Editorial: When the Treatment Needs a Home: The Application of Exercise Interventions in Long COVID, 2025, Menson and Gaalema

Andy

Andy

Retired committee member
[All text converted from the available image at link below]

The Centers for Disease Control and Prevention estimates that as of 2022, 7% of US adults are living with post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as long corona- virus disease (COVID).' In 2024, long COVID was formally defined by the National Academies of Sciences, Engineering, and Medicine as "an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects 1 or more organ sys- tems. Key features include the impairment to function, individually and in society, acknowledging the profound impact on patients and their support systems. Common symptoms include fatigue, dyspnea, anxiety, and cognitive impairment, although presentation varies by phenotype." While we know there is a greater predilection towards long COVID for females, middle-aged (ages 35-49 years), and those of Hispanic ethnicity, it is not understood what places a person at risk of getting the disease.'

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"The overlapping symptomatology of long COVID with myalgic encephalomyelitis/chronic fatigue syndrome (ME/ CFS), a disease that has been described since the 1930s, allows us to extrapolate prior evidence to this patient population. Similar to long COVID, ME/CFS is felt to be a post-viral complication in which one has impairment in the ability to engage in pre-illness levels of activity, exhibits post-exertional malaise, and lacks reprieve despite adequate sleep, in addition to cognitive impairment or orthostatic intolerance."

A Cochrane review last updated in 2024 determined that exercise therapy likely has a positive effect on fatigue symptoms in ME/CFS compared to usual care, although evi- dence was limited. Yet, in 2021 the British National Institute for Health and Care Excellence Guidelines did not advise exer- cise therapy unless overseen by a specialist team, citing varying results, potential harms, and lack of quality evidence." The incorporation of a specialist oversight for exercise therapy in complex conditions could provide additional insight for treating long COVID."
 
Editorial on Effects of Physical Exercise on Functional Physical Performance in Individuals With Long COVID: A Systematic Review (2025)

In this edition of the Journal, the authors of 'Effects of physical exercise on functional physical performance in individuals with long COVID: A systematic review* explore exercise therapy as a potential treatment for this disease. The existing literature is limited, as only 7 of 2033 articles fit the eligibility criteria of the review. Exercise protocols varied in frequency (from 2 to 7 days/wk) and duration (2-16 weeks) and included both acrobic exercise and resistance training. Explicit comment of supervision by trained professionals was explicitly mentioned in 6 of the 7 studies. The control groups included medical care, standard physiotherapy, unsupervised training, and World Health Organization home guidelines, allowing comparison to some level of standard of care rather than inactivity alone.
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Andy said:
"The overlapping symptomatology of long COVID with myalgic encephalomyelitis/chronic fatigue syndrome (ME/ CFS), a disease that has been described since the 1930s, allows us to extrapolate prior evidence to this patient population. Similar to long COVID, ME/CFS is felt to be a post-viral complication in which one has impairment in the ability to engage in pre-illness levels of activity, exhibits post-exertional malaise, and lacks reprieve despite adequate sleep, in addition to cognitive impairment or orthostatic intolerance."

A Cochrane review last updated in 2024 determined that exercise therapy likely has a positive effect on fatigue symptoms in ME/CFS compared to usual care, although evi- dence was limited. Yet, in 2021 the British National Institute for Health and Care Excellence Guidelines did not advise exer- cise therapy unless overseen by a specialist team, citing varying results, potential harms, and lack of quality evidence." The incorporation of a specialist oversight for exercise therapy in complex conditions could provide additional insight for treating long COVID."
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Well there is our evidence for that misdating by Cochrane leading to misuse

Inferring a dodgy piece of research done with papers up to 2014 ‘was updated in 2924’ to infer it’s more recent than nice done in 2021

Was the word ‘likely’ to help used in that old larun reviews conclusion either?

I had hoped from the title - a treatment looking for a home - that this would be addressing the issue that workers adapting to work with other people who do need them or changing their knowledge and techniques to be in line with genuine science was ‘normal expectation for a profession’ and not some huge thing worse than patients being harmed for the rest of their lives.

At the moment it feels too many who think ‘they care/help’ also out their own minor discomfort or having to keep with the times as above in importance the safety of others and must think harming people seriously at the expense of that is ok as long as they feign denial. Where is the perspective in the world on calling people out m

Ps it’s always been clear to me at the start that bps rhetoric was always about those who injure others trying to wheedle out of liability if responsibility for the damage they cause. Either byvrelabelling horrific things that happened to people ‘trauma’ and pretending a nonsense therapy would somehow make it like that never happened and someone should be whole when obviously that’s not the case, or by pretending the injury doesn’t exist or the fake treatment didn’t make someone worse ‘unless it’s the victims mind’ etc

This sort of stuff is just another self-centered angle of this where someone hasn’t been forced to step out of thinking only along the lines of what works for them and then seeking confirmation to ‘carry on regardless’ and be allowed to keep with the claims they want yo make of being a good person or it being help. It’s all backwards to me.

But I’m aware for some reason these people in industries where they are taught to coerce with their communication style and threats of vindictive notes they are also somehow oblivious to the coercion they impose, so think that even tho there would be penalties they’d personally impose on those who came back to tell them what they did harmed them or didn’t say thanks at the end of a session and pretend it helped that those anecdotes are ‘evidence’ and really have no clue of how to remove it in research.

Except it’s easy - blind the staff so the controls are getting coerced too and the research design makes sure that is subtracted from any ‘effect’ in the treatment arm. Strange they never want to do that ?
 
The paper said:
The incorporation of a specialist oversight for exercise therapy in complex conditions could provide additional insight for treating long COVID."
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Why do they keep talking about the past and present as if it didn't happen and isn't happening? Is this not a sign of insanity? It's definitely usually a sign of insanity to pretend like reality is not happening. We literally had 5 years in which this has been the main treatment model, applied onto hundreds of thousands of people, and everyone is out there pretending like it's some new idea no one's ever tried. It's just as insane as the current push in the US to invalidate vaccination programs, "just asking questions" about whether they work, and having them all submit to randomized trials all over again. It's the same thing!

And they're not even citing correctly what NICE recommend, or the fact that the Cochrane review was not, in fact, updated in 2024. This shouldn't even get a passing grade in high school.

There is some unintentional honesty in the title, in that exercise is indeed a treatment trying to find a home, a conclusion seeking supporting evidence for itself, not because any such evidence is promising, or is backed by theoretical knowledge, but simply because it wants to be relevant, after literally decades of having asserted so, despite zero supporting evidence, and to widespread failure, destroying millions of lives in the process.

At some point, when AI gets smart enough to recheck all the work done in health care, it's not going to look pretty for them. The amount of bullshit they are peddling is at a giant corporate farm the size of a nation level.
 
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