CHEST Guidelines-Postexertional-Malaise-and-Rehabilitation-in-Long-

Postexertional-Malaise-and-Rehabilitation-in-Long-

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The correspondence published in CHEST journal explores the challenges faced by individuals with long COVID, particularly post-exertional malaise (PEM), a symptom they share with patients diagnosed with myalgia encephalomyelitis/chronic fatigue syndrome (ME/CFS). Daynes et al. review highlights the benefits of pulmonary rehabilitation, including aerobic and resistance exercises, education, and self-management strategies for patients experiencing lingering COVID-19 symptoms. However, the presence of fatigue and PEM complicates these rehabilitative efforts. Twomey et al.'s study reveals significant prevalence of fatigue (91.1%) and PEM (94.8%) among long COVID patients, drawing comparisons to ME/CFS, and emphasizing the need for tailored rehabilitative approaches.<br /><br />While the National Institute for Health and Care Excellence (NICE) guidelines for ME/CFS advise against graded exercise therapy, newer studies reported no harm from exercise therapy in post-COVID conditions. Notably, Tryfonos et al. and a commentary by Ladlow et al. conclude that exercise is beneficial and non-harmful for post-COVID patients, albeit with a need for personalized adjustments due to increased reports of impaired concentration and muscle soreness.<br /><br />Daynes and colleagues caution against solely relying on tools like the DePaul Symptom Questionnaire for diagnosing PEM, advising that clinical assessments by healthcare professionals are crucial. They reiterate that pulmonary rehabilitation is not synonymous with graded exercise therapy, as it is a patient-specific program meant to adapt to individual symptoms without exacerbating them.<br /><br />Dr. Kenneth Nugent underscores the necessity of proper attention to PEM while pursuing rehabilitation for post-COVID syndromes, suggesting that using questionnaires could help identify patterns of fatigue and PEM, prompting further investigation within rehabilitation frameworks to cater to the unique needs of long COVID patients.

Keywords

long COVID

post-exertional malaise

myalgia encephalomyelitis

chronic fatigue syndrome

pulmonary rehabilitation

aerobic exercises

resistance exercises

NICE guidelines

DePaul Symptom Questionnaire

personalized rehabilitation