3. Modify exercise.
Most of the time, exercise boosts health and reduces risk for certain diseases. But this strategy may not work for people who have certain symptoms from long COVID, such as postexertional malaise or postural orthostatic tachycardia syndrome (POTS), a condition that causes symptoms such as a fast heart rate, dizziness, and fatigue when transitioning from lying down to standing up.
“With long-COVID patients, it often has to be symptom-titrated exercise,” said Dr. Schamess. This means physical activity needs to be constantly monitored and adjusted on the basis of a patient’s symptoms. “We need to figure out what they can do that doesn’t provoke their symptoms,” he explained.
Dr. Schamess often recommends that patients with long COVID, at least initially, focus on exercises in which they are sitting (such as cycling) or prone.
“The key thing is most people with long COVID can do a lot more exercise in a sitting or lying position than a standing position,” he said. “It’s baffling to them that they can’t walk two blocks but can bike 10 miles.”
For symptoms like fatigue or postexertional malaise, Dr. Schamess often refers patients to physical therapy to develop an individualized exercise program. A 2022 study published in Scandinavian Journal of Medicine & Science in Sports found that when long-COVID patients completed an 8-week program of three exercise sessions per week, they experienced significant improvements in quality of life, fatigue, muscle strength, and overall fitness compared with a control group.
“It’s important to make sure that workouts are supervised, so that they can be modified as necessary” said Dr. Schamess.
4. Take steps to improve sleep quality.
A 2023 study published in the Journal of General Internal Medicine found that about 40% of people with long COVID report sleep issues such as insomnia or not feeling refreshed in the morning.
“Sleep may become challenging, which can be frustrating for a patient with long COVID who desperately needs rest,” said Lawrence Purpura, MD, an infectious disease specialist and director of the long COVID clinic at Columbia University Medical Center in New York City.
Some of the simplest ways to improve sleep are common sense; however, these issues never affected the person pre-COVID, so they have to become new habits.
“A lot of my patients with long COVID find that they are more sensitive to caffeine, so they really can’t have it anymore later in the day,” he said. “The same goes for bright screens” such as those on cell phones, tablets, and e-book readers, he said. “They may find that it’s harder for them to fall and stay asleep if they’re on their iPhone right before bed. These are all things that may not have been issues before they were diagnosed with long COVID.”
Dr. Purpura also said that he encourages his patients to practice mindfulness or relaxation exercises before bed, such as deep breathing. One technique he recommends is called box breathing, where the patient inhales for 4 seconds, holds his or her breath for 4 seconds, exhales for 4 seconds, then holds his or her breath again for 4 seconds. Some research suggests that this paced breathing technique, when done for 20 minutes before bed, helps to improve symptoms of insomnia.
While sleep medications such as zolpidem (Ambien) are often used as short-term relief for insomnia, Dr. Schamess said he has not found them particularly helpful for sleep issues that stem from long COVID.
“They help patients fall asleep but not necessarily stay asleep, which can be an issue for people with long COVID,” he said.