Winter break means sports break — but does it make sense to exercise with Long COVID, and what are the risks?

Description: Exercising despite long COVID? This article explains the risks of training in relation to post-exertional malaise (PEM) and 'crashes', and why pacing — conscious energy management — is crucial for those affected.

Exercising despite long COVID? Risks, PEM and Crashes explained.

In Switzerland, winter vacation time is traditionally sports vacation time. Schools organize ski trips and families spend time in the mountains skiing, cross-country skiing, ice skating, sledging or walking. However, for many with Long COVID, sport is hardly an option. 
Light physical activity is recommended for some chronic illnesses, as it has been shown to improve well-being. At the beginning of the pandemic, experts frequently recommended exercise and physical activity to help manage long-term symptoms of COVID-19, such as fatigue.&nbsp;
However, we now know that this does not apply to everyone affected. Therefore, such recommendations must be worded carefully. Physical training aimed at improving performance, as is usually the case in traditional rehabilitation programs, often does not lead to improvement, but to a drastic worsening of symptoms. This is referred to as a 'crash'.
A crash occurs when your personal stress or energy limit is exceeded. This phenomenon is also known as post-exertional malaise (PEM) and describes a worsening of symptoms following minor physical or mental exertion. PEM can either occur immediately after an activity or with a delay of 12&ndash;72 hours. Symptoms can last for several days or even weeks, and in some cases may even lead to long-term deterioration.
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<h2>Exercise yes, but...</h2>
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As a general rule, you should take a break from exercise not only when recovering from COVID-19, but also from other viral infections, because your body needs time to regenerate. Your immune system continues to work at full capacity in the period following the acute phase. Organs such as the lungs, heart and muscles are temporarily less resilient due to the infection. Starting exercise too early or too intensely can therefore increase the risk of complications, such as heart muscle inflammation.
But what if the body is unable to recover properly? How does this apply to Long COVID and other post-infectious syndromes?
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<h2>Pacing: Energy management instead of training</h2>
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The key word is 'pacing'. Rather than training in the traditional sense, pacing is about consciously allocating your energy resources and finding a balance between overexertion and underactivity &mdash; so that you never completely run out of energy.
Even everyday tasks require energy, such as getting up, showering, eating, tidying up or having short conversations. For those who are seriously affected, these activities alone can use up all their available energy for the day. If this limit is exceeded, their health can deteriorate significantly, new symptoms may arise and recovery can be delayed.
Pacing therefore means regulating activity appropriately, preventing further deconditioning wherever possible and avoiding exceeding individual stress limits:
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<li class="MsoListParagraph">Find your baseline: Over the course of a few days, identify the types and levels of physical, cognitive and social activities you can tolerate without symptom deterioration, for example, by keeping a diary.</li>
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Don't push yourself too hard: stay below your limits and plan enough breaks.
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Recognize warning signs: Identify early signs of overload, such as headaches, sore throat, increasing exhaustion or heightened sensitivity to stimuli, and reduce or stop the activity immediately.
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Plan your breaks: Schedule fixed breaks and rest periods in advance instead of waiting until you are exhausted. Allow your body to recover fully rather than trying to train through symptoms.
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Adjust gradually: If your condition remains stable for several weeks, activity levels can be increased slightly. However, if symptoms worsen, return to the previous level that was well tolerated.
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Stay calm. If exhaustion or deterioration occurs despite pacing, remain calm and consistently reduce the strain. Give your body time to recover.
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Important: Less is more. If you are unsure of your limits, work with your doctor or therapist to develop an individual activity plan.
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Further information and a detailed guide to pacing, heart rate monitoring and PEM can be found here: <a href="https://altea-network.com/en/vademecum/fatigue" target="_blank" rel="noopener">Guidebook</a>
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<h2 class="MsoNormal">Can exercise reduce symptoms?</h2>
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Experts and those affected have differing opinions on whether regular physical activity can contribute to long-term improvement. While pacing aims to stabilize the condition, another approach seeks to gradually improve physical performance through structured training. We will take a closer look at this controversial approach in the second part of our series at the beginning of March.