Until recently, running was a major part of Emma Zimmerman’s life. The 26-year-old freelance journalist and graduate student was a competitive distance runner in college and, even after she graduated, logged about 50 miles per week. So she tentatively tried to return to her running routine roughly a week after a probable case of COVID-19 in March, doing her best to overcome the malaise that followed her initial allergy-like symptoms. Each time, though, “I’d be stuck in bed for days with a severe level of crippling fatigue,” Zimmerman says.
Months later, Zimmerman still experiences health issues including exhaustion, migraines, brain fog, nausea, numbness, and sensitivity to screens—a constellation of symptoms that led doctors to
diagnose her with Long COVID. Though she can’t know for sure, she fears those workouts early in her recovery process may have worsened her condition.
“I had no idea that I should try to rest as hard as I needed to rest,” she says.
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Researchers are still learning a lot about Long COVID, so it’s impossible to say for sure whether rest can truly prevent its development—or, conversely, whether premature activity causes complications. But anecdotally, Friedly says many of the Long COVID patients she sees are working women with families who rushed to get back to normal as soon as possible. It’s hard to give one-size-fits-all guidance about how much rest is enough, but Friedly recommends anyone recovering from COVID-19 stay away from high-intensity exercise for at least a couple weeks and avoid pushing through fatigue.
For people who have already developed Long COVID, rest can also be useful for managing symptoms including fatigue and post-exertional malaise (PEM), or crashes following physical, mental, or emotional exertion. The U.S. Centers for Disease Control and Prevention
recommends “
pacing,” an activity-management strategy that involves rationing out activity and interspersing it with rest to avoid overexertion and worsening symptoms.
In
an international study published last year, researchers asked more than 3,700 long-haulers about their symptoms. Almost half said they found pacing at least somewhat helpful for symptom management. Meanwhile, when other researchers surveyed about 500 long-haulers for
a study published in April, the overwhelming majority said physical activity worsened their symptoms, had no effect, or brought on mixed results. That may be because long-haulers have impairments in their mitochondria, which generate energy cells can use,
recent research suggests.
Before Long COVID existed, researchers and patients encouraged rest and pacing for the
management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The condition’s hallmark symptoms include PEM and serious, long-lasting fatigue—diagnostic criteria that many people with Long COVID now meet.
A study of more than 200 people with Long COVID published in January found that 71% had chronic fatigue and almost 60% experienced PEM.
For years, clinicians tried to treat ME/CFS patients by gradually increasing their physical activity levels. But that practice has since been shown to be
not only ineffective, but often harmful, because people with ME/CFS “have a unique and pathogenic response to overexertion” due to cellular dysfunction, explains Jaime Seltzer, director of scientific and medical outreach at the advocacy group MEAction. Most people with ME/CFS prefer pacing over exercise-based therapy,
one 2019 study found.
