LONG C OV ID

REHA B
AMBER CLEES, SPT
WHAT IS LONG COVID?

• Long COVID can be:

– Symptoms of COVID lasting 4-12 weeks
– Post-COVID syndrome
• Persisting or new symptoms of COVID occurring >12 weeks
with no other explanation
 All over the world, the percentage of
COVID-19 survivors developing post-
COVID-19 syndrome is growing even
beyond the initially estimated 10–20%1

LONG COVID Long COVID can affect multiple body

systems:

• Respiratory
• Cardiac
• Renal
• Endocrine
• Neurological
SYMPTOMS
 Most common symptom

An overwhelming sense of fatigue not due to

inactivity or decreased cardiovascular status

FATIGUE Does not go away with rest

Can progress into myalgic encephalomyelitis (ME)

Can also appear as orthostatic hypotension or

POTS
QUESTIONNAIRE
TO SCREEN FOR
P O S T- E X E R T I O N A L
SYMPTOM
E X A C E R B AT I O N
SUGGESTED OUTCOME MEASURES

PHYSICAL C O G N IT I VE

• 6-minute walk test • Montreal Cognitive Assessment (MoCA)

• Pulmonary function test • Mini mental state exam (MMSE)
• Inspiratory muscle strength • Brief Cognitive Impairment Scale (BCIS)
• Berg balance scale
• Patient specific functional scale
WA L K I N G
SPEED
ARTICLE 1
L O N G C O V ID - 1 9 S YN D R O M E : A C O M P R E H E N S IV E R E V I E W O F I T S
E F F E C T O N VA R IO U S O R G A N S YS T E M S A N D R E C O M M E N D AT IO N O N
R E H A B I L ITAT IO N P L A NS

• Great detail of how long-COVID affects each body system

• A 6-week respiratory rehabilitation program significantly improves pulmonary
functions, quality of life, and anxiety in COVID-19 survivors2

Yan Z, Yang M, Lai CL. Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various Organ Systems and
Recommendation on Rehabilitation Plans. Biomedicines. 2021;9(8):966. Published 2021 Aug 5.
doi:10.3390/biomedicines9080966
ARTICLE 2
L O N G C O V ID A N D T H E R O L E O F P H Y S IC A L A C T IV I T Y: A
Q U A L I TAT I V E S T UD Y

• How participants struggled with drastically reduced physical function, compounded by the
cognitive and psychological effects of long COVID
• Challenges associated with finding and interpreting advice about physical activity that was
appropriately tailored
• Individual approaches to managing symptoms including fatigue and ‘brain fog’ while trying to
resume and maintain activities of daily living and other forms of exercise
• Their research suggests that pacing needs to be individualized, considering biographical factors
such as life-stage as well as current physical function and activity history3

Humphreys H, Kilby L, Kudiersky N, Copeland R. Long COVID and the role of physical activity: a qualitative study. BMJ Open.
2021;11(3):e047632. Published 2021 Mar 10. doi:10.1136/bmjopen-2020-047632
ARTICLE 3
T H E C O N U N D R U M O F ' L O N G - C O V ID - 1 9 ' : A N A R R AT I V E R E V IE W

• Provides lots of information regarding long-COVID (epidemiology, pathology,

predictors, and management)
• A few authors have reported reduced exercise capacity in Long-COVID-19 subjects
and suggested including aerobic exercises in rehabilitation, which may boost
immunity and respiratory functions4

Garg M, Maralakunte M, Garg S, et al. The Conundrum of 'Long-COVID-19': A Narrative Review. Int J Gen Med. 2021;14:2491-2506.
Published 2021 Jun 14. doi:10.2147/IJGM.S316708
REHABILITATION

• Symptom-based, individualized activity • Tips:

programs are recommended – Establish baseline
• Graded exercise therapy is contraindicated – Restorative rest
– Activity switching (physical to cognitive,
changing muscle groups)
– Prioritize activities
– Pacing (based on symptoms)
• Research suggest 55% of HRmax for
activities
 Patient’s activity tolerance
increases

Addition of light isometrics,

gentle stretches, short walks
• Gradual, low level, low reps
REHAB
PROGRESSION Begin graded exercise
therapy if
• No flare ups/regression with
increased activity for 3 months
• Patient reports feeling about 70%
PLOF
HANDOUT
REFERENCES

1. Yan Z, Yang M, Lai CL. Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various
Organ Systems and Recommendation on Rehabilitation Plans. Biomedicines. 2021;9(8):966. Published
2021 Aug 5. doi:10.3390/biomedicines9080966
2. Yan Z, Yang M, Lai CL. Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various
Organ Systems and Recommendation on Rehabilitation Plans. Biomedicines. 2021;9(8):966. Published
2021 Aug 5. doi:10.3390/biomedicines9080966
3. Humphreys H, Kilby L, Kudiersky N, Copeland R. Long COVID and the role of physical activity: a
qualitative study. BMJ Open. 2021;11(3):e047632. Published 2021 Mar 10. doi:10.1136/bmjopen-2020-
047632
4. Garg M, Maralakunte M, Garg S, et al. The Conundrum of 'Long-COVID-19': A Narrative Review. Int J
Gen Med. 2021;14:2491-2506. Published 2021 Jun 14. doi:10.2147/IJGM.S316708