High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

Abstract

BackgroundExercise-based treatments can worsen/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM and OI are not routinely assessed by clinicians. We estimated PEM and OI proportions in PL-PCC, as well as in people not living with PCC (PnL-PCC) and negatives (i.e., never reported a SARS-CoV-2 positive test), and identified associated factors.MethodsParticipants from the Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study were included. PEM and OI were assessed using validated questionnaires. PCC was defined as feeling unrecovered after SARS-CoV-2 infection. Multivariable regression analyses to study PEM and OI were stratified for sex.ResultsData from 3,783 participants were analyzed. In PL-PCC, the proportion of PEM was 48.1% and 41.2%, and the proportion of OI was 29.3% and 27.9% in women and men, respectively. Proportions were higher in PL-PCC than negatives, for PEM in women OR=4.38 [95%CI:3.01–6.38]; in men OR = 4.78 [95%CI:3.13–7.29]; for OI in women 3.06 [95%CI:1.97-4.76]; in men 2.71 [95%CI:1.75–4.21]. Associated factors were age ≤ 60 years, ≥1 comorbidities, and living alone.ConclusionHigh proportions of PEM and OI are observed in PL-PCC. Standard screening for PEM and OI is recommended in PL-PCC to promote appropriate therapies.

Exercise Therapy for Post–COVID-19 Condition—Does No Harm

“…Studies have shown that among individuals with PCC, up to 48% of female individuals and 41% of male individuals experience postexertional malaise, and 29% of female individuals and 28% of male individuals experience orthostatic intolerance. 1 The article by Tryfonos and colleagues 2 is, therefore, timely and necessary because it addresses an important topic in the debate surrounding patient acceptability and the therapeutic effects of different exercise modalities in the treatment of patients with PCC and their acute risks of developing PESE.Tryfonos et al 2 recruited 31 nonhospitalized, community-based participants with a mean (SD) symptom duration of 21.6 (9.2) months following COVID-19 illness (with 31 age-matched and sex-matched healthy controls for comparison). This previously healthy and working-age population represents an important section of society; 78% of the PCC group were employed full-time before SARS-CoV-2 infection.…”

“…Studies have shown that among individuals with PCC, up to 48% of female individuals and 41% of male individuals experience postexertional malaise, and 29% of female individuals and 28% of male individuals experience orthostatic intolerance. 1 The article by Tryfonos and colleagues 2 is, therefore, timely and necessary because it addresses an important topic in the debate surrounding patient acceptability and the therapeutic effects of different exercise modalities in the treatment of patients with PCC and their acute risks of developing PESE.…”