Dr. Lambert pointed out that some patients with long Covid are also diagnosed with postural orthostatic tachycardia syndrome (or POTS), a disorder that affects blood flow. In people who have POTS, “the nervous system can’t regulate the things that it’s supposed to automatically control, like heart rate, blood pressure, sweating and body temperature,” she said. Yet “those are all things that when you’re exercising need to be regulated properly.”

Some doctors also point to parallels between patients with long Covid and those with chronic fatigue syndrome, who have severe fatigue, memory and cognitive problems, and often muscle or joint pain. For decades, physicians advised chronic fatigue patients that exercise would improve their symptoms, but for many patients, exercise actually made their symptoms worse and now is no longer recommended.

In 2021, Dr. Systrom and his team studied 160 chronic fatigue patients, and found that when they exercised, they experienced many of the same blood vessel problems observed in long Covid patients, while control subjects did not. “We’re essentially finding the exact same thing” when it comes to potential mechanisms, he said.

This all leads to one question: Should Covid patients who are having trouble with exercise continue to ramp up their physical activity? Nobody knows — and opinions differ. “There are both patients and doctors who are vehemently against any exercise” because of these issues, Dr. Systrom said. But he also said that exercise can be possible, and even beneficial, after long Covid patients receive proper treatment. “If you can get the patient in a better place with medications, then you can embark on a graded exercise program without precipitating crashes,” he said.

Dr. Lambert agreed. “You can’t just jump into exercise, or you’re going to be set back,” she said, but you should “slowly try to reincorporate it if you are feeling better.” She added that long Covid can manifest in different ways, so doctors and patients may need to tailor their recommendations to patients’ needs.

“That’s really the story of Covid — that for every patient, long Covid is different,” she said. “There’s probably never going to be a one-size-fits-all recommendation for exercise.”

Melinda Wenner Moyer is a science journalist.


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