Long Covid is thought to affect 10% of those diagnosed with Covid-19 and consists of a wide range of symptoms affecting many systems including cardiac, respiratory, neurocognitive, and immune function. The illness commonly has an unpredictable, relapsing-remitting pattern with significant associated conditions often appearing weeks to months into the disease course.
The NICE clinical guideline was released on the 18th December 2020. On 14th June 2021
The CDC guideline released on 14th June 2021, notes that:
Objective laboratory or imaging findings should not be used as the only measure or assessment of a patient’s well-being; lack of laboratory or imaging abnormalities does not invalidate the existence, severity, or importance of a patient’s symptoms or conditions.
Understanding of post-COVID conditions remains incomplete and guidance for healthcare professionals will likely change over time as the evidence evolves.
The World Physiotherapy briefing paper is intended for physiotherapists, and other healthcare professionals assessing and treating people living with Long Covid. It considers how post-exertional symptom exacerbation, cardiac impairment, exertional oxygen desaturation and autonomic nervous system dysfunction impact on safe prescription of rehabilitation, including physical activity.
Safe rehabilitation statement 1
Before recommending physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, individuals should be screened for post-exertional symptom exacerbation through careful monitoring of signs and symptoms both during and in the days following increased physical activity, with continued monitoring in response to any physical activity interventions.
Safe rehabilitation statement 2
Exclude cardiac impairment before using physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, with continued monitoring for potential delayed development of cardiac dysfunction when any physical activity interventions are commenced.
Safe rehabilitation statement 3
Exclude exertional oxygen desaturation before using physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, with continued monitoring for signs of reduced oxygen saturation in response to any physical activity interventions.
Safe rehabilitation statement 4
Before recommending physical activity, including exercise or sport, as rehabilitation interventions for people living with Long COVID, individuals should be screened for autonomic nervous system dysfunction, with continued monitoring for signs and symptoms of orthostatic intolerance in response to any physical activity interventions.