Do you have long COVID? Exercise can help

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Post-acute sequelae of COVID-19 (PASC) – also called long COVID – can trigger a chronic hyperinflammatory state, immune system dysregulation, brain fog, and psychological distress. Sequels means “the consequences of a previous illness or condition”.

Persistent neuroendocrine symptoms of long COVID are associated with an increased risk of depression and new-onset diabetes months after a person has recovered from the initial SARS-CoV-2 infection.

It is not known how many people experience long symptoms of COVID. Last year, a systematic review (Groff et al., 2021) found that around 54% of COVID-19 survivors had PASC six months after their initial recovery.

A new paper (Rebello et al., 2022) hypothesizes that exercise may help break the long vicious cycle of COVID by reducing inflammation and improving immunosurveillance in ways that can improve health outcomes. mental health and offset the risk of diabetes. This hypothesis was recently published online ahead of print in the peer-reviewed journal Exercise and Sport Science Exams.

Exercise induces anti-inflammatory factors that may reduce long-lasting COVID symptoms

“We hypothesize that exercise counteracts the neuropsychiatric and endocrine sequelae of long COVID by inducing the release of circulating factors that mediate the anti-inflammatory response, support brain homeostasis, and increase insulin sensitivity,” write the authors in the abstract of their article.

    Image credited to Dr Candida Rebello

This graph from Dr. Candida Rebello illustrates how exercise improves immunosurveillance and reduces inflammation in ways that improve mental health outcomes and glycemic control in people with long-term COVID.

Source: Image credited to Dr Candida Rebello

Rebelle et al. speculate that the long COVID perpetuates psychological distress via a “triple whammy” of increased hypothalamic-pituitary-adrenal (HPA) axis activity, reduced parasympathetic nervous system activity, and triggering of dysregulation of the immune system. Hyperactivity of the HPA axis increases sympathetic nervous system stress responses and promotes systemic inflammation.

“We know that long COVID causes depression, and we know that it can raise blood sugar to the point that people develop diabetic ketoacidosis,” first author Candida Rebello said in a March 2022 press release. “Exercise can help. Exercise takes care of the inflammation that leads to high blood sugar and the development and progression of diabetes and clinical depression.”

How much exercise is needed to compensate for long COVID symptoms?

“You don’t have to run a mile or even walk a mile at a brisk pace. Slow walking is also exercise,” notes Rebello. “It doesn’t matter where you start. The important thing is to try.”

Ideally, Rebello recommends doing a 30-minute cardio session almost every day. That said, if you can only walk 10-15 minutes at a time, that should be enough exercise to have anti-inflammatory benefits. If you stick with this, over time you can gradually increase to the recommended dose of 30 minutes of cardiorespiratory physical activity most days of the week.

COVID-19 and Dysregulation (IMAGE) by Dr. Candida Rebello via EurekAlert

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