Post-covid patients are often told: “Go exercise, it's good for you. Just move, just persevere.” But hopefully that is now a thing of the past, says Diewke de Haen of patient organization PostCovid NL. Because this week there was finally recognition that this advice is not at all suitable for post-covid (also known as long covid) and can even lead to demonstrable deterioration.
Scientific research published on Thursday in Nature Communications shows that muscle tissue changes in post-covid patients after strenuous exercise. Researchers affiliated with Amsterdam UMC and the Vrije Universiteit Amsterdam saw death of muscle tissue and reduced oxygen uptake in the cells in 25 test subjects.
Michèle van Vugt, professor of internal medicine, internist-infectiologist (Amsterdam UMC) came up with the idea of examining the muscles after several post-covid patients complained of severe muscle pain after exercise. Van Vugt wanted to investigate whether a change could be seen in the muscles after physical exertion. The research was carried out using crowdfunding, among other things.
Disruption of energy factories
The fact that the coronavirus affects energy management was already suspected in American research, but has now actually been proven, according to the Amsterdam researchers. The Sars-CoV-2 coronavirus disrupts the energy factories, the mitochondria, in the cells. Mitochondria are found in virtually every cell in the body and provide energy by burning nutrients such as glucose. While this research is a step forward in the post-covid knowledge gap, much is still unknown. Van Vugt: “We know from this research that there is a demonstrable biological cause for these complaints. After the exercise test, the patients were extremely tired and exhausted. Complaints that patients with long Covid have – extreme fatigue, muscle pain and 'brainfog' – we can now also explain it. But the cause of the disruption in the mitochondria is still unknown. That is why more research needs to be done so that we can also develop suitable treatments for these patients.”
Mariska Hoos (48) was one of the participants in the Amsterdam study. She can no longer do her “fantastic job” as an ambulance nurse after she contracted Covid-19 in April 2020, did not recover from it and continued to deteriorate. Initially things seemed to be going a little better with physiotherapy. But then her condition actually deteriorated. The more she trained, the more tired she felt.
She has now been completely rejected and moved to a ground floor home, because she was no longer able to climb stairs. Sometimes she goes out with the mobility scooter, but during the day she has to rest a lot. She no longer plans trips with her husband and two young children. She quickly becomes overstimulated. Hoos suffers from post-exertional malaise (PEM), which causes her to experience additional complaints after minimal exertion, such as showering.
Heavy exercise test
For the Amsterdam study, Hoos had a piece of muscle tissue removed from her upper leg under local anesthesia, “with a kind of drill.” A week later, the exercise test followed: cycling as hard as possible for about ten minutes, with the resistance on the bicycle increasingly increasing. She didn't even make it ten minutes. Hoos: “I completely broke down and even fainted afterwards. After that I could no longer walk, only stagger a bit. But I was willing to do it. You want to know so badly where your complaints come from that you would do anything for it.” After the exercise test, another biopsy was taken from her upper leg, in the same place. Then it became visible what those ten minutes of cycling had done to her muscles. Dead muscle cells were visible.
It is estimated that there are about 450,000 people in the Netherlands with post-covid, of which 90,000 are severely disabled such as Hoos. The patient organization PostCovid NL is happy with the research that was published this week, but insists on further research and specialized centers to treat patients. Diewke de Haen: “This study is finally recognition for all patients who still encounter misunderstandings on a daily basis. From the outside you can't see what's wrong. Patients are then told: 'Come on, let's get on with it'. Or: 'Go for a nice walk, that's good for you'. But this study shows that exercising does not have to be a good idea at all and that complaints really need to be treated differently than, for example, burnout complaints.”
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