Mechanisms of exercise intolerance after COVID-19 new perspectives beyond physical deconditioning, 2021, Machado Ferreira & Oliveira

The final paragraph:

Thus, considering the current pathophysiological knowledge of intolerance mechanisms and the range of systemic manifestations of the acute phase of COVID-19 infection, it would be simplistic for us to consider that all chronic symptoms of the long-COVID-19 syndrome are due to physical deconditioning by inactivity or prolonged hospitalization. The physical deconditioning theory does not explain the presence of persistent symptoms in patients who were affected by mild forms of the disease, many of whom did not even require hospitalization. Similarly, this theory does not explain the dissociation between the severity of hospitalization and the reduction in peak VO2 reported so far, nor does it explain the antagonism of the persistence of symptoms in patients with preserved peak VO2. (4-6) In light of the potential complexity and the lack of knowledge on the post-COVID-19 syndrome, it is unacceptable to be simplistic when attempting to unravel the post-COVID-19 syndrome exercise intolerance mechanisms. More robust scientific evidence is needed before drawing simple conclusions.
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Much better than most though no mention of PEM as found in ME/CFS (though ME/CFS is alluded to), of orthostatic intolerance, of use of two day CPET testing or of relevant research in other areas.

[edited to clarify and correct typos]
 
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Ferreira and Oliveira said:
Thus, considering the current pathophysiological knowledge of intolerance mechanisms and the range of systemic manifestations of the acute phase of COVID-19 infection, it would be simplistic for us to consider that all chronic symptoms of the long-COVID-19 syndrome are due to physical deconditioning by inactivity or prolonged hospitalization. The physical deconditioning theory does not explain the presence of persistent symptoms in patients who were affected by mild forms of the disease, many of whom did not even require hospitalization. Similarly, this theory does not explain the dissociation between the severity of hospitalization and the reduction in peak VO2 reported so far, nor does it explain the antagonism of the persistence of symptoms in patients with preserved peak VO2. (4-6) In light of the potential complexity and the lack of knowledge on the post-COVID-19 syndrome, it is unacceptable to be simplistic when attempting to unravel the post-COVID-19 syndrome exercise intolerance mechanisms. More robust scientific evidence is needed before drawing simple conclusions.
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Agreed. ;)
 
What the authors say re ME/CFS

Similarly, it is hypothesized that these patients may develop post-viral myalgic encephalomyelitis/chronic fatigue syndrome with possible associated small-fiber neuropathy, as previously described in other viral infections, or damage to olfactory sensory neurons, causing reduced cerebrospinal fluid flow, with congestion of the glymphatic system and subsequent toxic accumulation in the central nervous system.(10,11)
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Here are the 2 papers referenced in the section on ME/CFS:

10. Wostyn, P. COVID-19 and chronic fatigue syndrome: Is the worst yet to come? Medical Hypotheses 2021; 146:110469. https://doi.org/10.1016/j.mehy.2020.110469.

Posted on the forum here

11. Joseph, P, Arevalo, C, Oliveira RFK, et al. Insights From Invasive Cardiopulmonary Exercise Testing of Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Chest 2021; 160(2):642-651. https://doi.org/10.1016/j.chest.2021.01.082.

Posted on the forum here

Note the second one is by one of the same authors as the article on this thread.

Edited to correct a link.
 
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> Similarly, it is hypothesized that these patients may develop post-viral myalgic encephalomyelitis/chronic fatigue syndrome with possible associated small-fiber neuropathy, as previously described in other viral infections, or damage to olfactory sensory neurons, causing reduced cerebrospinal fluid flow, with congestion of the glymphatic system and subsequent toxic accumulation in the central nervous system.(10,11)

i find this confusing. what does the causing?
 
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