Long Covid and Fatigue 18 Nov 2020
Fatigue in long covid has become a common symptom for those people that have contracted coronavirus. There is research being carried out at the moment, on the changes to the lung tissue and the affect of the virus on blood vessels. However, the results are likely to take sometime to come through, and the day to day fatigue for thousands of people, remains the same. So, what principles can we pull from fatigue in other areas to help. I will try to draw on some techniques used in MS and chronic fatigue syndrome (ME) and fatigue in overtraining in endurance sports to give people some ideas on how to manage their fatigue and still work, take care of the kids and have a better quality of life generally.
Manage your weekly diary
‘Everything in balance’
When looking at fatigue you have to look at both physical fatigue and mental fatigue. Within the latter is also emotional fatigue. If you have a heavy work week, where stress levels are high on certain days then physical activities may need to be reduced. Also, if work stress levels are high the daily stresses of the day need to be reduced. For example, shopping, picking up kids from school, washing etc. Do a weekly plan and space the work and house activities out so they are evenly spread through the week. Share the chores with others in the household and find you balance between work, life and physical stress.
Be aware of underlying deep stress as well, like concerns regarding job security or the recent death of a loved one in these difficult times and give yourself scheduled breaks.
‘Change your time expectations’
In a time when your body is recovering from Covid the anxiety of questions like ‘Will I always be like this’, ‘when will this end’ always come to mind. Get rid of these thoughts and concentrate on the present time. Set goals to return to yoga or running in weeks/ months not days. Whilst this may sound negative it will be quicker in the long run. Why?
‘Increasing your activity, will not get you fitter quicker’
In Endurance athletes there is a condition known as overtraining. This happens when, as the name suggests, athletes overtrain and there is an imbalance between training and recovery. As the athletes do the same sessions in their training, as the week before, their performance reduces. Getting frustrated, the athlete then thinks ‘I need to do more, my fitness is getting worse’. What they actually need to think is ‘I need more recovery’. This isn’t just being tired after a session, it is a cumulative exhaustion felt through the entire body. Athletes who try to push through this can be off their sport for months as there blood physiology, neurological and hormonal levels trt to return to normal and their energy levels return. Treatment can be complete rest, a reduction in sessions per week and intensity of sessions depending on the severity. To understand overtraining more see:
Often, patients that I have seen who have symptoms of long covid keep trying to push their fitness. This is primarily out of frustration, boredom and for mental well being in lockdown. Slow it down. Like overtraining stage III, you may need a period of guilt free COMPLETE rest first! Again maybe think months not weeks to your recovery . Depending on severity and your individual response you maybe able to use a technique called PACING to return to previous levels of function and work at a lower intensity..
On a bad day, what is the minimum you can do without feeling fatigue. If this is walk 400 metres, or doing 10 minutes of yoga, then do this amount everyday only. Even on a good day. This will stop the up and down motion of doing more on a good day and feeling worse the next day (were you can’t get out of bed). We call this boom and bust and this needs to be managed. With Pacing, overtime your energy will gradually improve and you will be able to manage your week better. Have a look at the graph from an asthma patient that illustrates why boom and bust doesn’t work in getting you back to normal activity:
Get a good night’s sleep
Sleep is key to recovery. There are many tips to getting a better nights sleep. These include in short:
- Have a standardised sleep routine – finish tasks before you go to bed if you can e.g doing the washing up from dinner. If not, write a list for the next day and forget about them so they are not playing on your mind.
- Set your alarm to go to bed (not just to get up)
- Go from a hot environment to a cold one – a hot bath to a colder bedroom is ideal
- Take out all artificial light from your room (turn off the phone, ideally charge in another room, remove TV from the bedroom or at least cover the stand-by light, use black out curtains)
- Use blackout curtains
- Do not use your computer or phone for 1.5-2hours before bed
- Have naps if you need to in the day, but do not make them too long – 20-40 mins is ideal to prevent them from affecting your main sleep overnight
- Work your sleep pre and post sleep routines in 90 minutes sections.
For more indepth knowledge and advice on the above read the excellent and easy to understand book called ‘Sleep by Nick Littlehales’
Eat well and Hydrate
I won’t ram home the obvious here but try to drink water regularly through the day. Monitor this by using the same water bottle every day so that you can see what you drink not just endless cups of tea that you will find it hard to monitor. Eat healthy, non-processed foods balanced through the day to stop any highs and lows in blood glucose levels. It will be worth if you are suffering from fatigue to get a blood test from your GP to determine if you are low in anything e.g. iron that can be addressed in your diet or by supplements.
I hope some of these tips help. Go away and do a plan for your week, include work commitments, household commitments and sleep. Discuss this with your boss so they understand what you are doing and drive home the point of faster recovery if you are allowed to do this. Acknowledge your deeper stress factors and any anxieties you may have regarding your situation without letting them control you. Pace, Eat and Sleep. Monitor your week and change it accordingly until you find a level that you can start from. Take complete rest if you need to. Remember think months not weeks for a faster recovery.