Take it slow when returning to running with long covid – The Washington Post

“I was constantly having to stop and huff and puff,” said McDonnell, 41, a high-altitude ultrarunner from Fort Collins, Colo., about returning to a trail she had run “a million times.” But McDonnell struggled with each step and had to turn back.

At first, the nurse, who was vaccinated, did not think much about her shortness of breath. By November, she was slowly alternating a couple of good running days with ones “where I felt like I was coming apart,” she said, and was using a long-acting albuterol inhaler prescribed by her primary care doctor, which gave some relief.

Her heart was also beating faster, she said, something she hadn’t been concerned with early in her bout with covid-19, thinking that it was because of her illness. “My heart rate was so high, even at rest. It was getting high just from my getting up from the couch,” McDonnell said. “And I just wasn’t listening to myself.”

“These covid patients [with exercise intolerance] often have had mild disease,” said Phillip Joseph, associate director of the Yale Pulmonary Vascular Disease Program. They stay at home for a few days and then go back to work or their normal life, Joseph said, “but they have persistent exertional symptoms, and they often come through the post-covid clinic or referring provider with a whole slew of tests that are normal. Their pulmonary function tests are normal. An echocardiogram that’s normal.”

By inserting a small catheter in the wrist artery during exercise, Joseph and a team of researchers assessed how much oxygen the body absorbs throughout exercise. Many of the patients had been athletes in the past and were absorbing less oxygen post-covid, Joseph said. “There is some kind of abnormal flow across the muscle bed where oxygen is just not being delivered appropriately or absorbed appropriately,” he said. The mitochondria “don’t absorb oxygen.”

They include Stephen Haskins, a marathoner and an anesthesiologist at Hospital for Special Surgery, 40, who contracted the coronavirus during the peak surge in New York City in March 2020. Haskins, who had two weeks of covid and a bout of pneumonia “that hit me a lot harder than I thought it would,” is slowly recovering. He credits deciding to get back into shape and train for marathons in 2017 for helping him battle the illness more effectively.

Longtime ultrarunner James Tenney, 57, of Las Vegas had a mild case of covid from the omicron variant in December. “It was all above my neck,” he says, “nothing respiratory.” Two months later, Tenney, who has been a runner for 35 years and who was vaccinated and had a booster shot, ran the Jackpot Ultra, a 100-miler in Las Vegas.

“I don’t think I was as crisp this year as previous” 100-milers, he said. “It was more of an 80 percent effort rather than 100 percent, because for me, anything beyond 70 miles is all mental. I had it in my head. ‘Oh, I hope, I hope covid doesn’t affect me,’ which is doomsday right there.’ ”

He recommends the 50/30/30/10 rule in guiding a return to running, absent of symptoms. Normal mileage should be reduced by 50 percent the first week, then by 30 percent the following week and so on. By the fifth week, runners should be able to resume normal training, he said. But “if clear cardiac symptoms develop when returning to running, such as chest pain, excessive shortness of breath, lightheadedness or faintness,” people should get evaluated, Strange said.

Joseph said he tells patients “to try to know what your limit is in terms of when you are going to develop those post-exertional symptoms, and exercise to just below that limit.” They could then gradually increase that over the course of weeks to months “instead of pushing yourself to the limit, to breathlessness,” he said. “That might actually be harmful because it tends to set you two steps back.”

McDonnell is working with Olin to open up her vocal cords to improve her breathing and strengthen her reduced lung capacity. “We’ve been on the stationary bike, the treadmill, walking and running,” she said, adding that some days she can walk or hike progressively longer distances, but on other days even household tasks are tiring. “My heart is 100 percent okay,” McDonnell said. “My lungs will recover. The decreased capacity is something that they’ve seen dissipate for pretty much everybody.”

She had two blood clots and scarring on her lungs as a result of covid, she said, but blood thinners are “significantly helping” her feel better and hike longer distances. “It does feel like there’s a light at the end of the tunnel,” McDonnell said, “and I can see longer hikes this summer and maybe even some running here and there.”

Triathlete Marilyn Stebbins, 60, a pharmacologist at the University of California at San Francisco, had the first documented case of the coronavirus in Yolo County, Calif., in March 2020. Her illness was so severe that her husband “really thought I might die,” she said. She went from slowly walking circles in her backyard to running, with plans for her first post-covid marathon in August.

This content was originally published here.