Strenuous exercise can trigger severe damage to muscle tissue, says study on long Covid

AMSTERDAM – Exercise is good for health, but it can be harmful for some long Covid sufferers, new research shows.

Those experiencing debilitating crashes after strenuous activity – a condition known as post-exertional malaise – risk severe tissue damage from hardcore exercise, scientists in the Netherlands found.

Researchers at VU University Amsterdam subjected 25 long Covid patients and 21 unaffected healthy “controls” to about eight to 12 minutes of high-intensity cycling.

Participants volunteered blood and muscle biopsy samples before and after the exercise test to identify biological changes that might explain patients’ persistent, debilitating symptoms. 

Those with long Covid had a markedly lower exercise capacity than controls – associated with a higher proportion of fatigue-prone white muscle fibres and fewer so-called slow-twitch red muscle fibres – according to the study, published in earlier in January in the journal Nature Communications.

The exercise test triggered post-exertional malaise in all the patients and lasted for three weeks in some of them, said Dr Rob Wust, an assistant professor in muscle physiology who co-led the study.

All the participants with long Covid, including former bodybuilders, taekwondo exponents and professional athletes, have had to stop full-time work since developing the coronavirus-induced condition. 

Biological reason

An analysis of post-exercise tissue collected from participants’ upper leg muscle found patients were more likely than controls to display signs of severe tissue damage, including dying muscle fibres, inflammation and metabolic disturbances.

Patients also had an increased accumulation in their muscle of amyloid-containing deposits, which other studies have observed in the blood vessels of long Covid sufferers.

The findings do not establish a cause of long Covid, Dr Wust said. Still, it shows a biological reason for their symptoms and that this is not psychological or simply due to deconditioning or a lack of physical exercise, he added. 

Further research is under way to understand the damaging process, including in patients with myalgic encephalomyelitis/chronic fatigue syndrome, and how it can be treated and prevented.

In the meantime, long Covid patient support groups recommend a “stop, rest, pace” approach to avoid severe crashes triggered by certain levels of physical, mental or emotional activity.

“We can’t help them yet, apart from saying don’t over-reach yourself so that you get into this problem,” Dr Wust said. “We know from other studies that moving your muscles, keeping them active is good for you, but patients have to know their own exercise threshold and try to stay below that.” BLOOMBERG

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