Long COVID: The importance of pacing for recovery.

While clinical evidence supports the use of natural medicines for immune support and increasing resistance against infections, the below-listed recommendations do not replace medical advice regarding treatment of Long COVID, which is a notifiable condition under Public Health and Wellbeing Regulations. If a patient or Practitioner presents with symptoms, is suspected to have COVID-19, or has come into contact with a confirmed COVID-19 case, individuals must undertake immediate testing and return/stay at home until test results are confirmed. Refer to the New Zealand Government Department of Health for the latest case numbers, medical advice and information on treatment.

For people experiencing Long COVID a phenomenon termed “post-exertional malaise” (PEM) is a common experience (1). This is when you do physical activity, socialize, or perform a mental task and afterwards you have more severe symptoms (2). Many people with Long COVID are taking individual approaches to managing these symptoms including fatigue and ‘brain fog’ while trying to maintain activities of daily living and basic exercise (2). A practice called pacing has been found in research to be an effective way for people experiencing Long COVID symptoms to help manage energy and reduce fatigue.

How do I practice pacing?

It involves being strategic with your physical and mental energy reserves with the aim of preventing symptom flares (2). 

There are two parts to pacing. 

1. Pre-emptive rest: With support from a naturopath you can identify times in your day that you have an energy drop and/or symptoms worsen. Here you can plan rest periods to minimize these energy drops and with this reduce the emotional toll of feeling like you are regressing in your progress to get well. 

2. Reduced activity/pacing intervention: This is where you lie still with your eyes closed, not engaged in any activities or distractions around you. Planning reduced activity moments into your day both prior to, and after larger tasks can support you to create habits of doing nothing as you recover.

Common Activities associated with PEM

Some activities are more common than others to trigger PEM. For women there are times in their menstrual cycle where they can be more prone to PEM (2). Using a cycle tracking app and recording when you have worsened symptoms or increased fatigue can help you see patterns and identify when you may be more at risk. In a recent study done on patients with Long COVID PEM was most common just prior to menstruation and during menstruation (2). 

The other most common triggers or Long Covid Patients were physical activity, stress, exercise and mental activity (2). 

Be mindful of these stressors and write down which ones make you feel an increased severity of symptoms. Then make a plan to reduce them for 3-4 months. If they can't be completely avoided make sure to plan rest times before and after the activity to reduce the impact and improve your recovery. 

Acceptance of Reduced Function

(even temporarily)

One of the battles people face living with Long COVID is the acceptance that they are unwell and that tasks and activities will take them longer to do (2). The fear of permanent reduction in physical and cognitive ability can be extremely stressful. Speaking to a health professional to support with acceptance and creating a plan of recovery is essential for reducing this stress.  

It's helpful to break activities into smaller chunks. Rather than pushing yourself for the crash and burn afterwards, reduce the time spent on tasks, give yourself lots of breaks and delegate tasks as much as possible. This might require an uncomfortable conversation with your Boss. However, once people understand what Long COVID is and how it impacts people they are usually more than happy to make adjustments to support you to get well. 

Anaerobic threshold and PEM

Staying below your  anaerobic threshold is another way to measure if you are over exerting yourself. This can also help prevent PEM. 

Ways you can calculate your individual anaerobic threshold include:

1. Estimated maximum heartrate, measured by subtracting age from 220 (e.g. 220 – 50 years = 170 beats per minute). Use a heart rate monitor or a smartwatch to ensure you remain below maximum heart rate.

2. Treadmill stress test. This can be done by a professional at a gym or specialized exercise center. Enquire with your gym to see if this is something they offer. 

3. You can monitor/prevent increases in resting heart rate daily. This can be assessed by using a heart rate monitor/smartwatch or by counting the number of beats in 15 seconds and multiplying by four (measure before getting out of bed in the morning).

The reality of Long COVID recovery

Many people experience Long COVID as ‘Life altering’ (2). Due to people not feeling like themselves this can have a large impact on their identity(2). The range of symptoms, severity and duration associated with Long COVID presents significant challenges to the individual. A naturopath or other health professional can create a tailored plan for individuals supporting them to pace, accept their current energy levels and adapt the plan as recovery occurs. Most importantly they are there to remind the individual of their progress (even though it may be slow) and that they will enjoy wellness again.

References

1.Proal, A. D., & VanElzakker, M. B. (2021). Long COVID or Post-acute Sequelae of COVID-19 (PASC): An Overview of Biological Factors That May Contribute to Persistent Symptoms. Frontiers in microbiology, 12, 698169. https://doi.org/10.3389/fmicb.2021.698169. 

2. Humphreys, H., Kilby, L., Kudiersky, N., & Copeland, R. (2021). Long COVID and the role of physical activity: a qualitative study. BMJ open, 11(3), e047632. https://doi.org/10.1136/bmjopen-2020-047632.