Study Finds Exercise May Have Negative Effect on Those With Long COVID

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• New research found changes that could explain why some people with long COVID struggle to exercise.

• The study found that COVID-19 can cause changes that impact some people on a cellular level.

• Doctors recommend listening to your body when it comes to exercising with long COVID.

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While the medical community has recognized long COVID for years, there is still a lot of mystery about the condition and how to treat people who have it. Now, new research finds yet another piece of information about long COVID: Exercise can be bad for people with the condition.

The small study, which was published in the journal Nature Communications, analyzed post-exertional malaise (feeling wiped out after exercise) in 25 patients with long COVID as well as people who didn’t have the condition. The researchers took biopsies from patients’ skeletal muscles before and after they worked out for 10 to 15 minutes on a stationary bike. They found that the mitochondria, which are considered the “power plants” for cells, in the long COVID patients was compromised and that their tissues didn’t have enough energy as a result.

The researchers also discovered that the tissue samples taken from patients with long COVID showed severe muscle damage, an impaired immune response, and “microclots,” which are small clots in the blood.

Ultimately, the researchers found that something about the way long COVID impacts the body made it hard for these patient’s muscles and cells to work properly—and that things got worse after they exercised.

It’s important to point out that post-exertional malaise isn’t the same as feeling sore or a little tired after a workout. Instead, it’s having symptoms like exhaustion and brain fog 12 to 48 hours after even minor activity, according to the Centers for Disease Control and Prevention (CDC). Those symptoms can last for days or even weeks, the CDC says.

So, why does this happen and how should you approach exercise if you have long COVID? Here’s what we know right now.

Why may some with long COVID experience exhaustion with exercise?

It’s important to point out that not all people with long COVID will have trouble exercising. However, if you have long COVID and struggle with exercise or even basic physical activity, doctors say these findings are validation that this is a real thing.

“This is not in your head,” says Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York. “This supports what some people with long COVID have been saying all along, which is that exercise is making things worse for them.”

But why does this happen? It’s not entirely clear at this point, although there are some theories. “Previous studies indicate that COVID initiates an inflammatory response that can persist and smolder for a long period of time,” says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. That inflammation could lead to fatigue that makes it tough to exercise or be active the way you once were, he says.

The latest findings are “brand new,” Dr. Schaffner says. “Within cells, some of the energy mechanisms can be impeded and, in some way, distorted,” he says.

Worth noting: A Yale study published in ERJ Open Research in December had 55 patients who were dealing with post-COVID exercise intolerance undergo exercise testing. The researchers found that, while the hearts and lungs of patients were working as they should, the tissues of patients who had exercise intolerance after having COVID-19 weren’t able to draw out oxygen from their blood that they needed as well as they should.

Ultimately, the reason some people with long COVID struggle after exercising “could be a combination of all of this,” Dr. Schaffner says.

How to approach exercise if you have long COVID

Doctors stress that the findings don’t mean that people with long COVID shouldn’t exercise or be active. Dr. Russo says that being sedentary isn’t great for overall health, but that “you should not do more than what your body is telling you that you can do.”

Mindful movement is key. “The critical thing is to listen to your body and not push yourself beyond your limit,” Dr. he says. “You have to appreciate that you want to do what you can, but you also don’t want to overdo it—that will be unhelpful at this point.”

In general, Dr. Schaffner says that people tend to benefit from gradual workout programs, which step up exercise intensity and duration with time.

Research has found that most people with long COVID get better within a year, but Dr. Schaffner says recovery is usually a gradual process.

If you suspect that you have long COVID, Dr. Russo recommends seeing your primary care physician first. “They can rule out other potential causes of fatigue,” he says. Then, try to find a long COVID clinic at a major medical center near you. “A lot of these centers have trials going on that may help,” he says. “These physicians will also not discount your symptoms and will appreciate that they are real.”

Dr. Russo says that the latest study findings are “very important” and may eventually help lead to more effective diagnosis and treatment for long COVID.

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