Lessons From Myalgic Encephalomyelitis: Analeptic Management of Long COVID
Presented by Todd E. Davenport
Nonfinancial: Todd Davenport serves as a scientific advisor to the Workwell Foundation and is education cochair of Long COVID Physio.
Long COVID frequently involves postexertional malaise (PEM) or postexertional symptom exacerbation (PESE), which break many of the physiological principles on how the human body responds to exercise. Exercise treatments that usually are effective for fatigue, dizziness, orthostatic intolerance, pain, and other signs and symptoms actually may harm people living with PEM/PESE. These observations suggest we need a different approach to provide care for patients living with PEM/PESE, including those with long COVID, starting with the application of first aid principles to compromised bioenergetic pathways.
In this course, you will learn current information regarding activity pacing, phased approaches to rehabilitation, use of wearable sensors, and service design considerations for people living with PEM/PESE as a symptom of long COVID. These topics will draw on lessons from another (commonly) postviral syndrome, myalgic encephalomyelitis, which may be applied to also help people with long COVID. Last Reviewed: June 2025
Meet your instructor
Todd E. Davenport
Todd serves as professor and vice-chair of the Department of Physical Therapy in the School of Health Sciences at the University of the Pacific in Stockton, California, where he teaches in the Doctor of Physical Therapy (DPT) program. Todd is a graduate of the University of Southern California’s DPT and Orthopedic Physical…
Chapters & learning objectives
1. The Energy System First Aid Concept
The principle of “check, call, care” guides the application of basic first aid, which in turn provides for physiological stabilization. This chapter discusses how these first aid principles, including screening and pacing, may be applied to address impaired aerobic metabolism in people with long COVID and other conditions involving PEM/PESE.
2. Getting Started With Heart Rate Biofeedback
Heart rate is a marker of physical exertion that may be reliably measured using commercially available devices. This chapter provides a case-based scenario describing the basic rationale and specifics of how to get your patients started with activity pacing based on heart rate measurements.
3. Caring for How We Provide Care: Practice-Based Considerations
PEM/PESE involves a whole host of functionally disabling signs and symptoms that often challenge the usefulness of our traditional clinic-based care models. In this chapter, you will engage service and program design considerations to optimize utility and participation for people living with PEM/PESE as a symptom of long COVID. Specific recommendations are provided to optimize the patient experience and outcomes through mitigating common program-based barriers to care for people with PEM/PESE.
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