youUntil recently, running was an integral part of Emma Zimmerman’s life. The 26-year-old freelance journalist and graduate student was a competitive distance runner in college and, even after graduating, clocked in at around 50 miles a week. So she tentatively tried to get back to her running routine about a week after a probable case of COVID-19 in March, doing her best to overcome the discomfort that followed her first allergic symptoms. Each time, however, “I was stuck in bed for days with a severe level of crippling fatigue,” Zimmerman says.
Months later, Zimmerman is still experiencing health issues including exhaustion, migraines, brain fog, nausea, numbness and sensitivity to screens – a constellation of symptoms that have led doctors to diagnose her with Long COVID. Although she can’t know for sure, she worries that those workouts early in her recovery process may have made her condition worse.
“I had no idea that I should try to rest as hard as I needed to,” she says.
Stories like Zimmernan’s – sickness, improvement, exercise, accident – are common in the world Long COVID. And they highlight what many researchers, patients, and advocates say is one of the most powerful tools for managing, and potentially even preventing, Long COVID: rest.
The only guaranteed way to avoid Long COVID is to not become infected with SARS-CoV-2. But if someone does get sick, “rest is extremely important to give your body and your immune system a chance to fight off the acute infection,” says Dr. Janna Friedly, post-COVID rehabilitation specialist at the University of Washington which recovered from Long COVID se. “People kind of fight and think it’ll go away in a few days and they’ll be fine, and that doesn’t really work with COVID.”
Researchers are still learning a lot about Long COVID, it is therefore impossible to say with certainty whether rest can really prevent its development or, conversely, whether premature activity leads to complications. But for the record, Friedly says many of the Long COVID patients she sees are women working with families who have been scrambling to get back to normal as soon as possible. It’s hard to give any one-size-fits-all advice on how much rest to get, but Friedly recommends anyone recovering from COVID-19 stay away from high-intensity exercise for at least a few weeks and avoid crossing over. tiredness.
For people who have already developed Long COVID, rest may also be helpful in managing symptoms, including fatigue and post-exertional malaise (PEM), or crashes following physical, mental, or emotional exertion. The United States Centers for Disease Control and Prevention recommended “perambulatean activity management strategy that involves rationing activity and interspersing it with rest to prevent overwork and worsening of symptoms.
In an international study released last year, researchers surveyed more than 3,700 long-haulers about their symptoms. Nearly half said they found stimulation at least somewhat helpful for symptom management. Meanwhile, when other researchers surveyed around 500 long-haul carriers for a study published in April, the overwhelming majority said physical activity made their symptoms worse, had no effect, or produced mixed results. This may be because long-haulers have deficiencies in their mitochondria, which generate energy for cells to use, recent research suggests.
Before Long COVID existed, researchers and patients encouraged rest and stimulation for the management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/SCF). Characteristic symptoms of the disease include PEM and severe, long-lasting fatigue — diagnostic criteria that many people with Long COVID now meet. A study of more than 200 people with Long COVID published in January found that 71% suffered from chronic fatigue and nearly 60% suffered from PEM.
For years, clinicians have tried to treat patients with ME/CFS by gradually increasing their level of physical activity. But this practice has since proven not only ineffective, but often harmful, because people with ME/CFS “have a unique, pathogenic response to overwork” due to cellular dysfunction, says Jaime Seltzer, director of science and medical outreach at advocacy group MEAction. Most people with ME/CFS prefer stimulation over exercise therapy, a 2019 study found.
To pace effectively, people must learn to pick up on cues that they’re overdoing it and unlearn ingrained ideas about productivity, Seltzer says. “If you’re doing laundry, for example, there’s no telling you have to fold every item in one sitting,” she says. Separating tasks may seem strange, but it can be crucial for conserving energy.
People with new Long COVID symptoms should keep a diary of their food, activity, sleep and symptoms for a few weeks to learn about their triggers, Friedly says. For those who can afford it, a fitness tracker or other wearable accessory can also be helpful in gauging how excessive the exertion is, Seltzer says. Once someone has an idea of which behaviors improve or worsen symptoms, they can use this information to plan their days and break activities down into manageable chunks.
However, for many people who test positive for COVID-19, even taking a few days off to self-isolate is a financial and logistical challenge. Many people have no choice but to return to physically demanding work or responsibilities such as childcare as soon as possible. “Rest is absolutely socio-economically and politically weighted advice,” Seltzer says.
People with long COVID or ME/CFS may be able to secure workplace accommodationssuch as working from home, taking on a role that can be done sitting instead of standing, or disability claim if necessary. Seltzer also suggests relying on friends, faith groups, or self-help networks for help with certain tasks. Beyond that, Friedly recommends looking for creative ways to use less energy throughout the day. When she was living with symptoms of Long COVID, she bought many identical pairs of socks so she never wasted time and effort looking for a match.
Things like this “may seem small,” she says, “but if you add them up throughout the day, they make a big difference in the amount of energy you expend.”
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