Many people believe that the fatigue and disability experienced by those with long COVID is simply a result of deconditioning or inactivity. This statement is not true, and is a common misconception about fatigue in Long COVID.

 

The fatigue that comes with Long COVID is a result of physiological changes to the body. One of the symptoms of Long COVID is post-exertional malaise (PEM) or post-exertional symptom exacerbation (PESE) which are conditions where even very minimal exertion (including physical, cognitive, or social/emotional) can lead to a disproportionate worsening of fatigue and symptoms, and the worsening of symptoms can last a long time. You can learn more about PEM here.

 

Each person has a different goal when it comes to returning to physical activity. Your goal might be to return to doing daily activities, like preparing food. If you were quite active before Long COVID, your goal may be to return to certain physical activities or exercise. Whatever your goal, you will use the same strategies, regardless of the type or the intensity of activities you want to return to.

 

This topic focuses on returning to physical activity. The same principles can be applied to returning to all types of activities, including cognitive activity. See Brain Fog in this My Guide for more information on cognitive activities.

 

Physical exercise programs can be a valuable strategy for some people who have Long COVID but do not experience PEM. Based on current research evidence, the Canadian Guideline for Post COVID-19 Condition suggests activity, movement, or exercise based interventions for people with long COVID who do not experience post-exertional malaise (PEM) or post-exertional symptom exacerbation (PESE). 

 

For people who experience PEM or PESE as part of their long COVID, traditional graded exercise programs should be avoided. A graded exercise program is where a person gradually increases exercise duration or difficulty, pushing the limits of their endurance, week after week. These programs are typically prescribed to help people recover from deconditioning or inactivity. However, graded exercise programs will typically trigger PEM and make Long COVID symptoms worse rather than better over time. For people with PEM, it is important to stop and rest before they feel tired. Therefore, the graded approach should be avoided for people experiencing PEM or PESE. 

 

Instead, for people who experience PEM or PESE an approach called symptom titrated activity progression is typically recommended. A symptom titrated approach involves gradually increasing or decreasing activity based on symptoms to find the best level for each person. This will be reviewed in more detail later in this section.