Orthostatic and Exercise Intolerance in Recreational and Competitive Athletes With Long COVID, 2022, Rao, Systrom et al

Andy

Andy

Retired committee member
Wow, this is a nice rebuttal to the "You're out of shape" meme:
A 31-year-old female recreational alpine skier with no significant prior medical history experienced initial symptoms of fever, dyspnea, chest pain, and palpitations likely due to acute COVID-19 illness....One year after initial symptom onset, she received the second dose of an mRNA COVID-19 vaccine, which was shortly followed by severe and limiting orthostatic symptoms, particularly palpitations and overwhelming fatigue. These symptoms progressively worsened, and she was unable to tolerate ambulating around her house to perform routine daily activities.
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An 18-year-old male Division 1 collegiate rower with a history of well-controlled asthma presented with a year of decreased exercise tolerance and exertional chest pressure. The symptoms began following an acute COVID-19 illness associated with fevers, body aches, and anosmia.
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This is an apples and oranges comparison because the first test was cycling and the second was rowing, but for what it's worth, his VO2Max before Covid was 49.1. After Covid it was 36.7 mL/min/kg. That's a 25% drop.
A 38-year-old woman with no past medical history was diagnosed with COVID-19 early in the pandemic. Her infection was treated conservatively on an outpatient basis. She developed symptoms consistent with PASC, including severe fatigue, headaches, and palpitations that occurred predominantly in an upright position. She previously was highly athletic, participating in CrossFit at least 5 times per week for the past 10 years. Given the severity of her PASC symptoms, she was unable to resume participation in CrossFit.

A few months after development of PASC, she became pregnant and developed profound fatigue in her second trimester which limited her ability to engage in routine activities of daily living.
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The first and third went from being highly trained athletes to being severely disabled.

They recommend exercise...
Additionally, she was provided a structured, graduated exercise regimen that emphasized recumbent exercises and strength training to facilitate reconditioning.
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...but they seem to think this is only applicable to people with dysautonomia-like symptoms:
Importantly, however, caution should be heeded in providing exercise recommendations to patients who exhibit post-exertional malaise, in which symptoms worsen with excessive physical and/or mental stress.
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I just with they were more direct about saying that people with PEM simply don't tolerate exercise.
 
Dr. Systrom is probably the best exercise intolerance expert out there. Very familiar with the concept of PEM.

Having consulted myself with him before, I am not surprised with the theme of this paper. He is usually associated with Mestinon, which is his drug of choice, but not everyone talks about the gradual exercise program, which is as much recommended by him as the drug. He also prescribes a mitochondrial cocktail, when necessary.
I do believe that exercise has a therapeutic effect, when done correctly. There is plenty of evidence that mitochondria can adapt to aerobic training. But this is easier said than done. It is very hard to pull it off without any professional support. If you overdo, I/R injuries are just around the corner. In general, breaking something is much easier than building it.

My hope is that Bocidelpar will make exercise programs safer for us.
 
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