Though most individuals who experience COVID-19 recover to their normal levels of health, there is a subset of those infected who do not return to their previous level of activity after being infected due to post-viral infection fatigue. These individuals may require physical therapy in order to improve their strength and endurance.
However, physical therapy looks very different when treating patients recovering from COVID-19. The National Institute for Health and Care Excellence recommends avoiding a technique that is frequently used in physical therapy called Graded Exercise Exposure or GET. GET was initially proposed for individuals who experience mild to moderates symptoms of Chronic Fatigue Syndrome. Due to the similarities in the presentation between Chronic Fatigue Syndrome and post-viral infection fatigue, it was postulated that this technique could be used for patients recovering from COVID. Instead, what is currently being witnessed is that graded exercise exposure sets patients with post-viral infection fatigue back by giving them post-exertional malaise. This often results in someone feeling so tired after exercise, that they basically require returning to their bed.
What does physical therapy for patients with post-viral infection fatigue look like?
The current recommendation is to utilize pacing strategies during physical therapy for post-viral infection fatigue. This involves teaching the individual recovering how to implement specific pacing techniques in order to maximize their functional capacity throughout the day without experiencing post-exertional malaise.
Physical therapists who treat post-viral infection fatigue might also incorporate the use of activity journals to help with pacing and breathing techniques to improve lung capacity when the patient must complete a task. Instead of general exercises, the physical therapist will focus on stimulating activities of daily living that the patient will need to complete in order to return to being independent in his or her home and community. These simulations will be adjusted in the level of difficulty to allow the patient to complete the task, but not overload him- or herself while doing so.
There is still much we don’t know about the long-term effects of COVID-19, but we are starting to develop clearer guidelines as to which physical therapy interventions to implement and which to avoid.