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Changes In Muscles May Explain Fatigue In Patients With Long COVID

A new study identified various abnormalities in the muscle tissue of the patients with long COVID. Photo by Adobe Stock/HealthDay News

Muscle cells' "power stations" function less effectively in people with long COVID, potentially explaining the persistent fatigue that's a hallmark of the condition.

That's the finding of a Dutch study published Thursday in the journal Nature Communications.

"We're seeing clear changes in the muscles in these patients," said study lead author Michèle van Vugt, a professor of internal medicine at Amsterdam University Medical Center (UMC).

According to background information from the researchers, about one in every eight COVID-19 patients will go on to experience long COVID. Symptoms can last for months and include fatigue, problems with memory and thinking, and other issues.

In the study, van Vugt's group examined the muscle cells of 25 long COVID patients and 21 healthy people.

They had all of the participants engage in a 15-minute bout of cycling. In folks with long COVID, this burst of exercise led to a transient worsening of their symptoms.

The researchers examined participants' blood and muscle tissue at two time points: One week before the cycling test and one day afterwards.

"We saw various abnormalities in the muscle tissue of the patients. At the cellular level, we saw that the mitochondria of the muscle, also known as the energy factories of the cell, function less well and that they produce less energy," said study co-author Rob Wüst, an assistant professor of human movement sciences at Vrije University, in Amsterdam.

"So, the cause of the fatigue is really biological," Wüst said in a UMC news release. "The brain needs energy to think. Muscles need energy to move. This discovery means we can now start to research an appropriate treatment for those with long COVID."

Could coronavirus lingering in muscle tissue be causing all this?

"We don't see any indications of this in the muscles at the moment," Van Vugt noted.

The team also saw no decline in heart or lung function, suggesting the issue with fatigue is not originating in those organs.

Could exercise help patients fight long COVID fatigue?

"In concrete terms, we advise these patients to guard their physical limits and not to exceed them," said Brent Appelman, a researcher at Amsterdam UMC. "Think of light exertion that does not lead to worsening of the complaints. Walking is good, or riding an electric bike, to maintain some physical condition. Keep in mind that every patient has a different limit."

Van Vugt agreed.

"Because symptoms can worsen after physical exertion, some classic forms of rehabilitation and physiotherapy are counterproductive for the recovery of these patients," she said.

More information

Find out more about long COVID at Yale Medicine.

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ADHD Fatigue: Understanding The Connection

Medically reviewed by Kira Graves, PhD

There is a common link between attention deficit hyperactivity disorder (ADHD) and fatigue. Though the exact reason for the connection is unknown, many people with ADHD will experience mental or physical exhaustion that can lead to burnout if left unaddressed,

This article will provide information on ADHD fatigue, potential causes, ADHD and burnout, and ways to address fatigue.

Iuliia Burmistrova / Getty Images

Can ADHD Make You Feel Tired?

There is a strong correlation between ADHD and tiredness or fatigue, and people with ADHD often report experiencing more tiredness, stress, and fatigue than those without it. Some people also experience central fatigue syndrome, which causes tiredness and long-term fatigue. Conversely, those with central fatigue syndrome are often found to have ADHD symptoms.

Fatigue looks and feels different for everyone, and it can be mental or muscular and result from lack of sleep or depression.

Fatigue Is a Warning Sign

Fatigue is one of the ways the body signals a warning. Experiencing fatigue is your body's way of telling your brain it needs to rest.

Related: The Relationship Between ADHD and Sleep

What Does ADHD Fatigue Feel Like?

ADHD fatigue can bring feelings of physical and mental exhaustion and difficulty sleeping. Some people also experience pain and less awareness of body movements. Periods of worsened or more intensified ADHD symptoms can make it difficult to relax and get rest.

For many people with ADHD, fatigue feels overwhelming. Competing tasks and priorities become challenging to manage, and it's common to be distracted and forgetful and to struggle with staying organized and on track.

Related: The ADHD Brain vs. The Non-ADHD Brain

What Causes ADHD Fatigue?

There are varying possible reasons why people experience ADHD fatigue, including other co-occurring disorders, medication, or burnout from managing symptoms.

One possible cause of ADHD fatigue is the association between hypermobility spectrum disorders (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS) and ADHD. Though a person can have HSD or hEDS without ADHD, the two are often linked. HSD and hEDS often cause sleep problems and overall fatigue.

It is also common for people with ADHD to experience central fatigue syndrome (CFS). CFS occurs when there is increased plasma tryptophan in the brain, which causes feelings of tiredness and overall fatigue.

ADHD medications can also cause fatigue or drowsiness in some people, and for others, not being able to "turn off" their brains can cause difficulty sleeping and tiredness throughout the day.

ADHD and Brain Fog

ADHD and brain fog have similar symptoms. Distractibility, trouble organizing thoughts and tasks, and losing track of conversations and items are commonly experienced by those with ADHD as well as those with brain fog due to other conditions, like long COVID (symptoms that persist for an extended period of time after having had COVID-19), illness, or lack of sleep.

For some people who have never experienced ADHD symptoms before, sudden brain fog is likely due to another cause, such as diet, medication, or illness. Talking with a healthcare provider is the best way to determine the cause of brain fog. A provider can help you understand any factors contributing to brain fog through psychological and physical testing and a complete medical history.

ADHD Burnout

It's common for adults with ADHD to overcompensate for their difficulties with concentration, organization, and time management by overly focusing on tasks and work responsibilities to the point of exhaustion or even burnout. People with ADHD often find it difficult to relax or take breaks and are therefore at higher risk of overwork or hyper-focusing on tasks.

It can also be difficult for people with ADHD to manage life responsibilities, like parenting and managing appointments. These responsibilities can be taxing and difficult to organize which can feel exhausting.

Adult ADHD and Sick Leave

Adults with ADHD are at higher risk of exhaustion and burnout and take twice as much sick leave as their peers.

Related: 10 Surprising Benefits of Having ADHD

Other, Similar Symptoms

People with ADHD have a hard time staying focused and often have to work harder than others to complete tasks, stay on track, and accomplish goals. This extra work can lead to ongoing stress and difficulty coping. ADHD also often leads to marital problems, difficulty on the job, financial issues, and other challenges.

People with ADHD also often report feeling sensitive to criticism, especially at work. Ongoing criticism can be tiresome and lead to burnout as well. For some people, being understimulated can lead to boredom, which may appear as fatigue.

Related: Do ADHD Symptoms Differ in Boys and Girls?

What You Can Do About ADHD Fatigue

Learning to manage symptoms and overcome fatigue is an important way to avoid burnout. Here are some approaches to avoiding ADHD-related fatigue:

Use tools such as computer and phone applications that help with task management and organization of priorities to help manage day-to-day tasks.

Keep lists of things that need to be accomplished throughout the day, things that were left unfinished, thoughts and feelings you want to return to, and other items that need to be addressed.

Schedule and take frequent breaks throughout each day and schedule open blocks to avoid mental fatigue.

Get plenty of exercise.

Avoid things that trigger or worsen symptoms.

Summary

Fatigue is a common symptom in those with ADHD. Fatigue often brings tiredness and stress and can lead to burnout. Though the exact cause can be unknown and vary from person to person, ADHD-related fatigue may be due to other coexisting disorders, medication, or burnout from managing ADHD symptoms. Using organizational tools and techniques can help prevent fatigue and avoid burnout.

Read the original article on Verywell Health.

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