From the Guidelines
The most effective treatment for post-exertional malaise (PEM) in patients with Long COVID is pacing, which involves carefully balancing activity with rest to avoid triggering PEM episodes, as supported by the ME/CFS literature 1. This approach is crucial in managing PEM, as it helps prevent overexertion and allows the body to recover. Pacing involves planning activities within your energy limits, taking frequent breaks, and prioritizing essential tasks.
- Key components of pacing include:
- Planning activities to avoid exceeding energy limits
- Taking regular breaks to rest and recover
- Prioritizing essential tasks and delegating non-essential ones when possible
- Additional supportive measures that can help manage PEM include:
- Heart rate monitoring to keep exertion below the anaerobic threshold (typically 50-60% of maximum heart rate)
- Adequate hydration
- Proper nutrition with anti-inflammatory foods
- Good sleep hygiene
- Working with physical therapists experienced in post-viral conditions to develop appropriate activity plans It is essential to note that exercise, cognitive behavioral therapy, and graded exercise therapy are contraindicated for patients with PEM, as they can exacerbate symptoms 1.
- Other treatment options, such as medications, may be considered for managing specific symptoms associated with PEM, but pacing remains the primary approach for managing the condition itself.
- The current treatment options for Long COVID are based on small-scale pilot studies, and several additional trials are in progress 1.
- A recent study published in 2022 provides guidance on the management of post-acute sequelae of SARS-CoV-2 infection, including cardiovascular sequelae, but does not specifically address PEM treatment 1.
- However, the study highlights the importance of individualized management approaches and the need for further research to develop effective treatments for Long COVID and its associated conditions, including PEM.
From the Research
Available Treatments for Post-Exertional Malaise (PEM) in Long COVID Patients
- A structured pacing protocol can effectively reduce PESE episode frequency, duration, and severity, as seen in the study 2.
- Exercise prescriptions tailored to the Long COVID patient, based on the pathophysiology underlying this syndrome, can alleviate symptom burden associated with this condition 3.
- A symptom-titrated exercise program has been shown to be effective in reducing fatigue and improving quality of life in people with post-COVID condition, with significant effects on fatigue severity, health-related quality of life, and physical performance capacity 4.
Characteristics of Post-Exertional Malaise (PEM) in Long COVID Patients
- People with Long COVID experience PEM, with similarities to ME/CFS including low and medium physical and cognitive exertion to trigger PEM, symptoms of fatigue, pain, immune reaction, neurologic, orthostatic intolerance, and gastrointestinal symptoms during PEM, rest to recover from PEM, and pacing to prevent PEM 5.
- Exercise intolerance in long COVID-19 is associated with impaired oxygen extraction, supporting impaired energy metabolism as a mechanism of exercise intolerance in long COVID 6.
Exercise Intolerance and Treatment
- Therapies that optimize bioenergetics and improve oxygen utilization may be effective in treating long COVID-19, as suggested by the study 6.
- Commercial fitness and health facilities can present an appropriate setting for outpatient exercise rehabilitation in PCC, under the guidance of qualified professionals and by utilising symptom-titrated training recommendations 4.