-- Until you feel 100%, stop the moment you think, "I'm a little tired." Not five minutes later. If you can, sit or lie down when you get tired. (Being horizontal helps dysautonomia.) -- This counts not just for exercise, but for all exertion, physical, mental or emotional.

-- Monitor for feeling worse the next day, either increased fatigue or any other symptom. You might be experiencing post-exertional malaise. So if you feel lousy, consider your previous day's activities and think about if you need to scale back.

-- Exertion that doesn't wear you out or bring on other symptoms, either immediately or the next day, is totally fine! Living full lives requires doing stuff, and within our limits, movement is good for us, so go for it (as you safely can).

Early in the pandemic, #MEAction produced this great pacing guide: http://www.meaction.net/wp-con... In collaboration with Patient Led Research, they've now produced this guide for clinicians, with references: https://www.meaction.net/wp-co...

Final resource (not about pacing) that may be helpful to those recovering from acute Covid is this list of drugs and supplements that have the best evidence of supporting recovery and reducing the chance of Long Covid, by the amazing @organichemusic: https://pharmd.substack.com/p/...

Big thanks to @meaction and @patientled.

@julierehmeyer Ugh I tried to go back to work since I was working from home but the mental exertion did me in. I thought I could work my way out of it and that just wasn’t happening. Still isn’t.

@DanaLeighLyman So, so hard.

@julierehmeyer @slsandpet hate to disagree but it is completely correct for some long covid sufferers a woman I know felt better than she had in weeks so went for a very gentle swim she was back in bed for the next month.

@CharlizeTheroff @slsandpet If you actually have Long Covid, you have to work out your ever changing limits day by day. I’m giving guidelines for people recovering from acute Covid who don’t have signs of long Covid yet.

@julierehmeyer No one knows what’s true. Let’s be honest

@MarylandOnenita We certainly don’t have solid scientific studies. But we do know that many people with LC and ME have permanent setbacks from doing too much, so I think these guidelines are a reasonable guess at what makes sense.

@julierehmeyer Thanks for this. Does heavy exertion during the recovery phase of COVID increase the risk of mitochondrial toxicity? Do you think that taking supplements like CoQ10, Vit B, NAD and NAC while infected might help to reduce #longcovid risk?

@iSpySchool Might. I’d start with the supplements and meds in @organichemusic’s post that I linked to. But PWME and PWLC do sometimes report that those supplements help.

@julierehmeyer Unrefreshing sleep was my first sign. I didn't detect PEM for months, I simply felt terrible the entire time (could have been rolling PEM from just trying to keep living life)

@julierehmeyer I'm asking earnestly; is there ANY activity that doesn't produce fatigue post covid (1st month) after infection? I feel like if people were assessing symptoms honestly instead of based on what they need to accomplish the answer would be "none".

@julierehmeyer I wish what we know now could've been applied to those who got mononucleosis decades ago...

@julierehmeyer I thought ‘Take it easy for the first month’ is about possible cardiac inflammation and ‘stop as soon as you feel tired’ is about fatigue / developing long covid

@julierehmeyer Side note that PEM can be delayed by a couple of days, (maybe more?)

@julierehmeyer It wouldn't hurt to be sedentary for a month, though, would it? Long Covid for three years now, just got a real nasty acute case this Christmas, and I tried to stay in bed as much as possible.

@julierehmeyer I have POTS, not from COVID, but about all the regular exercise I get is low-intensity with a pedal exerciser/mini bike. It's easy to do sitting or lying back, so it's definitely good for me, as long as I don't go overboard. It is very important to not push yourself too hard.

@julierehmeyer When I first went back to uni I had to go home again after one of three lectures to lie down. Also no exercise for a whole month because I barely made it up the stairs to our fourth floor apartment without taking breaks and coughing. Really glad I had the option to do this.

@julierehmeyer Thanks for this. Very comprehensive. @threadreaderapp unroll

@julierehmeyer @ahandvanish Following 10 days of Covid isolation, bed rest, I finally felt descent! So, I did some light cleaning and the following day I took a brief walk in the cold to watch the start of the Iditarod. By evening, started all over, by the next day I could barely move, lungs full, heavy!

@julierehmeyer My body took 8 weeks to recover from mild covid coz my mum died 2 days after isolation & I walked lots that week for sanity's sake. If I hadn't overdone it (keeping it slow to keep my heart rate low). Everyone just do nothing strenuous for 4-8 weeks and hopefully you'll be ok

@julierehmeyer Thank you!! That's very helpful!

@julierehmeyer @threadreaderapp unroll please. #COVID19 #PEM

@julierehmeyer Lucky them if it was a choice. I was astonished at how easily exhausted I was

@julierehmeyer https://x.com/parentmishmash/s...

@julierehmeyer People are still getting Covid? We haven’t had a case in our schools in many months. Seriously, no cases.