Exercise May Improve Fatigue Associated With Long COVID in Active Young Adults

Jennifer Middleton, MD, MPH
Posted on April 10, 2023

As of January 2023, 11% of surveyed people in the United States with a history of COVID reported long COVID symptoms, including fatigue and brain fog, and more than one-fourth (27%) of those with long COVID reported that it was causing “significant activity limitations.” The evidence for treating persons with long COVID is limited, with no clinical trials available to guide clinicians as of this 2022 AFP “Long COVID: Rapid Review.” A new observational study provides one possible clue to guide patients; although most of its adult population was quite physically active at baseline, those who continued regular exercise reported less fatigue one year after their COVID-19 diagnosis compared with those who were sedentary.

The study researchers enrolled a convenience sample of 506 adults in Italy with persistent fatigue six months following COVID-19 infection. Participants had self-presented to an Italian sports medicine service with these symptoms; none had required hospitalization for COVID-19 while ill. The sports medicine center was close to a major mountain range, and thus most participants were either avid skiers or mountain climbers. The researchers divided participants into four groups: competitive cross-country skiers (115 people who identified as male and 66 people who identified as female), ski instructors (75 males and 10 females), amateur mountain climbers (113 males and 45 females), and sedentary individuals (45 males and 17 females). The average age of participants was 33 years, and none had hypertension or diabetes. Participants continued their physical activity (or lack thereof) on their own without any guidance from the research team. Using a previously validated rating of fatigue (ROF) scale, researchers found that ROF values decreased in all four groups at 12 months post-COVID diagnosis but decreased more in the three more active groups; all groups began with a ROF near 7 out of 10, but six months later (a total of 12 months after COVID diagnosis), the three most active groups had an ROF between 2 to 3, whereas the sedentary group had an ROF around 4.

This study’s findings can be interpreted onlyas preliminary, given its observational design and young, healthy population. Caution regarding extrapolating these findings is important as well because the best data for chronic fatigue syndrome (not necessarily associated with COVID) has shown that exercise is not helpful. Individualized return to exercise is consistent with the AFP “Long COVID: Rapid Review” article, which advises “[a]n individualized, symptom-guided, phased return to activity program is recommended for patients with fatigue or postexertional malaise....patients should be assessed for fatigue patterns throughout the day and advised to avoid activities that trigger postexertional malaise.” Most people with long COVID are not young, professional athletes, as in the study above, and should probably rest when fatigued.

Additional resources for patients with long COVID include this AAFP webpage on “Post-COVID Syndrome,” with a link to education that includes seven hours of free CME. Thankfully, we can counsel patients at this point that many patients with long COVID will see their symptoms resolve. We should also continue to counsel our patients to receive the COVID vaccine series because COVID vaccination lowers the risk of long COVID. You can read more at the AFP By Topic on COVID-19.