Long COVID Rehab Program: Reduce Symptoms and Boost Physical Activity

Long COVID affects between 7.7 to 23 million Americans. Long COVID refers to symptoms that last four weeks or more beyond a COVID infection. We now know that long COVID can affect people for weeks, months, or years. The Journal of Medical Virology recently published a study from the University of Leeds that produced “exciting” findings regarding long COVID.

Key takeaways:
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    Long COVID affects 7.7-23 million Americans and can last weeks, months, or years.
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    Long COVID, or post-COVID syndrome (PCS), has over 200 reported symptoms.
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    Only a healthcare professional can diagnose long COVID or PCS.
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    Long COVID participants in a rehabilitation program had reduced symptoms and an increase in their quality of life.
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    The only guaranteed way to avoid getting long COVID or PCS is to avoid getting a COVID infection.

Participating long COVID patients experienced a reduction in their symptoms and increased physical activity levels.

Long COVID & post-COVID syndrome

Long COVID with symptoms that last longer than 12 weeks after a COVID infection is called post-COVID syndrome (PCS).

PCS has over 200 reported symptoms. The most common PSC symptoms include:

  • Breathlessness.
  • Fatigue.
  • Palpitations.
  • Dizziness.
  • Pain.
  • Brain fog.
  • Anxiety.
  • Depression.
  • Post-traumatic stress.
  • Skin rash.
  • Allergic reactions.

Characteristics of PCS include occasions when symptoms become much worse and cause a “crash” that can take hours to days from which to recover. These crashes are preceded by physical, cognitive, or emotional exertion that would not have caused a problem before the COVID infection.

The patients participating in the rehab program (the program) reported an average of three “crashes” per week.

"When patients get a crash, they experience feelings of complete exhaustion and wipe out and are unable to resume activities for hours or sometimes days. Long COVID…has an impact on their quality of life and, in some cases, their ability to work. It is distressing and disabling."

Dr. Manoj Sivan

These PCS crashes are severe, and sufferers currently have no clear advice or direction to safely return to their previous activity levels without worsening their symptoms. Healthcare professionals (HCPs) do not have an evidence-based protocol, and patients receive differing advice on how to get better. This study aims to offer evidence in support of a practical tool that HCPs can recommend to patients for a gradual, paced return to their previous activity level.

After six weeks of participation in the program, participants reported a reduction from an average of three crashes per week to an average of one crash per week. This is a considerable improvement in quality of life.

The duration of COVID rehab program

The pacing in this rehab program is based on a World Health Organization (WHO) Borg CR-10 rating of perceived exertion (RPE) based on a scale of 0-10 (0 being the lowest and 10 being the maximum level of exertion).

According to the journal article, each participant uses the Borg CR-10 pacing protocol to “identify their perceived exertion level and functional activities, without triggering symptom exacerbation and potentially hindering progress in their rehabilitation.” So in this way, the rehab is self-paced, and each participant follows the same protocol, but it is highly customizable.

The program has five phases of paced or gradual increases in a patient’s physical activity and includes example activities for each phase.


The program includes regular support and follow-up by the study team while the participants work through the WHO Borg CR-10 pacing protocol. The researchers recommend further research to learn if the regular contact during the 6-week follow-up period contributed to accountability and encouraged participants to continue with the rehab pacing protocol.

Over the 6-week period, participants reported a reduction in weekly crashes, increased activity tolerance, and improved quality of life.

However, improvements in PCS symptoms of breathlessness, headache or migraine, and fatigue may be the most significant benefits coming from the program.

Exciting study findings

Dr. Sivan stated, “The findings of this research are exciting because this is the first time that crashing episodes have been used as a marker for the condition, and a structured pacing program has now been shown to substantially reduce symptoms and improve quality of life.”

The 31 participants in this study had symptoms of PCS for an average of 17 months. While this study is small, it has the potential to be an effective approach to the treatment of PCS to bring people back to their baseline of physical activity and beyond. A patient can continue using the Borg CR-10 for as long as needed to reach the desired activity level. While more research is needed to investigate an extended pacing program, the improvement of the participating PCS patients is heartening for others who suffer from long COVID.

Diagnosing long COVID or PCS

If you think you or a loved one might have long COVID or PCS, the place to start is seeing your healthcare professional (HCP). Your HCP can determine if you have a long COVID or PCS diagnosis by reviewing your medical history and performing a physical examination.

Prepare for your HCP appointment

Preparing for your appointment is the best way to ensure that your HCP has the information to make an accurate diagnosis.

Make a list of your symptoms, how often you have each one, what makes it better or worse, and how it affects your daily life to bring with you to your appointment. Also, make a note of when you had a COVID infection and when your symptoms started.

Write down any questions you have and ensure they are answered during your visit.

If this is your first visit, bring your medical history and list of medications. In addition, include any over-the-counter medications you take and any vitamins or supplements in your medication list.

During the HCP visit

Share all your symptoms even if you think it’s not important. For example, if you are experiencing severe symptoms or “crashes” that leave you weak and exhausted for hours or days, it is crucial to let your HCP know. Having all of the information will help to get a proper treatment plan.

Talking with your HCP is the most important part of your visit. You can take notes and ask questions.

You might be able to bring a trusted friend or relative with you to your appointment. This person can help take notes and remember what was said. If you can’t bring someone, prepare to talk to a trusted person right after your appointment so they can help you remember what was said.

Make sure to ask what to do next. For example, do you need another appointment? Are tests being scheduled for you? Do you need new medication? Will you need lab tests?

Write down the information and add it to your calendar for future appointments. Depending on your specific symptoms and their severity, your HCP may refer you to specialists for treatment (for example, a cardiologist for heart symptoms like palpitations or a pulmonologist for breathing difficulties). You may even talk about the long COVID rehab program study results with your HCP and show them the pacing protocol used. Especially if you think a phased program of this type may help you get back to your baseline of physical activity.

How do I avoid PCS?

The only guaranteed way to avoid getting long COVID or PCS is to avoid getting a COVID infection.

Nearly one in five Americans are suffering from long COVID and PCS. So do your best to stay well.

Continue to do the basics to protect yourself: wash your hands, wear a mask (especially in crowds indoors), get vaccinated and boosted, wear a mask when caring for someone who is sick, keep your distance from others when possible, stay active, and eat a healthy diet.

The Journal of Medical Virology recently published a study from the University of Leeds that produced “exciting” findings regarding long COVID. People participating in the study experienced reduced symptoms and increased physical activity levels. In addition, results showed that a paced rehabilitation program substantially reduced symptoms and “crashes” for participants with an average of 17 months of PCS symptoms, which can be disabling. The study’s authors recommend that future research be performed to investigate more extended pacing programs and explore the potential of this treatment to prevent chronic PSC. What do you think? Have you experienced long COVID? Share your thoughts and experience! Post a comment below.


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