have been diagnosed with Long COVID, who may simply be deconditioned due to prolonged bed rest while they had the active infection.

If you stay in bed for a week, you’re going to lose some physical strength and conditioning. If you’re laid up for more than a week, it really starts to weaken you. If you weren’t in particularly good shape to begin with, that loss is going to hit you harder in terms of normal daily activities than someone who’s relatively fit. So, even once you’re clear of the active infection, you’ll still feel pretty weak and tired.

You feel bad, so you minimize your physical activity, and this leads to further deconditioning and intolerance to activity. The downward spiral begins, and since you had COVID, it’s not a big stretch to get the Long COVID diagnosis.

Now being erroneously diagnosed with Long COVID might not make that much difference one way or another, but oftentimes people with this diagnosis are told… to rest!

That recommendation to rest is becoming less popular. In fact, I’ve heard that at least one of our local hospitals has a Long COVID treatment program that, among other things, involves incredibly cruel physical therapists making the people in the program exercise (it’s more in-depth than that, but supervised exercise is an important part of the program).

Nonetheless, the rest recommendation is still pretty common and I suspect that it’s probably doing more harm than good in many cases.

Ultimately, as much as it sucks to exercise and be physically active when you have no energy, it may be necessary for people with persistent post-viral fatigue (be it from COVID, Flu, or other viruses) to have a chance to improve significantly any time soon.

Now, depending on how severe your fatigue and weakness are and what your level of fitness was before you got sick, you may need to increase your activity very slowly at first.

I’m pretty fit, so going back to working out two weeks after COVID was tough, but do-able. I would not recommend for someone who was out of shape to begin with, to try to do an intense workout that soon!

If you’re dealing with post-COVID fatigue and you’ve been mostly sedentary for months or years, my suggestion is to start with something simple like walking or riding a bike for a few minutes each day and see how it goes. You may very well feel worse initially, but exercise can take a little time to show benefits, so I suggest you try to stick with it for at least a couple of weeks to see if it helps you. Gradually increase the duration and/or intensity of the exercise as you can.

With a little luck, your chronic COVID-related fatigue can be cured, but it make take a period of pushing yourself a bit to get on the road to recovery.

Until next time…

George F. Best, D.C.