Women with Long COVID May Need Targeted Rehabilitation to Help Counter Problems with Physical Activity Tolerance

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Since the global spread of Covid-19 from early 2020, there is an emerging body of evidence from several countries that shows that a growing number of people experience prolonged symptoms beyond the initial, acute stage of the disease.

A 2021 study, Characterising Long Covid in an International Cohort: 7 Months of Symptoms and Their Impact, has found that between 10% and 30% of patients who recover from acute Covid-19 become ‘long haulers’, still experiencing symptoms six months later.

In one study of 3 762 patients who had confirmed or suspected Covid-19, most of whom had symptoms lasting longer than 90 days, 45% needed a reduced work schedule compared to before they became ill, and 22% were not working due to their health conditions.

A South African woman, Tammy Sondlo, 32, suffered from long Covid, which left her fatigued most days.

“I had Covid-19 for almost two months. Despite testing negative after 12 days, I was still sick. My sense of smell and taste was gone. The biggest challenge was the chest. After a month of being sick, I was diagnosed with Covid19 pneumonia. I struggled talking. Most people said I sounded like I was crying because Covid affected my voice.

“During the long Covid period, there's nothing much that the doctor could do but to keep monitoring my breathing and chest. What people fail to understand is that it's not Covid19 that kills. It's actually the after effects. Besides the physical issues I had, it also affected me mentally,” said Sondlo.

It was only recently that she started feeling better in terms of the chest and voice.

“It's been almost four months since I've had Covid, and I still suffer from headaches and fatigue and have not fully gone back to my pre-Covid self. I’ve been told I need to be patient,” added Sondlo.

Another new study also indicates that women with long Covid-19 may need targeted rehabilitation to help counter problems with physical activity tolerance. They experience heart rate irregularities in response to physical exertion, and this has the potential to constrain not only exercise tolerance but free-living physical activity.

In light of the greater prevalence of age-related physical disability among women compared to men, the findings highlight a need for targeted rehabilitation programs to manage the consequences of persistent heart and lung problems in women with lingering Covid-19 related symptoms.

That’s according to another study published in The Physiological Society’s journal Experimental Physiology: Evidence for impaired chronotropic responses to and recovery from 6-minute walk test in women with post-acute Covid-19 syndrome.

The study reported significant differences in the heart rate responses to and recovery from a 6-minute walk test in women several months following mild-to-moderate Sars-CoV-2 infection compared to non-infected controls.

Dr. Stephen Carter and Dr. Marissa Baranauskas, physiologists from Indiana University Bloomington and USA, explain the control and experimental groups were matched on age and body mass index, providing greater certainty that the present findings were attributed to long Covid syndrome rather than underlying differences related to aging or obesity.

“Specifically, heart rate was reduced during physical exertion, and recovery (i.e. the slowing of heart rate back to the baseline) was delayed after the exertion among Sars-CoV-2 participants despite a similar distance traveled and ratings-of-perceived exertion to controls.

“Women reporting shortness of breath, or joint / muscle aches at the time of testing achieved a lower proportion of predicted 6-minute walk test distance compared to controls as well as Sars-CoV-2 participants not actively experiencing such symptoms.

“Furthermore, more abnormal heart rate responses were associated with a greater number of days experiencing shortness of breath at illness onset, and poorer ability for gas exchange in the lungs.” the study revealed.

Although males are associated with increased Covid-19 symptom severity and mortality, recent reports suggest women may be more susceptible to certain lung-related limitations months into recovery.

Commenting on the study, Carter said: “Given the greater prevalence of age-related physical disability in women, as compared to men, our findings show that a targeted rehab program might be especially useful to women and other groups affected by persistent Covid-19 symptoms – thus promoting recovery and minimizing susceptibility for deteriorating physical condition.”

A control group was then recruited consisting of women who had never tested positive for Sars-CoV-2 and were matched to participants in the Sars-CoV-2 group based on age and body mass index.

Women who had a history of major lung disease (e.g. COPD, emphysema), heart disease (e.g. stroke, heart attack), or reported smoking/use of tobacco products within the last six months were excluded from participation.

“An inventory of Covid-19 symptoms experienced at illness onset as well as details regarding time since diagnosis and facility where diagnostic test results were collected.

“On the same day, participants completed a series of standard lung function tests and a six-minute walk test at the Indiana University – Bloomington School of Public Health campus.

Immediately following the test, post-exercise heart rate, oxygen in the blood, ratings-of-perceived shortness of breath, and ratings-of-perceived exertion were assessed.

Heart rate recovery was then calculated as the difference in heart rate immediately post-exercise for each minute of recovery. The distance traveled during the six-minute period was normalized to predicted values (for age, height, sex, weight, and exercising heart rate).

Since menopause is associated with a greater prevalence of restrictive lung abnormalities, it is important to note, the proportion of women exceeding the average age of menopause (51 years) were similar for the Sars-CoV-2 (79%) and control (81%) groups.

“Indeed, menopausal status or hormone levels were not controlled for in the investigation. Considering many patients seeking treatment for persistent Covid-19 symptoms, have been women around the ages of 40-45 years old, it is possible that hormonal changes during the menopausal transition may increase susceptibility to the development of persistent Covid-19 related symptoms,” the study indicated.

Therefore, the abnormalities observed in the present cohort of predominantly post-menopausal women might not be generalizable to men or younger women recovering from Covid-19.

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