from LONG COVID ESSENTIALS
a resources series by The Sick Times x Long COVID Justice

After having COVID-19, it’s important to get as much rest as possible. Slowly restart activity at the pace your body can tolerate.

For some people, routine activities that were okay before Long COVID could cause energy depletion, make symptoms worse, or cause muscle damage. This is not the case for every person after COVID-19, but affects an estimated 80% of people with Long COVID.

What counts as exercise or exertion?

Everyday activities like caring for children, working, reading a book, or taking a shower may lead to severe fatigue and worsening symptoms. This is called post-exertional malaise (PEM) or post-exertional symptom exacerbation (PESE). Physical, cognitive, orthostatic stress and emotional exertion can all contribute to PEM.
Although some doctors may recommend exercise for these symptoms, often activity can do more harm than good. Make sure your doctor understands the difference between PEM and exercise intolerance. With exercise intolerance, someone has less capacity for physical exercise than expected. People with PEM may also have exercise intolerance, but not everyone with exercise intolerance has PEM.
Avoid high-intensity activities as much as possible. Figuring out what your body can handle may take time.

How soon to RETURN to higher activity levels?

Take it easy for at least 6 weeks after COVID-19, if your life circumstances allow.
Gradually introduce lighter forms of exercise like yoga or walking – not too much at once.
Breathwork, stretching, and bodywork can be helpful before restarting exercise. Stretching while lying down may be easier than upright activities.
Pacing, or finding the balance between activity and rest, can help you to manage and preserve your energy.
Monitor your body’s response to activity. Remember: there may be a delay of 24 to 72 hours in the start of PEM symptoms after the activity itself.

If you’re experiencing concerning symptoms

Track your symptoms for several days after specific activities in a journal or on a free app like Visible. This can help you figure out what’s too much for your body and help with recording information to bring to medical visits.
Use a pulse oximeter or wearable device to track your heart rate. Take note of your heart rate while doing activities and standing. Talk to a doctor if you notice increases of more than 30 beats per minute (bpm) with activity, or a resting heart rate over 100 bpm.
Treating orthostatic intolerance can help reduce your symptoms with activity.

Resources for managing activity-triggered symptoms, including physical therapy and rehab

There are now many clinics for Long COVID and post-COVID treatment.
Not all healthcare workers are trained to recognize PEM. Listen carefully to how they talk about exercise. If they minimize your experiences or urge you to ignore or push past your symptoms, they are likely not the best provider for this issue.
Talk to others with Long COVID or ME/CFS to help find trustworthy medical providers. See lists of recommended providers and advocacy groups.
Some cases of Long COVID and post-COVID symptoms can be treated with pulmonary rehabilitation or autonomic conditioning.
Long COVID Physio and Workwell Foundation provide many resources on rehabilitation, fatigue, PEM exacerbation, pacing, and more.

Writer: Elly Belle • Editor: Betsy Ladyzhets • Medical reviewer: Dr. Alba Azola

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Notes

This series was published in fall 2024; some information may be subject to change.
Although each topic has been reviewed by medical professionals, they are informational resources, not medical advice. Always talk to your medical providers before trying treatments or symptom management strategies.
Each resource page offers brief information and is not comprehensive. We know there is much more information on each topic we cover, and that there are additional topics not yet addressed in this series.