Exercise may be the key to treating the sequelae of Long COVID by supporting brain homeostasis, increasing insulin sensitivity, and mediating the inflammatory response.
Researchers from Pennington Biomedical Research Center (LA, USA) and the University of Pittsburgh (PA, USA) recently published their hypothesis on exercise as a moderator of persistent neuroendocrine symptoms of COVID-19, detailing how exercise could help counteract the detrimental inflammatory effects of Long COVID that cause sequelae such as depression and new-onset diabetes. There is currently no medical treatment for Long COVID, so a holistic approach to treatment may be crucial to preventing the potential side effects of the illness.
Although it is unknown exactly how many people are living with Long COVID, it is estimated that 15–80% of those infected with SARS-CoV-2 go on to experience Long COVID. The Centers for Disease Control (Atlanta, Georgia) describes Long COVID as “a constellation of other debilitating symptoms” including brain fog, muscle pain, and fatigue that may persist for months after recovery from the initial viral infection. “For example, a person may not get very sick from COVID-19, but 6 months later, long after the cough or fever is gone, they develop diabetes,” lead author Candida Rebello (Pennington Biomedical Research Center) reported.
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This is linked to the cycle of inflammation induced by the initial SARS-CoV-2 infection, which disrupts the immune metabolic homeostasis. Hyperglycemia can arise from psychological stress, lingering inflammation, and immune dysfunction that then causes downstream effects on the β-cell microenvironment, inhibiting insulin secretion. This amounts to a vicious cycle of autostimulation and inflammation.
“We know that Long COVID causes depression, and we know that it can increase blood glucose levels to the point where people develop diabetic ketoacidosis, a potentially life-threatening condition common among people with type 1 diabetes,” explained Rebello. “Exercise can help. Exercise takes care of the inflammation that leads to elevated blood glucose and the development and progression of diabetes and clinical depression.”
“You don’t have to run a mile or even walk a mile at a brisk pace,” Rebello assured. “Walking slowly is also exercising. Ideally, you would do a 30-minute session of exercise. But if you can only do 15 minutes at a time, try to do two 15-minute sessions. If you can only walk 15 minutes once a day, do that. The important thing is to try. It doesn’t matter where you begin. You can gradually build up to the recommended level of exercise.”
The team concluded that exercise modulates the key lingering features of SARS-CoV-2 infection that contribute to the risk of depression and diabetes. By controlling the elevated blood glucose levels increased by inflammation and stress, exercise can help break this inflammation–hyperglycemia cycle to prevent the development of diabetes. Exercise may also help prevent the progression of preexisting type 2 diabetes in Long COVID patients – a vulnerable group in which severe SARS-CoV-2 infection and mortality rates are among the highest.
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