Nutrition and exercise as key factors in long Covid
Patients with long COVID experience symptoms such as exercise intolerance, shortness of breath, concentration problems and a general feeling of exhaustion for months or even years after a SARS-CoV-2 infection. Professor Elisabeth De Waele and Berenice Jimenez Garcia of VUB & UZ Brussels, the hospital of the VUB, investigated the role of nutrition and exercise in the recovery process in a pilot study.
Long COVID remains a complex and often invisible condition. Because their symptoms cannot always be objectively demonstrated through conventional tests, patients are regularly told that “everything is fine”, even though their daily lives remain severely restricted. This invisibility makes long COVID an under-recognised condition that urgently needs greater recognition and better care.
In Belgium, Prof. Dr. Elisabeth De Waele, Head of Clinical Nutrition and Dietetics at UZ Brussels and lecturer at Vrije Universiteit Brussel, and Berenice Jimenez Garcia (VUB/UZ Brussels) are playing a pioneering role in this process. They are combining their expertise in nutrition, metabolism and rehabilitation within the UNLOCK project (Nutrition and LOComotoric Rehabilitation in Long Covid), a pilot study that investigates how a personalised approach to nutrition and exercise can support recovery.
Lack of energy as drive behind fatigue
The study shows that many long COVID patients do not consume enough energy and nutrients, which further undermines their recovery. Jimenez Garcia emphasises that this problem should not be underestimated. A significant proportion of the participants in the pilot study were found to be unable to meet their basic energy requirements and exhibited disturbed eating patterns, which may contribute to the severe fatigue that limits their functioning. Through systematic measurements of body composition, resting metabolism and nutritional intake, the researchers were able to draw up an accurate and individualised nutrition plan. Weekly consultations helped patients gradually evolve towards a personal ideal diet that optimised both the quantity and quality of their nutrition.
Movement: carefully forward, without falling back
In parallel with nutritional guidance, patients were given a tailor-made rehabilitation programme. Because physical exertion can often exacerbate symptoms in long COVID, the focus was on gradually rebuilding activity with an emphasis on energy conservation. This was intended to help patients return to a more active lifestyle without worsening their symptoms. Professor David Beckwée (VUB) and Dr Stijn Roggeman developed a tailored programme for this purpose. At the start of the programme, the physical condition of the study group was significantly lower than that of the general population. The 1-minute sit-to-stand test and other functional tests confirmed that muscle strength and capacity were greatly reduced.
"What seemed invisible – the underlying disruption of the body – is becoming more recognisable to healthcare providers and patients themselves"
Promising results
After twelve weeks, both the reference group and the test group showed improvement. The difference between the groups increased further after the end of the intervention. This was mainly due to greater improvement in the intervention group. For De Waele, this is significant: "The personalised treatment programme was feasible in the long COVID population. As a pilot study, UNLOCK is not suitable for demonstrating whether patients are truly cured, but the results are promising and reinforce the need for research into a multidisciplinary approach to long COVID with longer follow-up."
De Waele also emphasises that relatively small adjustments can sometimes have a noticeable effect: "There is no cure for long COVID yet. But ensuring that people eat enough to meet their basic needs is something we have experience with and that can be implemented quickly. And we may already be able to reduce that terrible fatigue. We're not there yet, and it may not be a solution for everyone, but our new insights are crucial."
An invisible condition requires visible care
The UNLOCK project not only demonstrates that integrated treatment is feasible, but also that it is necessary. The combined approach makes what seemed invisible, the underlying disruption of the body, more recognisable to healthcare providers and patients themselves.
Jimenez Garcia and De Waele are thus taking an important step towards the recognition of long COVID. Their work shows that recovery requires a tailored approach, multidisciplinary support and attention to the individual situation of each patient. Long COVID is not merely a residual symptom after a virus, but a long-term disruption that requires ongoing attention, research and specialised care.
Bio
Prof. Dr Elisabeth De Waele (VUB/UZ Brussel) is head of Clinical Nutrition and specialised in metabolism and nutrition. She combines a medical background with expertise in intensive care and clinical nutrition. Her research focuses on nutritional and energy metabolism in critically ill, oncology and surgical patients. With over 120 peer-reviewed publications, she is active internationally in both research and education.
Bio
Dr Berenice Gabriela Jimenez Garcia (VUB) is a doctoral researcher within the Vitality Research Group. Her research focuses on clinically driven questions around nutrition, rehabilitation and functional recovery, including in the context of long COVID. She collaborates across disciplines within the VUB and the Universitair Ziekenhuis Brussel, and is active in international publications and conferences.
