The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome

Abstract

Background Post-COVID-19 syndrome (PCS) shares many features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). PCS represents a major health issue worldwide because it severely impacts patients’ work activities and their quality of life. In the absence of treatment for both conditions and given the beneficial effect of pacing strategies in ME/CFS, we conducted this study to assess the effectiveness of pacing in PCS patients. Methods We retrospectively included patients meeting the World Health Organization definition of PCS who attended the Internal Medicine Department of Angers University Hospital, France between June 2020 and June 2022, and were followed up until December 2022. Pacing strategies were systematically proposed for all patients. Their medical records were reviewed and data related to baseline and follow-up assessments were collected. This included epidemiological characteristics, COVID-19 symptoms and associated conditions, fatigue features, perceived health status, employment activity, and the degree of pacing adherence assessed by the engagement in pacing subscale (EPS). Recovery was defined as the ability to return to work, and improvement was regarded as the reduction of the number and severity of symptoms. Results A total of 86 patients were included and followed-up for a median time of 10 [6–13] months. Recovery and improvement rates were 33.7% and 23.3%, respectively. The EPS score was the only variable significantly associated with recovery on multivariate analysis (OR 40.43 [95% CI 6.22–262.6], p < 0.001). Patients who better adhered to pacing (high EPS scores) experienced significantly higher recovery and improvement rates (60–33.3% respectively) than those with low (5.5–5.5% respectively), or moderate (4.3–17.4% respectively) scores. Conclusion Our findings demonstrated that pacing is effective in the management of patients with PCS, and that high levels of adherence to pacing are associated with better outcomes.

Different but the Same: Common Themes in Illness Experience Among People With Diverse Long COVID Symptoms and the Potential Benefits of Virtual Group Medical Visits

“…The strategy of “listening to one's body” and avoiding overexertion is sometimes referred to as “pacing.” This has become an important cornerstone of long COVID treatment. 13 , 14 A young adult patient recounted the danger of pushing through their exhaustion and trying to put “mind over matter”: “People just want to push it to the back of your mind because I know at the beginning, I was like ‘I’m 22 years old. I can’t let this thing take over my body.'…”

“… 20 Therefore, patients’ comments about learning to listen to their bodies are particularly salient given the central role that pacing has come to play in the management of postexertional malaise associated with long COVID. 1 , 13 …”

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

“…Screening and scoring PEM was suggested to be a useful procedure for assessing the tolerance of certain interventions in patients with chronic fatigue [ 69 ]. Pacing was shown to be associated with better outcomes in the management of people with long COVID [ 70 ] and may be especially beneficial for individuals with higher available energy who are pushing themselves beyond their energy limitations [ 57 ]. Since people with mild to moderate PEM are at risk of developing more frequent, severe, and long-lasting PEM triggered by daily activities, they need to be carefully guided to remain as active as possible while avoiding “crashes” resulting from too much exertion [ 57 ].…”

Possible Role of Cannabis in the Management of Neuroinflammation in Patients with Post-COVID Condition

“…A retrospective study showed that pacing generated recovery and improvement rates were 33.7% and 23.3%, respectively, in 86 patients with PCC. Additionally, a longitudinal cohort study of 31 participants with PCC demonstrated that a structured pacing protocol over 6 weeks significantly reduced the post-exertional symptom exacerbation episodes with an average decrease of 16% each week, and a reduction across all three exertional triggers (physical, cognitive, and emotional) [163,164]. Other therapeutic options have been proposed, including meditation, music therapy, disease-modifying therapies, ozone therapy, and the ingestion of probiotics or foods with anti-inflammatory properties [65,165,166].…”