“Is it just deconditioning?” 

This is one of the common questions people have about Long Covid.  Deconditioning is the effect on the body due to a period of disuse of muscles, and can lead to a decrease in bulk and strength. It can also lead to lower fitness due to the lungs and heart also being less active.  However Long Covid has been shown to be the result of complex impacts on multiple areas of the body, including the mitochondria (energy creating organelles in cells), blood vessels, and neurons in the brain. Long Covid is therefore not due to the long periods of rest people need to have while recovering.

While deconditioning isn’t a cause of Long Covid, some people may find themselves concerned with the change in condition in their bodies due to their inability to exercise.  So we asked physiotherapist Raewyn Burrough to explain the effects of inactivity on muscles, in particular, muscle wastage, and whether this atrophy is reversible.

Will long term rest lead to muscle wastage?

In terms of muscle atrophy or wastage – the short answer is yes, over time there will be atrophy of your muscles.  Also yes – there is not much you can do about that.

A principle you can think about is basically our muscle strength “matches” our muscle use. When people exercise more their muscles get stronger and over periods of illness or inactivity our muscles get weaker. Our body doesn’t spend energy on keeping muscles strong, if we aren’t using that strength.

At the moment, because of the way your body is processing energy with Long Covid, you don’t have the surplus of energy to do exercise, and therefore have no need for stronger muscles. As long as you have enough strength to do all of the movements you need to do in a day (ie. get up out of a chair, walk, pick objects up etc.) then you have enough strength for now.

Can excercise help?

Sometimes people struggle through a day because of weakness / being unfit, and that is where exercise can help improve their energy levels. However if you have Long Covid, you aren’t tired because you are weak/unfit. You are tired because of the changes that COVID has made to your energy processing systems.

If weak muscles aren’t the cause, strong muscles won’t fix the problem.

We have known for a few years that exercise doesn’t fix an energy problem, and now from new research, we can see that it can actually be quite harmful. 

A recent research article discusses the way in which our body is affected by COVID and what happens if we cause post exertional malaise (the worsening of symptoms after even mild physical or mental exertion). The study mentions a build up of amyloid protein in the skeletal muscle, which is a protein that weakens muscles. Damage to the mitochondria which is responsible for energy production in our cells, and evidence of muscle necrosis (muscle death). So if someone with Long COVID tried pushing through to avoid muscle wastage, they wouldn’t stop the atrophy, but could in fact worsen it! 

Can muscles be rebuilt?

It is also important to note  that atrophy is reversible. Weak muscles can get stronger again. 

If muscle wasting is from underuse, then that is reversible using exercise. So down the track, if your energy levels increase, you will be able to strengthen your muscles again. But if you push it now, you may cause lasting damage to your muscles which is much much more difficult to deal with, and would make the strengthening process harder.

For a healthy person with the choice to either exercise and get stronger, or be sedentary and have muscle wastage – then muscle wastage is the worse option. But for someone with Long Covid, the choice is to rest and allow some muscle wastage to happen, or exercise and damage / weaken muscles further – in this case, allowing some muscle wastage to occur is absolutely the best choice!

If you get worried, just keep in mind that muscle wasting is reversible, and as soon as your body has more energy to use, you will naturally start moving more, and your body will build strength and muscle bulk (hypertrophy) again. 

The point of our muscles is to help us move, so as long as you have enough strength to do the movements you currently have enough energy for, then there is nothing to worry about at all.

Raewyn Burrough is an experienced neuro-physiotherapist working in the Manawatu area of New Zealand. 

She works with people who have neurological conditions and long term disability management which now includes people suffering from Long COVID.