Long COVID and you - how to ease back into fitness and good health

Dr Seranne Motilal, clinician at Discovery Vitality, says that most people with COVID-19 experience mild symptoms or moderate illness and recover in two to six weeks. "But the World Health Organization tells us that, for a small percentage, symptoms can linger for several months after infection. This is known as 'long-Covid' - which the science community is still researching and trying to understand.""

The most commonly reported longer-term symptoms according to the US Centers for Disease Control (CDC) include:

• Fatigue
• Shortness of breath or a cough
• Joint, chest and muscle pain
• Heart palpitations
• Difficulty with thinking and concentration (sometimes referred to as 'brain fog')
• Depression
• Fever
• Headaches

"The science is still developing around 'long COVID'. In the meantime, it's important to listen to your body so that you can improve both your physical and mental health. Eat nourishing food, which can also improve your mental wellbeing. Also, get enough rest and prioritise sleep,"" says Dr Motilal.

"Importantly, if you need help coping, reach out to professionals for help. The impact of being ill can have lasting effects on the body, but also the mind," she adds.

Easing back into fitness and good nutrition

"Keeping the body nourished during any illness is essential, so if you have been infected with the novel coronavirus, nutritional and fluid intake are very important," says Vitality dietitian Terry Harris.

Many people have reported not being able to smell or taste as a symptom of COVID-19. Others report that the symptoms can affect your appetite and ability to eat.

"Firstly, don't change your diet drastically if you have diabetes or if you have specific dietary needs relating to existing conditions," says Terry.

"If you are losing weight or strength in your muscles, you may need to think differently about the foods you are eating," she adds. Terry advises that it is important to continually monitor your weight. If you are losing weight rapidly, inform your doctor. "Also check your urine colour. Dark urine is a sign of dehydration. Aim to drink enough water to keep urine a pale straw colour. Avoid alcohol and include nourishing liquids such as smoothies prepared with fresh fruit and plain yoghurt," she says.

Changes to your taste and smell are common symptoms of COVID-19 and can make eating and drinking less enjoyable. "Experiment with herbs, spices and different flavour combinations if you are struggling to taste food. Sometimes, a new and different flavour may improve your ability to taste. Try foods hot or cold, and decide which goes down better," she says.

• Read more: What to eat while you're ill with COVID-19

Eating when you are short of breath or have a dry mouth

"Eating can be very challenging when you are short of breath. Try to eat smaller portions of energy-rich and protein-rich foods, like Greek yogurt, lean chicken and seafood, more frequently throughout the day. Take your time," says Terry. "Choose softer, moist foods that are easier to chew and swallow."

Dry mouth can be caused by nebulisers, inhalers and oxygen therapy. It can make it difficult to chew and swallow foods, and the taste of food can change.

"Try to drink six to eight cups (1.5 to 2 litres) of liquid every day, including water, fresh fruit smoothies and homemade vegetable soups," she says.

Right now, focus on quality not quantity of calories

Eating well when you've lost your appetite can be difficult. When you do feel up to eating, try to eat small amounts of foods you enjoy. Healthy options include a handful of unsalted nuts, peanut butter and a fresh apple, mashed avocado on wholewheat toast or crackers, yoghurt and fresh fruit.

"If you are really battling to eat food, opt for powdered nutritional supplement drinks. These are available from most supermarkets and pharmacies, as well as online. You can take the supplements between meals or as a meal replacement to help you to get the extra nutrition you need while you are feeling unwell," she says.

The question of exercise

Vitality biokineticist Mari Leach says that if you want to exercise after having been ill, you should always follow your doctor's advice, even before mild exercise like walking.

"Under your doctor's advice and based on your medical history, you may be able to continue with some low-intensity physical activity, like walking, only when you no longer experience symptoms," she says.

"If you have had mild or moderate COVID-19 infection or you were asymptomatic, you should still take at least a two-week exercise break. When you are completely clear of symptoms for at least seven days, start with general daily activity, like housework and walking at an easy pace. Build up slowly, for two to four weeks after recovery. If you are unsure what to do, use these exercise guidelines from the British Medical Journal," she says.

Read more: Can you exercise after recovering from COVID-19? We answer this and more of your exercise questions

Mari adds these symptom-specific guidelines:

• If you have pre-existing health conditions, especially heart disease, only start exercising again when your doctor confirms you can.
• If you have had gastrointestinal symptoms of COVID-19 like vomiting, nausea, diarrhoea or loss of appetite, wait until your fluid and calorie intake is back to normal before exercising.
• If you have had musculoskeletal symptoms like joint and muscle pain, gradually return to your pre-COVID-19 workouts once symptoms are clear.

Managing your mental wellness

"Fatigue following a bout of COVID-19 means you will likely have less physical, mental and emotional energy. Confusion, trouble concentrating problems, forgetfulness and even depression has been reported by some who have experienced 'long COVID'. Should you be struggling to cope with any ongoing or new symptoms, it's important to reach out to a profession for further support," says Dr Motilal.

"To tackle how you are coping mentally, we must first differentiate between mental health (or mental wellbeing) and mental illness (or biological mental disorders). According to the World Health Organization, mental health is 'a state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community'. Therapeutic psychology and psychiatry have sought to address mental illness disorders, but much less work has been done to address improving happiness and mental wellbeing," she adds.

"But we now know that to improve mental wellbeing, there are some non-pharmaceutical measures you can try. When you are able to do so comfortably, practise mindfulness, which includes meditation and mild breathwork, remembering your lungs are still recovering after COVID-19. Importantly, allow yourself to recover fully before getting back into mentally strenuous situations, be it work or even managing your household again," she says.

"This might be a good time for you to reprioritise holistic, healthy behaviour that will aid your recovery and give you better outcomes for general good health," says Dr Motilal.

References

British Dietetic Association: COVID-19 / Coronavirus - Advice for the General Public

https://www.bda.uk.com/resource/covid-19-corona-virus-advice-for-the-general-public.html

Discovery Health Medical Scheme, registration number 1125, administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07, an authorised financial services provider and administrator of medical schemes. Vitality is a separate wellness product, sold and administered by Discovery Vitality (Pty) Ltd, registration number 1999/007736/07. Limits, terms and conditions apply.