Paced activity programme can improve symptoms and quality of life in long Covid

A rehabilitation programme for people with long Covid has shown ‘impressive results’ say researchers at the University of Leeds.

Using a technique to gradually increase levels of physical activity at a pace the patient could manage led to moderate but substantial improvements in symptoms and quality of life, an evaluation of the programme found.

Before starting the rehab programme, participants reported three ‘crashes’ a week on average where they felt physically, emotionally or cognitively exhausted after mild physical or mental exertion.

But after the six-week intervention, that had reduced to an average of one crash a week, the researchers said.

The pacing programme was part of a long-Covid service at Leeds Community Healthcare NHS Trust and reporting the results in the Journal of Medical Virology, the team said it suggests it has the potential to be an effective treatment option.

In all 31 people who had been experiencing long-Covid for an average of around 17 months took part in the six-week study.

Their symptoms included fatigue, including brain fog, breathlessness, headache and palpitations. 

They followed a home-based pacing protocol developed by the research team for the World Health Organisation, which takes them through five levels of activity.

Step one involves preparing to return to activity with breathing exercises and gentle stretching.

By the fifth phase, participants would be involved in activity they did before they were ill such as regular exercise or sports. 

Patients had weekly phone calls from a clinician to check how they were doing and were advised to stay at each level for at least seven days and not to overexert themselves.

Their exertion levels and ‘crashes’ were assessed each week before a decision was made whether to move to the next level. 

When it came to easing long-Covid symptoms, the biggest benefit was seen in reducing fatigue, breathlessness and headaches, the researchers reported. 

A larger study would be needed to identify trends in individual symptoms where the most improvement is seen or who would most benefit, they added.

Yet there is generally a lack of awareness among clinicians that a paced or gradual return to physical activity could aid recovery and patients often received conflicting advice. 

Dr Manoj Sivan, associate clinical professor in the School of Medicine at the University of Leeds and consultant in rehabilitation medicine at Leeds Teaching Hospitals NHS Trust who developed the protocol said post-exertional malaise or post-exertional symptom exacerbation or ‘crashes’ is a defining and important symptom of long-Covid. 

‘When patients get a crash, they experience feelings of complete exhaustion and wipe out and are unable to resume activities for hours or sometimes days. 

‘The findings of this research are exciting because this is the first time that crashing episodes have been used as a marker for the condition and a structured pacing programme has now been shown to substantially reduce symptoms and improve quality of life.’ 


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