A rehabilitation programme based on a gradual or paced increase in physical activity has shown “exciting” results in helping people with long Covid, according to scientists.
The research programme has been run by the long Covid service at Leeds Community Healthcare NHS Trust and evaluated by clinicians and scientists at the University of Leeds and Leeds Beckett University. The findings have been published in the Journal of Medical Virology.
Under the programme, 31 people with long Covid took part in the six-week study in Leeds. On average, they had been experiencing long Covid for around 17 months before entering the programme. They were suffering from a range of symptoms along with fatigue, including brain fog, breathlessness, headache and palpitations, the researchers recorded.
The patients followed a gradual return-to-physical activity programme called the World Health Organization (WHO) CR-10 Borg pacing protocol, which takes them through five levels of activity. They followed the programme at home.
The first phase was a preparation for return to activity and involved breathing exercises and gentle stretching. This was then progressed until by the fifth phase patients were doing activities before they were ill, such as regular exercise or sports.
During the programme, the patients had weekly phone calls from their long Covid clinician to check on their progress. They were told to stay at each level for at least seven days and not to over-exert themselves, so their condition remained stable.
The patients completed a questionnaire to assess their exertion levels and ‘crashes’ each week before a decision was made whether to progress to the next level of the pacing protocol.
Over the six weeks, not only was there a reduction of crashing episodes, but there were also improvements in activity level and quality of life. In terms of easing long Covid symptoms, the biggest benefit was seen in terms of reducing fatigue, breathlessness and headaches.
This protocol was developed for the World Health Organization by Dr Manoj Sivan, associate clinical professor in the School of Medicine at the University of Leeds, and his team. Dr Sivan is the WHO advisor for long Covid rehabilitation policy in Europe.
He said of the programme: “Long Covid affects around two million people in the UK and it has an impact on their quality of life and in some cases, their ability to work. It is distressing and disabling.
“Post-exertional malaise or post-exertional symptom exacerbation or simply ‘crashes’, as described by patients, is a defining and important symptom of long Covid.
“When patients get a crash, they experience feelings of complete exhaustion and wipe out and are unable to resume activities for hours or sometimes days.
“The findings of this research are exciting because this is the first time that crashing episodes have been used as a marker for the condition and a structured pacing programme has now been shown to substantially reduce symptoms and improve quality of life,” Dr Sivan added.
However, while promising, the study also needs to be seen in the context of concerns around pacing and/or graded exercise therapies and long Covid.
Just in August, for example, another study from Leeds University warned that patients experiencing long Covid are receiving “inconsistent advice” on how to resume physical activities.
It found that some healthcare professionals were recommending patients should gradually increase their physical activity levels, but the researchers warn this could result in symptoms getting worse.
Instead, the researchers advised that patients should be encouraged to “pace” their return to exercise, doing enough to stay within their energy reserves so as not to cause a flare-up of symptoms.
The researchers argued physical activity is likely to play a part in helping people to recover from long Covid, but a delicate balance had to be found between doing too much and not enough.
Equally, there have been concerns raised about the use of such therapies for people with chronic fatigue syndrome, including questions raised by the National Institute for Health and Care Excellence.
Separately, another study from Leeds University has highlighted the links between contracting Covid-19 and potential long-term mental ill health or depressive symptoms.
The study led by Professor Daryl O’Connor and Dr Sarah Wilding from the university’s School of Psychology has concluded that people who reported contracting Covid-19 early in the pandemic were twice as likely to experience depressive symptoms 13 months later than those who did not.
Those who reported having Covid in early 2020 were also 1.67 times more likely to experience clinically meaningful levels of anxiety after 13 months, than those who avoided Covid-19 in the same time period.
“The findings highlight the importance for GPs and other healthcare professionals to be vigilant to these longer-lasting symptoms and to put in place treatments and support for mental health, as well as physical health, for patients who may have contracted Covid-19 infection,” said Professor O’Connor.