The addition of a 30-minute exercise program may break the cycle of inflammation that can lead to the development of at least 2 post-COVID conditions: diabetes and depression, according to the results of a new study published in Exercise and Sport Sciences Reviews.1

An increasing number of patients are being diagnosed with long-COVID, also known as post-COVID conditions, greater than 4 weeks after infection. Patients with post-COVID conditions exhibit “a constellation of other debilitating symptoms,” according to the Centers for Disease Control and Prevention.2 The most common long-COVID complaints include difficulty breathing, shortness of breath, tiredness, fatigue, postexertional malaise, chest pain, stomach pain, headache, heart palpitations, and musculoskeletal pain.

The risk for severe SARS-CoV-2 infection is among the highest in patients with pre-existing type 2 diabetes. “We know that long-COVID causes depression, and we know that it can increase blood glucose levels to the point where people develop diabetic ketoacidosis,” said Candida Rebello, PhD, a research scientist at Pennington Biomedical Research Center and lead author of the study. “For example, a person may not get very sick from COVID-19, but 6 months later, long after the cough or fever is gone, they develop diabetes,” Dr Rebello said.  

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One potential solution is exercise. “We know that physical activity is a key component to a healthy life,” said Pennington Biomedical Executive Director John Kirwan, PhD, who is a coauthor of the paper. “Exercise modulates the key lingering features of a SARS-CoV-2 infection that promote elevations in blood glucose concentrations including inflammation and stress. By modulating blood glucose concentrations, exercise can be used to break the vicious cycle of β-cell inflammation that leads to hyperglycemia and thus prevent the development or progression of type 2 diabetes,” wrote the authors.

Post-acute COVID-19 hyperglycemia likely results from lingering inflammation or chronic psychological stress that is compounded by β-cell dysfunction, noted the authors. Chronic psychological stress produces a dysregulated and overactive hypothalamic-pituitary-adrenal axis that drives sympathetic nervous system activation and an exaggerated immune response, which promotes insulin resistance and β-cell dysfunction.

The study also found that high local concentrations of interleukin-1β (IL-1β) in the β-cell microenvironment inhibit insulin secretion, trigger β-cell dysfunction and apoptosis, increase levels of glucose, and prompt IL-1β autostimulation.

Patients don’t “have to run a mile or even walk a mile at a brisk pace,” Dr. Rebello said.  “Walking slowly is also exercising.” Ideally, patients should exercise in 30-minute sessions; patients can begin with 15-minute increments and work up to 30-minute sessions, noted Dr Rebello.  “The important thing is to try. It doesn’t matter where you begin.  You can gradually build up to the recommended level of exercise.”


Rebello CJ, Axelrod CL, Reynolds CF 3rd, Greenway FL, Kirwan JP. Exercise as moderator of persistent neuroendocrine symptoms of COVID-19. Exerc Sport Sci Rev. 2022 Jan 12;50(2):65-72. doi: 10.1249/JES.0000000000000284

Centers for Disease Control and Prevention (CDC). Post-COVID conditions. Updated September 16, 2021. Accessed March 11, 2022.