For the first time, an exercise-based rehabilitation programme has been found to improve the health of people with long covid.
It might seem like this would be universally welcomed. But it could reopen the long-standing dispute over whether people with post-viral fatigue conditions should be encouraged to build up their exercise levels or whether this risks setting them back further.
Long covid is a term used to describe lasting symptoms after a covid-19 infection, with the most common ones including fatigue, breathlessness and difficulties concentrating. It is unclear exactly what causes it, how likely it is to occur after the infection and how best to treat it.
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While there are no specific treatments, doctors tend to recommend generic strategies for improving symptoms. For any form of post-viral fatigue, this generally means trying to build back strength by slowly increasing activity levels.
That brings conflict with ideas about myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), another poorly understood long-term health problem, which is possibly sometimes triggered by a viral infection.
Until recently, the main treatments in the UK for ME/CFS were rehabilitation programmes combined with talking therapy, but these are unpopular with some patient activists who say they imply the condition is all in the mind.
Campaigners also say that encouraging people to raise their exercise levels can trigger post-exertional fatigue, something that can also be experienced by those with long covid.
In the new study, which involved 585 people with long covid, at University Hospitals Coventry in the UK and his colleagues investigated a similar approach that involved gradually increasing exercise levels, alongside talking therapy. But there were crucial differences to the regimes that have earned the ire of some ME/CFS groups.
In the old ME/CFS approach, called graded exercise therapy, people may be asked to raise their exercise levels by a certain amount every week, which some find too onerous. In McGregor鈥檚 trial, people didn鈥檛 have to stick to a rigid schedule of increasing their exercise levels according to a certain timescale, but could tailor the intensity up or down as needed.
The team offered half the participants online rehab sessions in groups of up to eight people, once a week for eight weeks. A control group just had one online advice session about a self-directed exercise programme.
Those who got the eight weeks of rehab had significant improvements in a score for health-related quality of life, which assessed how they were affected by factors such as pain, fatigue and depression, compared with the control group. After three months, 50 per cent felt at least somewhat better, compared with 30 per cent of those who only got the advice session. And 17 per cent said their overall health was 鈥渕uch better鈥�, compared with 8 per cent in the control group.
Importantly, only one person had a severe adverse event that might have been related to the treatment, when they fainted and vomited the day after a rehab exercise session.
One caveat, however, is that all the people in the trial had an initial covid-19 infection so severe that they had been treated in hospital, with about a third spending time in intensive care or high-dependency units. Many people who have long-lasting symptoms after covid-19 initially had a milder illness. The causes of their lasting symptoms are less clear and might be different to those who needed hospital treatment, possibly for weeks or even months, who may have had muscle wasting and organ damage.
As a result, we can鈥檛 necessarily conclude from these results that non-hospitalised people with long covid would also benefit from this rehab programme, says at Long Covid Support, a UK charity.
Also, only about half of the people who were offered the rehab attended most of the sessions, which might indicate that those who dropped out couldn鈥檛 tolerate the exercise, she says. Putting these facts aside, it is also disappointing that the success rate wasn鈥檛 higher, says House.
On the other hand, it is the first time a randomised trial 鈥� the best medical evidence 鈥� has shown anything to have even a modest benefit for this condition. That should surely be a cause for cautious celebration.
The BMJ
