Information alert

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As you start to recover from Long COVID, you may feel ready to start increasing your physical activity again. Everyone will be at different stages with different symptoms, but the aim is to return to physical activity. This should be specific to you and to your own individual triggers to prevent exacerbating your long COVID symptoms Returning to physical activity will need to be a gradual process using symptom titrated
activity as your muscle strength and endurance may have reduced. 

  • Maintaining and improving strength in your muscles and bone
  • Maintaining and improving heart strength, circulation, and blood pressure
  • Maintaining of energy levels
  • Good for your mental health - anxiety and depression
  • Helps to manage stress levels
  • Helps to prevent other problems associated with prolonger bed rest such as infections, blood clots and reduced strength and balance
  • Improves wellbeing, independence, and confidence

Return to physical activity needs to be carefully considered and gradually incremented to
reduce post exertional malaise and post exertional symptom exacerbation (PEM/PESE).
This can be referred to as a ‘relapse’ of your symptoms.

Before increasing your activity levels, it is important to ensure your fatigue is in a stable or
improving phase with reduced boom and bust cycles. For further information on self management of fatigue please refer to the fatigue management leaflet provided. 

PEM/PESE symptoms can include a marked increase in physical, cognitive, sensory or mental fatigue in response to increased activity. It is important to remember it can be normal to experience slight tiredness, muscle aches or stiffness after an increase in activity; this should not be excessive or cause a flare up of other Long COVID symptoms. Please avoid pushing through any excessive increase in fatigue or flare of other symptoms.

We suggest returning to physical activity using the Borg score and the associated five phases. The Borg scale enables you to understand how hard you are working during physical activity and allows you to adjust based on your own symptom severity. 

Return to work PA.JPG

(WHO - Support for rehabilitation: self-management after COVID-19-related illness, 2nd edition)

Phase One: Preparation for return to exercise

Types of exercise advised: gentle walking, stretching and flexibility exercises, yoga nidra. Borg: zero – one. 

Phase Two: Low intensity exercise

Types of exercise advised: Walking, light household/garden tasks, gentle yoga/Pilates, recumbent cycling. Borg: two – three

Phase Three: Moderate intensity aerobic and resistance exercise

Types of exercise advised: Walking – including inclines, resistance exercise, gentle swimming or cycling, yoga and pilates. Borg: four – six. 

Phase Four: Moderate intensity aerobic and strength exercises with co-ordination and functioning skills

Types of exercise advised: Fast paced walking, jogging, swimming, cycling, Zumba or dance classes. Borg: seven – eight

Phase Five: Return to baseline exercises

To be able to complete your regular activity or exercise programme without exacerbation of your symptoms. Borg: Aiming up to a Borg of 10.

  • It is important to use symptom titrated activity or pacing up: this means using small increments of up to 10% to increase one activity at a time. Then monitor your symptoms for 24 – 48 hours.
  • If no change in symptoms, then complete the same level of exercise and repeat the monitoring phase. If your symptoms remain stable, this then becomes your new level of stability.
  • If you do have a ‘relapse’ in symptoms, then step down a phase of the Borg score, you may need to stay at the new reduced level for two – four weeks before considering any increase in physical activity.
  • It is important after any increase in activity, you stay at that level for two-four weeks before adding in another small increment in activity.
  • This could be up to a 10% increment of time, distance, step count, weight resistance or reps.
  • Choose activities that you enjoy, you are more likely to continue with these and they will have a positive impact on your wellbeing.
  • The type of physical activity you chose may have to be different from the physical activity you completed pre your COVID illness especially at the initial phases.
  • The above advice should be adapted to your individual symptoms and phase of your recovery. This may fluctuate over time, and you can step up or down phases on the Borg scale as needed.
  • If you have any concerns or further questions about increasing your activity levels, then please speak to your healthcare professional.

Page last updated: 21 May 2024

Review due: 31 October 2025