Long-COVID recovery: The promising combo of breath exercises and creatine supplementation

Could simple breathing exercises, coupled with a sprinkle of nutritional science, hold the key to overcoming the lingering effects of a virus that has touched the lives of millions globally? A study published in the Journal of Postgraduate Medicine sheds light on this very possibility, exploring the potential of combining breathing exercises with creatine to combat the symptoms of long coronavirus disease, a condition marked by persistent fatigue and lung discomfort well beyond the initial infection phase.

Long COVID, or post-COVID-19 fatigue syndrome, affects a significant portion of individuals who have recovered from the initial infection of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Characterized by long-lasting fatigue and lung discomfort, long COVID can severely hinder daily activities, necessitating effective rehabilitation strategies.

The International Task Force has highlighted the importance of pulmonary rehabilitative exercises and adequate nutrition for COVID-19 survivors. Among the recommended interventions, breathing exercises stand out as a simple, cost-effective method to enhance physical health. However, the integration of nutritional supplements such as creatine in the rehabilitation process for long-COVID patients remains largely unexplored.

Creatine is a naturally occurring compound that plays a vital role in energy production at the cellular level. Its effectiveness, when combined with exercise, has been documented across various health conditions, but its application alongside breathing exercises for long-COVID rehabilitation has not been thoroughly investigated until now.

“As a medical doctor, I’ve encountered numerous patients grappling with chronic fatigue syndrome (CFS), especially post-COVID-19 pandemic, with limited nutritional interventions available,” said study author Sergej M. Ostojic, a professor of nutrition at the University of Agder and head of the Applied Bioenergetics Lab at the University of Novi Sad.

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“After reviewing scientific literature on metabolic disruptions in CFS, it became evident that creatine deficiency might be implicated in this multifaceted condition. Consequently, I embarked on a study to explore the potential effects of creatine supplementation, combined with breathing exercises, in individuals experiencing long-COVID.”

This randomized, placebo-controlled pilot trial involved eight long-COVID patients who were experiencing moderate fatigue and respiratory discomfort for at least three months post-infection, without any other underlying cardiopulmonary conditions. Participants were divided into two groups: one received daily creatine supplementation (4 g) in addition to performing breathing exercises, while the control group performed breathing exercises alone.

These breathing exercises were designed to strengthen respiratory muscles, particularly the diaphragm, and reduce breathing effort. Patients were monitored over a three-month period, during which their adherence to the program and any changes in their condition were closely followed.

Participants who received creatine supplementation alongside breathing exercises showed a significant increase in tissue creatine levels across various locations, including muscles and brain areas, indicating a large effect of the combined treatment on creatine amplification. Moreover, this group experienced a reduction in post-exertional malaise and improved exercise tolerance, as demonstrated by a notable increase in time to exhaustion during physical activity.

In contrast, the control group, which only engaged in breathing exercises, did not show significant changes in creatine levels or time to exhaustion, although both groups reported reduced breathing difficulty and respiratory discomfort by the end of the study.

“Our data suggest that a three-month regimen of dietary creatine, when combined with breathing exercises, may be beneficial in alleviating fatigue associated with long COVID, as well as in ameliorating metabolic imbalances in the brain and skeletal muscles,” Ostojic told PsyPost. “Patients undergoing this intervention also showed modest improvements in exercise capacity, with no significant side effects observed.”

Despite these promising results, the study’s authors acknowledge its limitations, including the small sample size and the short duration of the intervention. They call for further research to validate these findings in a larger group of long-COVID patients over a longer period. Additionally, future studies should consider controlling for factors that might affect creatine homeostasis, such as age, gender, diet, and physical activity levels, to gain a more comprehensive understanding of the potential benefits of creatine supplementation in long-COVID rehabilitation.

“Our study recruited a relatively small number of middle-aged patients, thus we were unable to determine whether these beneficial effects extend to elderly individuals or children, if there are any gender differences, or if shorter or longer treatment intervals would be equally effective,” Ostojic said. “Additionally, we did not analyze respiratory function, which could be crucial in long COVID. Finally, we did not assess the vaccination status of our patients, which may also impact disease severity and individual response to treatment.”

“This is a preliminary study, and further research is necessary to confirm our findings in larger studies with longer treatment durations. However, adding creatine to the treatment regimen of long COVID patients could be a cost-effective and safe option.”

The study, “Creatine supplementation combined with breathing exercises reduces respiratory discomfort and improves creatine status in patients with long-COVID,” was authored by J. Slankamenac, M. Ranisavljev, N. Todorovic, J. Ostojic, V. Stajer, and S.M. Ostojic.