Nothing is new under the sun

We’ve seen it before… A brief illness, a seemingly good recovery, then unexpected symptoms that appear later~ sometimes much later. This is the road for those with long COVID, which can be an extension of symptoms after acute illness or unexpectedly appear up to 6 months after apparent recuperation from COVID. In an earlier posting I mentioned the symptoms experienced by patients I worked with in the 1980’s with post-polio syndrome, which surfaces 15 to 40 years post-acute illness. It’s widely recognized that those who have had chicken pox harbor the virus after they recuperate and are susceptible to getting shingles as adults if they have not gotten a shingles vaccine. A recent Nature Medicine review reveals that latent post-acute infection syndromes (PAIS) follow a wide range of illnesses, including Ebola, Dengue, West Nile virus, Epstein-Barr Virus, Giardia, Borrelia and Q fever, among others. Infectious agents may be viruses, bacteria or parasites. While there is often a long and varied list of complex symptoms across many different body systems, many PAIS manifest with functional limitations, exertion intolerance, severe fatigue and unrestful sleep.

So what do you need to know when you encounter aquatic clients who say they have exertion intolerance or fatigue, regardless of the etiology? Before beginning community exercise, your participants need to be medically stable~ body temperature, blood pressure, heart rate, and blood oxygen (SpO2) levels must all be within normal limits. A resting SpO2 level of 90% or better is recommended by the Royal Dutch Society for Physical Therapy before embarking on an exercise program.

For those who identify fatigue or brain fog as an issue, the 10-item DePaul Symptoms Questionnaire for Post-exertional malaise (DSQ-PEM) is a helpful tool. Those with post-exertional malaise (PEM) can track their own SpO2 levels with a splash-proof pool side finger monitor or a smart watch and stop exercise at 85% SpO2 to avoid reaching the tipping point where they “crash” a couple of days later. The Workwell Foundation recommends daily heart rate tracking, and slowing down when an activity results in more than 15 beats per minute of the weekly average. Laminated copies of the linear Borg Scale of Perceived Exertion are a helpful tool to have on hand to estimate heart rate based on perceived exertion while exercising. With this tool, the heart rate is approximately 10x the exertion level. Those with PEM should work at a maximum of the level that correlates with their average weekly heart rate + 15 bpm, but no more than a moderate exertion level on this scale. For a more accurate reading, breaks can be taken for heart rate tracking with digital devices.

It’s not hard to give space for participants to work with post-exertional malaise during Ai Chi sessions. Simply extend the repetitions for soothing or shifting or add a “holding pattern” of the core stance with arms extended to the sides on the water surface, turning palms up and down for the group while participants who need to check their SpO2 or heart rate do so. Being flexible is all a part of Ai Chi. However it turns out is how it was meant to be…

Check out post-exertional malaise resources available through World Physiotherapy:

What has been will be again,
what has been done will be done again;
there is nothing new under the sun. Ecclesiastes 1:9

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Finding calm in a fatiguing world

Recently I have given a lot of thought and study on fatigue, particularly the sudden-onset, overwhelming fatigue that those with chronic fatigue syndrome, myalgic encephalomyelitis and long COVID experience a day or so after expending too much energy. I was chatting about this phenomena with a couple of friends right before we were going to do Ai Chi together, when one of them speculated that she may have been experiencing this sort of post-COVID fatigue. Before we got in the water, I found a copy of the DePaul Short Questionnaire for Post-exertional malaise DSQ-PEM which revealed that her fatigue occurred only after taking extremely long walks and resolved quickly~ and fortunately the questionnaire did not suggest that post-exertional malaise was an issue!

It seems that feelings of stress and fatigue are a common experience right now. The calming effects of Ai Chi are a good antidote. It feels good to move and stretch in warm water. The familiarity of the patterns of movement are comforting in a world of change. Our parasympathetic nervous system kicks in to temper the tension of our over-active sympathetic nervous system. We can find centering as we bring focus on our movements and our surroundings.

Even if my stressed friend had been experiencing post-exertional malaise, there are tools that could help her to enjoy the benefits of Ai Chi fairly easily. Long-COVID rehabilitation for fatigue is customized for personal symptoms, but generally includes instruction in tracking activity, as well as heart rate and blood oxygenation monitoring, with a titrated rather than prescribed pacing given the available physical and cognitive “energy envelope.” The key is to learn how to expend the amount of energy to do what needs to be done and what you want to do at any given time, without exhausting your available energy stores. As a former rehab director, I know Occupational Therapists are a great resource in this area.

Sanibel ATRI conference

The Sanibel National ATRI conference is coming up in June, in paradise! On Thursday morning, please join me for an Ai Chi calming workshop where I will be focusing on calming aspects of Ai Chi along with Swedish aqua gong specialist Anne Asterhall and psychotherapist Patty Henry-Schneider. If you are interested in learning more about working with long-COVID survivors (or those with chronic fatigue syndrome/myalgic encephalomyelitis), join Beth Scalone, Mary Wykle and me on Friday morning for a Long-haulers round table discussion. I hope you can attend this memorable conference.

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