Fatigue and post-exertional symptom exacerbation in Covid

Long Covid rehabilitation should include educating people about resuming everyday activities conservatively: WHO

Fatigue is a feeling of extreme exhaustion. One feels over tired, low level of energy and extreme urge to sleep. It is the most common symptom of long Covid. It is easily relieved by rest or sleep. It is not the result of usually difficult activity. It can limit functioning in day to day activities. It negatively impacts the quality of life.
Now talking about post-exertional symptom exacerbation (PESE), it is a disabling and often delayed exhaustion disproportionate to the effort made. It is something described as crash.
The activity that can trigger this worsening of symptoms can be something that was easily tolerated before such as a daily activity e.g., a shower, a social activity, walking, reading, writing or working at a desk, an emotionally charged conversation, being in a sensory environment e.g., loud music or flashing lights.
Many of the symptoms experienced by those living with long Covid are very similar to those of myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).
According to WHO, long Covid rehabilitation should include educating people about resuming everyday activities conservatively, at an appropriate pace that is safe and manageable for energy levels within the limit of current symptoms and exertion should not be pushed to the point of fatigue or symptom exacerbation.
PESE is most often triggered by physical activity and exercise. 75% of people living with long Covid still experience PESE after 6 months.
Many of the symptoms experienced by those living with long Covid are very similar to those of myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).
The symptoms worsened by exertion can include:
  1. disabling fatigue / exhaustion
  2. conginitive dysfunction or brain fog
  3. pain
  4. breathlessness
  5. heart palpitation
  6. fever
  7. sleep disturbance
  8. exercise intolerance
representative image
Image: representative image
Symptoms typically worsen 12 to 48 hours after activity and can last for days, weeks or even months.
Your physiotherapist can guide you in pacing as activity management tool that is also used successfully for people with ME/CFS to prevent triggering PESE.
  1. STOP trying to push your limits.
  2. Overexertion may harm your recovery
  3. REST is your most important management strategy. Do not wait until you feel symptoms to rest.
  4. PACE your daily activities and cognitive activities. This is a safe approach to navigate triggers symptoms.
Physical activity and exercise interventions warrant caution as rehabilitation strategies among people with long Covid and persistent symptom of disproportionate breathlessness on exertion, high heartbeat or chest pain.
Graded exercise therapy should not be used, particularly when post exertion symptoms exacerbation is present.



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