When Natalie Hollabaugh tested positive for COVID-19 in March 2020, her recovery felt extremely slow. Eighteen months later, she was still suffering from a litany of symptoms, including fatigue, shortness of breath, headaches and joint pain. She saw a cardiologist and a pulmonologist, who both ruled out other health problems, she said. And they advised her to start exercising, suggesting that some of her symptoms may have been a result of being out of shape. So Hollabaugh dutifully began using an exercise bike, speed walking on a treadmill and walking her dogs several miles a day.
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But instead of helping, her new exercise regimen only exacerbated her symptoms. “I had never felt worse,” said Hollabaugh, 31, a lawyer who lives in Portland, Oregon. She found she had to start taking daily naps, that her heart rate would skyrocket even when she was at rest and that she was so tired she couldn’t concentrate.
As one of the many Americans suffering from long COVID, a condition characterised by new or lingering symptoms that can be felt for months after a coronavirus infection, Hollabaugh is not alone in experiencing setbacks with exercise. Natalie Lambert, a biostatistician and health data scientist at the Indiana University School of Medicine, has collected self-reported data from more than a million long COVID patients through a collaboration with Survivor Corps, a Facebook support group for COVID-19 survivors. Patients frequently report that their doctors have advised them to exercise, she said – but many say that when they do, they feel worse afterward.
“The research that I’ve done has shown that inability to exercise is one of the most common long-term symptoms,” Dr Lambert said. Some people are simply too tired to exercise, she said, while others experience debilitating symptom relapses like increases in fatigue, brain fog or muscle pain. This worsening of symptoms after engaging in even just a little bit of physical activity – what is sometimes called “post-exertional malaise” – seems to be common among long COVID patients. When researchers performed an online survey of 3,762 people with long COVID, as part of a study published in August, they found that 89 per cent reported post-exertional malaise.