In the wake of misleading headlines, we set out to clarify the relationship between exercise and long Covid – and the simple steps you can take to manage your exercise intensity.

Millions of individuals have had or will have Covid-19, and most of us will recover completely and return to normal health. However, some of us (up to 30% according to some experts) will continue to suffer well after recovering from the initial acute stages of the illness. This is referred to as post-acute sequelae of SARS‐CoV‐2 infection (PASC), or simply ‘long Covid’.

The symptoms of long Covid can include fatigue, shortness of breath, palpitations, cognitive dysfunction, a.k.a brain fog, sleep disorders, fevers, gastrointestinal symptoms, anxiety and depression. These symptoms can last for months – for some they may be life-long – and range from mild to incapacitating.

Getting adequate rest is fundamental to overcoming the virus, but that doesn't necessarily mean avoiding physical activity.

This illness may seem relatively new on the scene, however, post-viral illnesses are not new, and long Covid shares many similarities to Myalgic Encephalomyelitis/chronic fatigue syndrome (ME/CFS). One of the shared features of long Covid is the misconception that this illness is psychological, or a result of deconditioning.

There is still a lot to learn about the mechanisms of all post-infection illnesses – including long Covid – and research into how to treat or reverse these illnesses is pretty thin on the ground.

Dr. Anna Brooks, a cellular immunologist who is leading a major research project on long Covid in New Zealand, says long Covid is likely a result of damage from a direct viral infection of cells and persistent inflammation associated with widespread blood vessel damage. She explains that ongoing inflammation may be caused by incomplete clearance of the virus (viral persistence or debris) or the onset of a misfiring immune attack on the body (autoimmunity).

Getting adequate rest is fundamental to overcoming the virus, but that doesn't necessarily mean avoiding physical activity. “There’s no “one-size-fits-all” advice about when to return to exercise and when to rest, it may come down to how you feel in yourself, and recognizing signs that you may not have fully recovered,” says Brooks. “If you take a ‘rest only’ approach, it does not mean you will not suffer long Covid, and likewise there is no evidence that exercising straight after infection will trigger long Covid either.” However, exercising too soon, or pushing through the warning signs, has been noted by many of those with long Covid as the key trigger. "We just don’t know who the virus will cause damage to and trigger this illness cascade, so a precautionary approach when returning to exercise is recommended".

Making sure you're listening to your body and not pushing through symptoms is the smartest approach to mitigating the risk of ongoing suffering.

If you’re experiencing symptoms (even after you’re no longer infectious), avoid all exertion and get as much rest as possible. Brooks says it is “incredibly important” to avoid graded exercise therapy (which is an outdated approach that involves introducing exercise in an effort to help treat fatigue) as this is dangerous and can not only exacerbate symptoms, but trigger a more severe condition.

If, on the other hand, you don't notice any ill effects from the virus, a gradual phased return to exercise is the best bet. Over-exerting yourself with intense exercise is almost certainly a bad idea. Making sure you're listening to your body and not pushing through symptoms is the smartest approach to mitigating the risk of ongoing suffering.

At the same time, you should be mindful of the bigger picture benefits of exercise when it comes to overcoming and preventing illness. Regular exercise as part of a healthy lifestyle is key to immunity and physical activity is widely regarded by many experts as the best medicine. There is even evidence suggesting that higher levels of EcSOD in the body (a potent antioxidant released during exercise) can prevent, or at least reduce, the severity of acute respiratory distress syndrome (ARDS) – one of the worst possible outcomes of Covid.

A team of doctors compiled comprehensive guidance on the treatment of fatigue and long Covid. In particular, it covers four key points to consider when returning to physical activity post-Covid.

How to return to exercise:
  • Begin individualized, structured low-dose return to physical activity
  • Explore energy conservation strategies, such as selecting activities that match your energy levels, scheduling time for periods of rest, avoiding busyness, rushing and unnecessary stress
  • Choose healthy nutrition and stay well hydrated
  • Treat underlying medical conditions (in collaboration with appropriate specialists). This means dealing with any pain, insomnia/sleep disorders/poor sleep habits, and mood issues that may be contributing to fatigue.
Keep an eye out for any long Covid warning signs:
  • Severe exhaustion after minimal physical or mental exertion
  • The sense of being weighed down all day
  • After having a ‘good day’ of increased levels of physical activity, you experience the feeling of ‘crashing’ and require several days of recovery
  • Persistent tiredness or exhaustion after sleep/upon waking.
  • Mild fatigue: This is when you are mobile and can perform all the usual daily activities and do light housework (although you may struggle with this slightly). You can continue with your work or study, but may feel the need to stop other nonessential activities. If you're suffering mild fatigue, you may feel the need to take time off, modify your schedule, and use weekends to recover from your work week.
  • Moderate fatigue: This is when you have limited mobility and your performance of instrumental daily living activities is limited. You may struggle with preparing meals, shopping, doing laundry, using transportation, and performing housework. It’s likely you’ll have to take time off work or study, and will require frequent rest periods and naps.
  • Severe fatigue: In this situation, you’ll have difficulty with activities of daily living, such as eating, bathing, dressing, transferring, toileting, and mobility. You will likely be confined to your home and if you choose to venture out, it could lead to prolonged/severe after‐effects.