Advice for Long-Haulers, from the Life-Longers

What the ME community can teach Covid long-haulers

Christina Baltais/@wordsasmedicine

While SARS-CoV-2 is new, the problem of long-term symptoms after an infection isn’t. I wrote about some tips and advice that people with myalgic encephalomyelitis (ME) can offer to the Covid long-haul community for Elemental, here. While we’re still looking for answers ourselves, given how historically underfunded ME research has been, we do have a few tips to share in the hopes they may help keep some of the long-haulers from becoming life-longers.

And, since there’s more than could reasonably fit in one article, I’m adding a few more details below:

Sure, but what the duck is the “anaerobic threshold”?

We have two energy systems: aerobic and anaerobic. Generally, we’re supposed to be able to go about most of our business using the aerobic energy system, and only switch to anaerobic if absolutely necessary. When in aerobic, the body converts glucose into a relative abundance of energy (ATP): one glucose molecule nets you 36 or so ATP. But the anaerobic energy system is inefficient; it’s the emergency system for high-intensity activities, and it’s meant to be used only for very short durations — for example, you suddenly need to run from a honey badger. As one does. Here, one glucose molecule gets you only 2 ATP.

But if the regular, aerobic energy system is broken, as is the case in ME patients and may also be the case in long-Covid, people shift into anaerobic much too soon. “If you’re constantly shifting into that emergency system to do your daily activities, it’s like running a sprint,” says Staci Stevens, exercise physiologist and founder and director of Workwell Foundation — which has given some thought to how rehabilitation strategies that help ME patients may also benefit some long-haulers.

“And you know how you feel after you run a sprint,” she says, “you pay the consequence.”

The only way to accurately pinpoint your AT is to undergo a cardio-pulmonary exercise test (CPET), which shows you at precisely what heart rate you switch over. Not only is a perfectly calibrated CPET not widely available (requiring specialized equipment and personnel), it’s also costly and comes with a not-small amount of risk. The equation many use to estimate what heart rate they should stay below may not be accurate, warns Stevens, since it is based on a healthy, normal heart rate response. Consequently, it will likely overestimate how high one’s heart rate can go before crossing the anaerobic threshold.



Megan E. Doherty is a writer and photographer based in Chicago, IL.

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