Fitness Testing for Long COVID Recovery

Many Long COVID patients experience significant exercise intolerance:

• Reduced VO₂ Max: Studies show 20 to 50% reduction in cardiovascular fitness in some Long COVID patients compared to pre-infection levels
• Post-Exertional Malaise (PEM): Worsening of symptoms 12 to 48 hours after physical or mental exertion. Can last days to weeks
• Dysautonomia: Autonomic nervous system dysfunction affecting heart rate, blood pressure regulation. Postural Orthostatic Tachycardia Syndrome (POTS) is common
• Chronotropic Incompetence: Blunted heart rate response to exercise (heart rate does not increase appropriately)
• Ventilatory Limitations: Perceived breathing difficulty despite normal oxygen levels and lung function tests
• Muscle Deconditioning: Prolonged inactivity during and after acute infection leads to muscle loss and reduced fitness

Exercise testing provides objective data that is valuable for several reasons:

• Validate Your Experience: Long COVID symptoms are often dismissed or minimized. Objective evidence of reduced fitness capacity validates that something measurable has changed
• Establish Baseline: Know your current fitness level as a starting point for recovery efforts
• Guide Rehabilitation: Results help determine safe exercise intensity for gradual return to activity. Avoid pushing too hard which can trigger PEM
• Track Recovery Progress: Retest every 2 to 3 months to objectively measure whether interventions are working and fitness is improving
• Identify Specific Limitations: Is the limitation cardiovascular, ventilatory, autonomic, or deconditioning related? Different limitations require different approaches
• Documentation for Disability: Objective fitness data can support disability claims or workplace accommodations if needed
• Research Participation: Many Long COVID research studies require baseline exercise testing

Before testing, consult your physician about:

• Cardiac Symptoms: Any chest pain, significant palpitations, or irregular heartbeat requires cardiac evaluation before testing. Many physicians recommend echocardiogram, Holter monitor, or stress test to rule out myocarditis or other cardiac complications
• Persistent Shortness of Breath: Pulmonary function tests and chest imaging may be needed to rule out pulmonary complications
• Post-Exertional Malaise: Discuss whether testing might trigger symptom flare. Risk versus benefit must be considered
• POTS or Orthostatic Symptoms: Autonomic dysfunction may require special monitoring or modified protocols
• Timing: How long since acute infection? Are symptoms stable, improving, or worsening?

Who Should NOT Test Yet:

• • Active COVID-19 infection (wait until completely recovered)
• • Within 3 months of acute infection with ongoing symptoms
• • Unexplained cardiac symptoms without cardiac workup
• • Severe autonomic dysfunction causing frequent syncope (fainting)
• • Recent hospitalization for COVID complications
• • Severe post-exertional malaise where minimal activity causes major setbacks

We implement special accommodations for Long COVID patients:

• Extended Appointment Time: Allow 75 to 90 minutes instead of standard 60 minutes for extra rest and recovery
• Gradual Warm-Up: Longer, more gradual warm-up period to assess tolerance
• Conservative Progression: Smaller increments in workload. More cautious progression than standard protocols
• Symptom Monitoring: Continuously assess for chest pain, palpitations, severe dyspnea, dizziness, nausea, cognitive changes
• Immediate Stop Criteria: Test stops immediately if you request or if concerning symptoms emerge. Your safety and comfort are paramount
• Extended Recovery Monitoring: Stay for 15 to 30 minutes post-test to ensure stable recovery
• Flexible Scheduling: Test at your best time of day when symptoms are typically lowest
• Submaximal Option: For severe cases, we can perform submaximal testing (stopping at moderate intensity) rather than pushing to maximum

Your test results provide multiple data points:

• VO₂ Peak Value: Current aerobic capacity in mL/kg/min. Compare to age and sex norms to quantify degree of limitation
• Heart Rate Response: Is maximum heart rate normal? Some Long COVID patients show blunted response (chronotropic incompetence)
• Heart Rate Recovery: How quickly does heart rate return to baseline after exercise stops? Slow recovery suggests autonomic dysfunction
• Ventilatory Response: Is breathing pattern normal? Breathing reserve adequate?
• Symptom Onset: At what intensity do symptoms emerge? This guides safe exercise limits
• Test Duration: How long could you sustain exercise before stopping?

Test results inform your recovery approach:

• Establish Anaerobic Threshold: Your VT1 (first ventilatory threshold) defines the upper limit of safe continuous exercise. Stay below this to avoid triggering PEM
• Pacing Strategy: Use heart rate zones to ensure you stay within safe limits during activities of daily living and rehabilitation exercise
• Gradual Progression: Start at 50 to 60% of peak capacity for 10 to 15 minutes. Progress very slowly over weeks to months
• Activity Modifications: Break tasks into smaller segments with rest breaks guided by heart rate data
• Avoid Boom-Bust Cycle: Zones prevent doing too much on "good days" which leads to crashes

Different rehabilitation strategies based on symptom severity:

• For Mild to Moderate Cases:
  • • Gradual return to exercise starting below anaerobic threshold
  • • Progress 10% per week if tolerating well
  • • Target eventual return to 150 minutes per week moderate activity
• For Severe Cases with PEM:
  • • Energy conservation and pacing rather than structured exercise
  • • Activity logs to identify triggers
  • • Stay within energy envelope to avoid crashes
  • • Very gradual increases only when stable for extended period
• Breathing Exercises: Diaphragmatic breathing, pursed-lip breathing may help dyspnea
• Physical Therapy: Supervised rehabilitation with PT experienced in post-viral syndromes

Critical: Unlike normal deconditioning, aggressive "push through" approaches can worsen Long COVID. Conservative, paced approach is essential.

Recommended retesting schedule:

• Initial Baseline: First test once medically cleared (typically 3+ months post-acute infection)
• Follow-Up Testing: Every 2 to 3 months if actively in rehabilitation
• Document Changes: Track VO₂ peak, heart rate response, symptoms during testing
• Adjust Rehabilitation: If not improving or worsening, may need to reduce activity level or investigate other issues
• Recovery Markers: Improvement in VO₂ peak, ability to exercise longer, reduced symptoms during testing, faster heart rate recovery

Emerging research on Long COVID and exercise:

• Studies show objectively reduced VO₂ max in 50 to 70% of Long COVID patients with exercise intolerance
• Cardiopulmonary exercise testing reveals abnormal responses not evident on standard testing
• Serial testing documents gradual improvement in most patients over 6 to 12 months, though some have persistent limitations
• Exercise testing data correlates with subjective symptom severity and quality of life measures

Your data contributes to our understanding of Long COVID recovery patterns.

Address psychological aspects of recovery:

• Validation: Objective testing data validates that your symptoms have a physiological basis
• Anxiety: Many Long COVID patients develop anxiety about exercise and symptoms. Data provides reassurance about safe limits
• Depression: Chronic illness increases depression risk. Consider therapy and support groups
• Fear Avoidance: Balance between avoiding PEM triggers and maintaining some activity. Testing helps find that balance

Long COVID evaluation may include:

• Cardiac: Echocardiogram, Holter monitor, cardiac MRI if indicated
• Pulmonary: Spirometry, DLCO, chest CT if persistent dyspnea
• Autonomic: Tilt table testing if significant orthostatic symptoms
• Laboratory: Complete blood count, comprehensive metabolic panel, thyroid, ferritin, vitamin levels
• Inflammatory Markers: CRP, D-dimer, troponin (research suggests persistent inflammation in some cases)

VO₂ max testing complements but does not replace this medical workup.

VO₂ Max Test: $250
Duration: 75 to 90 minutes (extended time for Long COVID accommodations)

This is a cash-pay service. We do not bill insurance. Some patients submit receipts for reimbursement under out-of-network benefits or use HSA/FSA funds. Check with your insurance.

Share your results with:

• Primary Care Physician: Coordinates overall Long COVID care
• Cardiologist: If cardiac involvement suspected or confirmed
• Pulmonologist: If respiratory symptoms predominate
• Physical Therapist: Uses data to design graduated rehabilitation program
• Occupational Therapist: For energy conservation and pacing strategies
• Long COVID Clinic: If available in your area, multidisciplinary clinics can integrate testing data into comprehensive care plan

Fit Evaluations
311 Soquel Ave
Santa Cruz, CA 95062

Behind Hindquarter restaurant (second entrance off Dakota St.)

Phone: 831-400-9227
Email: info@fitevals.com

Call to discuss your Long COVID symptoms and whether physician clearance is recommended before booking.