Long Covid: Post-Exertional Malaise
- Jan 17, 2024
- 3 min read
Updated: Jan 14
A new study has shown how returning to exercise too soon can be harmful for long covid patients.
"We very clearly show that excessive exercise – only 15 minutes, but this is excessive for the patients – causes a lot of damage," says Brent Appelman, a researcher at Amsterdam UMC.
The research has confirmed what many long COVID patients have experienced on their journey to recovery after their diagnosis, with symptoms such as muscle cramps, pain, fatigue, and even brain fog lasting from anything from two days to two months, depending on the person.
"The crash that these patients experience is so severe that it can set their rehabilitation back for many months. And you can imagine that regular exercise of one hour, intense working days of eight hours, or social activities of two hours, can show similar effects."
These symptoms are similar to those of patients with ME/CFS and POTS, and are a form of post-exertional malaise. With the number of POTS diagnoses doubling since the covid pandemic, learning more about the condition could be the key to treating long covid.
What is Post-exertional Malaise (PEM)?
Post-exertional malaise is a worsening of symptoms after exercise, triggered by ordinary activities that healthy people can tolerate. PEM is a hallmark symptom of ME/CFS and is common in long covid. The crash caused by PEM can happen instantly, or take days to appear, with 12–48 hours being most common.
Tips for managing Post-Exertional Malaise
Keep a Diary:
Since some symptoms can take days to appear, keeping a record of your activities and health can help you identify your triggers. With this information, you can make the necessary adjustments to minimize your symptoms.
Make Accommodations:
For example, using a stool while cooking can reduce the strain from standing for long periods. Camping stools are especially useful if you're going somewhere with limited resting spots. If heat triggers your symptoms, carrying a handheld fan can help lower your body's strain and keep you comfortable.
Pace Yourself:
Pacing is one of the most important adjustments you can make for many chronic illnesses. Taking things slowly can prevent burnout and support your overall well-being. This might mean planning regular rest stops during outings or splitting tasks into manageable segments so you don't do too much in one day.
Prioritize Rest:
When post-exertional malaise (PEM) occurs, resting in a dark, quiet room can be very beneficial. Avoiding screens and other stimuli while resting helps calm your nervous system. Since many people with chronic illnesses struggle with sleep or wake feeling less rested, establishing good sleep habits can ensure your body gets the rest it needs.
Stress Management:
Many chronic illnesses are believed to worsen with stress. Managing stress may help reduce levels of cortisol—a chemical known to exacerbate PEM—and improve sleep quality. Your body functions best and is more resilient when you're relaxed. Some effective stress reduction techniques include:
Learning to say "no" and limiting commitments
Meditation, breathwork, and mindfulness practices
Yoga, if tolerated without triggering PEM
Delegating tasks or asking for help with stressful situations
Practice Self-Care:
Everything mentioned so far is a form of self-care. Equally important is listening to your body—taking breaks when you start feeling strained and avoiding pushing through discomfort. This approach can help prevent burnout and is a vital part of managing a chronic illness. Remember, taking care of yourself is not a luxury—it's essential.
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