Understanding Long Covid and how to manage invisible illnesses with Exercise Physiologist and Myotherapist Rob Nash
In a world dominated by news and conversation about Covid, it’s hard not to hear someone mention Long Covid. To bring you the most up to date information, we have interviewed Exercise Physiologist and Myotherapist Rob Nash from Active Health Clinic in Melbourne. He unpacks for us the concerns of ongoing post-illness symptoms, in particular, Long Covid.
Thanks for taking the time to have a chat. Tell us a bit of what you do as a specialist Exercise Physiologist in your field…
I’m an Exercise Physiologist and Myotherapist, and I work as a chronic pain and fatigue management consultant. This encompasses what I term “Invisible Illnesses”. Including Chronic Fatigue Syndrome (ME/CFS), Persistent Pain (Fibromyalgia, Chronic Regional Pain Syndrome), Orthostatic Intolerance (OI/POTS), and more recently “Long COVID” (Post-Acute Sequelae ((PASC)).
They are called Invisible Illnesses, as you may not be able to see a physical injury or ailment from the outside. Someone can look perfectly healthy, but they can be quite unwell.
It’s been a tough couple of years for most of us in one way or another. What’s your experience with the clientele you support?
Over the last 24 months, I have seen many clients’ symptoms exacerbated in response to the rollercoaster of the pandemic and associated lockdowns and due to the chronic stress of the situation. I’ve also seen a significant upsurge in the number of people who have developed an Invisible Illness. In people who have had the COVID-19 virus and struggled to recover and those affected by the overwhelming stress imposed by the pandemic. There has been a lot of uncertainty fear for our safety and security, which amounts to a lot of stress.
How many individuals experience ongoing symptoms after the initial illness?
There is a lot of discrepancy in the statistics. There is also still a lot of unknowns as we try to wrap our heads around the whole picture. However, some studies are indicating between 9-26% of people who contract the COVID-19 virus still experience one or more moderate-severe symptoms two months afterwards. Between 3 and 15% of people continue to experience moderate-severe symptoms eight months after their initial illness.
What symptoms are being reported the most?
The most prevalent lasting symptoms that continue after the viral periods include the absence of taste and smell, physical fatigue that can feel like overwhelming heaviness in the body, mental fatigue, cognitive exhaustion, memory loss or “brain fog”, and shortness of breath.
What recommendations do you pass on to your clients about returning to physical activity or even day to day life?
There appears to be a strong correlation between psychological and physical stress and developing Long-COVID. This is also typically how other Invisible Illnesses develop. Traditionally, about 85% of Chronic Fatigue Syndrome (ME/CFS) cases came about after an acute infection or virus, typically Glandular Fever or Epstein Barr Virus (EBV). We usually refer to this as Post-Viral Fatigue Syndrome.
Most people who develop Post-Viral Fatigue Syndrome report quite stressful life circumstances when they contracted the virus or could not rest and recover after getting sick fully.
Often this looks like the ambitious VCE student striving for top grades and not wanting to be held back by getting sick, or the busy parent or small business owner who “doesn’t have time to be sick”.
It’s the combination of the body being placed under the extreme load of trying to recover from a severe illness while trying to maintain high-pressure situations that life often throws at us. This then leads to chronic dysregulation. Therefore, my single most important piece of advice around returning to activity after COVID-19 would be to take things slowly and ease back into it.
You’ve mentioned fatigue which sometimes gets confused or is misunderstood with just being tired. Please share the differences between the two and how someone would identify if they had fatigue versus being tired?
This is a tricky one and an important one to understand. Being tired is a normal part of life that everyone can relate to. Tiredness relates to our natural, 24-hour sleep-wake cycle. We get tired in response to being awake. We can identify being tired by yawning and struggling to keep our eyes open, and we intuitively know the only remedy to being tired is sleep. After sleep, tiredness should be almost non-existent. And this is where fatigue comes in. Fatigue is not usually helped by sleep. Someone with Chronic Fatigue Syndrome (ME/CFS), Post-Viral Fatigue, or Long-COVID fatigue may wake up after 7 or 8 hours of sleep and still feel fatigued. This may feel like a general full-body heaviness, an inability or resistance to moving, slowed cognition or thinking, and maybe even full-body achiness.
To follow on from that question- what would be some things someone who was suffering from fatigue could do to support their return to daily living or the life they were used to?
When fatigued, it is essential to acknowledge it and try not to push through. You may be able to suppress your fatigue for a short while, but eventually, it will become overwhelming and may result in a crash. This push through-crash cycle, also known as “Booming and Busting”, perpetuates and worsens fatigue over time. A more sustainable and recovery-focused way is to establish an Activity Baseline – an amount of activity that you can sustain daily without worsening symptoms. Over time, you will gradually increase the amount of activity you can sustain, but it can take a while.
And if they were to ignore the fatigue and keep going, what would happen in your experience?
Ignoring fatigue or trying to fight it or push through generally worsens the condition. It’s like your body says to you, “You aren’t listening to me, so I’m going to yell louder” (make the fatigue worse).
What’s the length of time it may take someone to recover from the ongoing illness?
This is the million-dollar question, and there is no one size fits all when it comes to recovery. Some people can recover in a matter of weeks, and others take years. It’s impossible to predict with any accuracy. Typically, people who are better at listening to their bodies and have a well-balanced work/rest ratio are better suited to get better faster.
There are mixed reports about exercise and fatigue. What’s your perspective, and can someone exercise safety with symptoms?
Yes, there is a lot of controversy around this. There were some extensive studies looking into this question, and where the researchers went wrong with exercise is that they tried to increase the intensity and amount of exercise by fixed increments, meaning they might have started someone on 5 minutes of walking, then instructed them to progress by 5 minutes each day until they were able to do 30 minutes. This method didn’t take into account individual differences in their ability to adapt, and it often led to major crashes.
Thankfully we know much better than this now. Exercise is extremely important in the recovery of these conditions, like almost every other health affliction we know of, but it’s important not to progress by fixed increments; instead, it is more patient-led. We consider how they are coping with the current exercise load, how they’ve been feeling recently, and whether other stressors are present in their lives. We make a combined decision about an appropriate amount of exercise that will be sustainable.
There’s a lot of literature about the mind-body connection. How does someone’s mindset impact their recovery, and what tools do you use to work with an individual’s mental health?
There really is no separation between mind and body. The body is an extension of the mind via the nervous system. Our mindset, that is to say, our thoughts, feelings, beliefs, mental disposition and stress levels, all play a critical role in our overall physical health. I encourage almost all my clients to learn the skill of mindfulness. Being more mindful allows you to manage your headspace and to notice the content of your consciousness.
It is important to be aware of any thoughts that might be impacting your ability to recover, for example. Many people find it difficult to allow themselves to take time to rest. Often this is because they experience feelings of guilt, have thoughts that they should be working, or worry that others might be judging them for indulging in rest. All these mental battles will make resting a challenging task, and their efforts to recover will be derailed. Someone who practices mindfulness is going to be able to sit and rest, and when a thought of guilt appears, they can go, “Ah, there’s that feeling of guilt again”, allow it to be there, but not get sucked into it, they can just carry-on resting.
At OsteoStrong, we are big believers in team-based care. Where does someone go to learn more about their options for support and healthcare in this field?
With complex conditions like this, you’re absolutely right team-based care is the gold standard. The first step is to speak to a good GP who understands these conditions, can rule out any “Red flags”, and put you in contact with some specialists. Ensure whomever you see does indeed have a particular interest or expertise in this area. There’s no use seeing an Exercise Physiologist who specialises in diabetes when you have chronic pain or fatigue. If you are after a really good support network, head over the Facebook group “AHC Connection”, where you’ll find a great community of people with pain and fatigue syndromes who are super supportive, empathetic and optimistic about recovery.
Recovery from illness can be a non-linear and complex pathway that won’t always look the same for everyone. Be sure to consult with your primary health practitioner before making any significant changes to your path back from illness, as they will be able to help you on your unique journey.