The Balancing Act: This Is What Happens Between Effort & Exhaustion
Living with long COVID is a daily balancing act. For many, even the most minor physical or mental activities lead to a flare-up of fatigue and other symptoms. New research is shedding light on why this happens and what it means for people living with the condition.
A recent study published in The Lancet Regional Health—Europe shows that both physical and cognitive stressors worsen symptoms in people with Long-COVID. The research involved 376 participants tracking their activities and symptoms over 24 days and found that everyday tasks like walking, thinking, or socialising can significantly increase fatigue, pain, and brain fog, among other symptoms. These flare-ups—often called post-exertional malaise (PEM)—aren't new to people with conditions like Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). However, this latest study highlights how widespread PEM has become following the COVID-19 pandemic.
Key Findings
The researchers asked participants to record their activity levels and symptoms every three hours.
They found that symptoms often got worse within 30 minutes of activity, but in some cases, flare-ups occurred days later.
Both physical and cognitive tasks led to symptom worsening, with fatigue levels increasing slightly more after physical effort than mental tasks like concentrating or problem-solving.
Fighting Stigma & Making the Invisible Visible.
The fluctuating nature of symptoms can lead to stigma, with some people - even including some healthcare professionals—dismissing long COVID as a psychological issue. This can also even impact decisions on benefits, employment and support. This study now validates what patients and carers already knew: the unpredictable nature of symptoms.
Patients might feel fine one day and then be unable to get out of bed the next because you pushed yourself too hard physically, mentally, or even socially. Greenwood's study challenges this and proves that even minor activities can profoundly impact symptoms.
This study is important evidence that Long-COVID symptoms are not just "in people's heads,". Long COVID is a severe condition with clear, measurable patterns of symptom escalation after exertion. This is a key diagnostic clue for healthcare providers who might be unsure how to recognise Long-COVID in patients or cautious about a diagnosis.
The study also has important implications for how long COVID research should be conducted. Many studies ask people to recall symptoms over days or weeks, which misses the immediate and fluctuating impact of activities and can be a struggle for many.
Studies should measure how symptoms change in real-time, especially after physical or cognitive exertion, to better capture the complete picture of long-term COVID.
Who needs to read this research?
This study proves that adjustments are necessary for schools, employers, and the benefits system. People with long COVID histories can't simply "push through" without risking severe setbacks. Employers and educators need to take this seriously, and policymakers need to use this to inform policy.
There's still a need for more research. At Long Covid Scotland, we're calling on researchers, policymakers, and health services to see us, treat us, and study us.
This sort of research, measuring the impact of exertion in real-time, needs to be extended wider to explore better treatment options. Tens of thousands of Scots are abandoned in a constant cycle of rest and recovery that limits their ability to work, learn, and participate fully in life.
More Information
You can learn more about the study here- The Lancet Regional Health—Europe and follow us at Long Covid Scotland for resources and advice on managing symptoms.
References: Greenwood et al. (2024). Physical and cognitive stressors exacerbate symptoms in long COVID: More evidence triggering new research and therapeutic needs. The Lancet Regional Health—Europe.