Post-Exertional Malaise and Symptom Exacerbation: The High Price of Physical Exertion in Long Covid, ME/CFS

Understanding Physical Exertion in Chronic Health Conditions

Physical exertion can have a significant impact on individuals with Post-Exertional Malaise (PEM) and Post-Exertional Symptom Exacerbation (PESE). These conditions are often seen in individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Long Covid. The complexities of these conditions, as highlighted by well-known science journalist Ed Yong, underline the need for a greater understanding and support for those affected. This article explores the intersection of physical exertion and chronic health conditions, urging increased awareness and research in this area.

The Dangers of Moderate to Intense Exercise in Long Covid Patients

Recent research indicates that Long Covid patients risk serious injury if they engage in moderate to intense exercises like running and cycling for more than a few minutes. This can lead to lasting muscle damage and symptoms such as muscle cramps, pain, fatigue, and brain fog, all resultant of Post-Exertional Malaise (PEM). Moreover, this study found that persistent fatigue in Long Covid patients is caused by biological factors, specifically mitochondria in muscle cells producing less energy. These findings challenge the current approach to treating conditions like Long Covid, ME, and CFS using graded exercise regimens.

Muscle Abnormalities and Post-Exertional Malaise

Further compounding the issue, another study found that muscle abnormalities worsen after post-exertional malaise in Long Covid. This indicates the high price of exertion for those with PEM. This disturbing revelation underscores the importance of developing treatment and management strategies that take into account the severe consequences of physical exertion in these patients.

The Immunological Aspect of ME/CFS

From an immunological perspective, a study on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) found a correlation between immunological characteristics and intestinal barrier function. ME/CFS patients were stratified into two groups based on their immune competence, with one group showing reduced complement protein C4a levels and the other group exhibiting mucosal barrier leakage. This discovery emphasizes the importance of precise patient stratification in ME/CFS for defining suitable treatment strategies.

The Biological Cause of Persistent Fatigue in Long Covid

Delving deeper into the biology of these conditions, a study by researchers from Amsterdam University Medical Center and Vrije Universiteit Amsterdam found that patients with Long Covid experience persistent fatigue due to biological causes. Specifically, a decrease in energy production in the mitochondria of muscles was observed. Interestingly, the study also found that the heart and lungs functioned well in these patients, indicating that the long-lasting effect on a patient's fitness is not caused by abnormalities in the heart or lungs. These findings suggest that the classic forms of rehabilitation and physiotherapy may be counterproductive for the recovery of these patients. They are advised to guard their physical limits and not exceed them.

Conclusion

In light of these studies, it is clear that there is a pressing need for a revised approach in the management and treatment of Long Covid, ME/CFS, and similar conditions. Overexertion can lead to severe and lasting damage, and as such, the benefits of exercise need to be carefully balanced with the potential risks. Increasing awareness and understanding of these complex conditions, along with further research and patient stratification, are key to developing effective treatment strategies that can improve the quality of life for those affected.