Balancing the value and risk of exercise-based therapy post-COVID-19: a narrative review

Abstract

Coronavirus disease 2019 (COVID-19) can lead to ongoing symptoms such as breathlessness, fatigue and muscle pain, which can have a substantial impact on an individual. Exercise-based rehabilitation programmes have proven beneficial in many long-term conditions that share similar symptoms. These programmes have favourably influenced breathlessness, fatigue and pain, while also increasing functional capacity. Exercise-based rehabilitation may benefit those with ongoing symptoms following COVID-19. However, some precautions may be necessary prior to embarking on an exercise programme. Areas of concern include ongoing complex lung pathologies, such as fibrosis, cardiovascular abnormalities and fatigue, and concerns regarding post-exertional symptom exacerbation. This article addresses these concerns and proposes that an individually prescribed, symptom-titrated exercise-based intervention may be of value to individuals following infection with severe acute respiratory syndrome coronavirus 2.

Practical Recommendations for Exercise Training in Patients with Long COVID with or without Post-exertional Malaise: A Best Practice Proposal

“…This paradigm change in the NICE guideline regarding GET evolved also into a controversial debate on the role of exercise training [ 63 – 65 ]. However, it is regarded as common sense that in patients with PEM, activity management strategies must be carefully customized to reflect the individual needs and limits of each individual [ 66 , 67 ]. We therefore propose an individualized and symptom-titrated approach rather than GET with a fixed progression of the exercise load in patients with mild/moderate PEM.…”

Changes in fatigue symptoms following an exercise-based rehabilitation programme for patients with long COVID

“…Long COVID rehabilitation programmes may require some modifications or adaptations in order to ensure they are appropriate for this population. Notably this includes a thorough medical assessment to exclude any risk factors, adjustments to educational component and close monitoring of fatigue symptoms [ 41 ].…”