A Deep Dive into the P.E.D.A.L. Approach for Long Covid Symptom Management

Clients we have worked with have been consistent in saying they appreciate a structured approach that is personalized to them, their health needs and their priorities. This is why we have developed our P.E.D.A.L. approach to support people to manage Long Covid symptoms. It provides a clear framework and guidance that is effective and backed by evidence, while also allowing a tailored approach to implementation that is practical, doable and safe for the individual. P.E.D.A.L. stands for Pacing, Exercise, Diet, Aligning the nervous system, and Loosening. When we mention our approach, we often get feedback that people are “already doing a lot of it”. Once we share our ideas in more detail, the difference between our approach and their assumptions becomes apparent, opening up a wider perspective about these terms and what actions may help them feel better.

In this blog article, we want to take the opportunity to explain the difference between what we often hear people are already doing in the hope of feeling better, and compare that to how we use P.E.D.A.L. for Long Covid symptom management. 4 elements of P.E.D.A.L. (Pacing, Diet, Alignment and Loosening) are specifically designed to support people with Long Covid to improve the functioning of systems in their body that have stopped working as they should. This includes the nervous system, gastrointestinal system and immune system. It also helps to relax your involuntary nervous system and the fight-or-flight, or stress, response that has been turned on and isn’t working as it should to self regulate and turn itself off. The issues with these systems directly lead to some prominent Long Covid symptoms like fatigue, brain fog, inflammation, heart rate changes and pain. 

Taking simple, but specific, actions that help regulate these systems allows people to feel better in the near term and provides a strong foundation for physical resilience and improvement into the future. Once that foundation is stronger, people have increased energy and tolerance for both mental and physical challenges. It is then possible to introduce light exercise, and use that and other elements of P.E.D.A.L. to continue to develop ability over time. We use evidence to embrace a new and effective approach to Long Covid management that is simple, but much more sophisticated than traditional recovery or rehabilitation regimens.      

P - The Spectrum of Pacing

Common Understanding:

Many people talk about pacing as resting or not overdoing things. This involves taking breaks when they feel tired and avoiding overexertion. It often means tapping into traditional recovery and rehabilitation thinking - letting the body rest in the hope that it will self repair and when that happens you can start to introduce more activity over time. 

Our Approach: The traditional approach to pacing is appropriate for injuries like strained muscles. However, Long Covid and other post-viral conditions often involve ongoing systemic issues in the body. Rest alone will not provide the healing needed. Our approach to pacing involves a comprehensive strategy that balances activity and rest, ensuring sustainable energy levels throughout the day. It's about recognizing and respecting your body's limits, allowing you to build a strong foundation, and increasing ability over time by using strategies that build back resilience.

We help you develop tools and create a rhythm that allows you to function optimally without crashing. This includes planning activities, prioritizing tasks, and learning to listen to your body's signals. By adopting a mindful approach to pacing, you can create a sustainable routine that supports your recovery pathway and symptom management. With this approach, people are able to help create a sense of “safety” in their body, avoid overstressing their systems, and be able to take on more and more activity over time. 

E - The Role of Exercise

Common Understanding:

A common view is that exercise involves working out and high-intensity cardio activities like running or biking. For those who exercised regularly before COVID, it often means trying to do similar workouts to those they did before they were ill (especially when that always used to help their body feel better). This approach traditionally involves pushing physical limits to stress the body and gain fitness and strength from that exertion. People also know that this cycle of overexertion comes with a high risk of “crashing” afterwards, or PEM (post exertional malaise). After experiencing that crash they may become wary about whether it is possible to do exercise at all.   

Our Approach: When we talk about exercise in the context of Long Covid, we mean any physical activity that promotes recovery and strength. This can range from gentle stretching to more structured exercise routines. The key is consistency and understanding that “what we do, we get good at.” Our exercise recommendations are designed to build a strong foundation first, which is tailored to each individual's current capabilities. This may include low-impact activities like walking or very light core strength, or simple mobility and flexibility exercises. 

Importantly, Exercise in the P.E.D.A.L. approach is about the right blend of rest and appropriate activity, focused on a gradual progression while not stressing your system. Doing physical activity and pushing yourself to the point where you crash frequently does not offer a path to improvement or sustainable results for those with Long Covid, or for any athlete looking to achieve high-level performance. An approach that supports improvement includes periods of non-progression and even less activity, ensuring that each step forward is sustainable and beneficial. 

Exercise is a cornerstone of the P.E.D.A.L. approach because it supports overall health and resilience. Physical activity helps improve cardiovascular health, muscle strength, and mental well-being, but it is also critical for general health, blood sugar regulation, immune function, and more. We help people benefit from that activity, while not overstressing their systems. 

D - Rethinking Diet

Common Understanding:

In general people think of this as “eating healthily” - including limiting sweets and including a lot of fresh food, fruit and vegetables. People may also think of this as limiting carbs as well. 

Our Approach: Katie thought she had a very healthy diet until Andrea helped her make some adjustments - and opened her eyes. Through her own recovery path, and while working on a book that is on its way to support others, she learned that what is commonly considered “healthy” might be overlooking important factors, especially for those with Long Covid. Our dietary recommendations are tailored to support immune function, reduce inflammation, and provide sustained energy.

Diet plays a crucial and direct role in recovery and Long Covid symptom management, and our approach involves understanding how different foods impact your body. We emphasize the importance of a balanced diet rich in nutrients, focusing on whole foods, adequate hydration, and avoiding processed foods and foods that cause inflammation. The timing of meals also significantly impacts inflammation and symptom triggers. By making strategic dietary changes, many people experience improvements in energy levels, cognitive function, and overall well-being.

A - Aligning the Nervous System

Common Understanding:

We often hear people think of “alignment” as doing yoga, meditating or generally using relaxation techniques. These elements are helpful, but they are not the whole picture, and they are not always attainable for everyone - people with limited energy may find yoga too strenuous and others prefer more physical or mechanical techniques over meditation. There are specific, simple, physical movements and techniques you can use regularly to help align and reset the nervous system.  

Our Approach: Nervous system alignment is often overlooked but is crucial in managing Long Covid symptoms. It involves practices that help regulate the autonomic nervous system, which can become dysregulated in people experiencing Long Covid. Techniques such as specific movements, eye exercises, and tailored breathwork are essential for restoring balance to the nervous system, reducing symptoms and helping your body’s systems get back to more normal functioning.

Our alignment practices focus on reducing stress and reducing the body’s fight-or-flight response by regulating the autonomic nervous system. Activities that activate the Vagus nerve and address other systems in the body, like the proprioceptive or visual system, can help calm the brain and nervous system and improve functionality. By aligning the nervous system, you can enhance your body’s ability to become more resilient to triggers that can put your nervous system into fight, flight, or freeze mode. Alignment is critical because people with Long Covid are often impacted by a mis-aligned nervous system. Without addressing this, positive impacts from other pillars will be harder to achieve and maintain. The “A” pillar is often not addressed by people trying to manage Long Covid symptoms but is a key component to achieving lasting results.

L - The Importance of Loosening

Common Understanding:

Doing stretching or occasionally getting a massage to help loosen muscles. Working on tight or tense muscles or joints when they become uncomfortable. 

Our Approach: Loosening, in our context, refers to the regular release of physical tension as a tool to reduce stress in the nervous system and alleviate mental tension. This in turn enables the body to be more physically flexible and resilient. We focus on specific stretches that reach fascia and connective tissue to support the body's natural recovery processes. “Loosening” is critical because it supports detoxification and lymphatic flow, enhancing the effectiveness of the other P.E.D.A.L. components.

We encourage practices that help release not only muscle tension but, more importantly, tension in the connective tissue and fascia to promote relaxation and the feeling of releasing space and reducing stored tension and toxins in the body. This includes biomechanical techniques and different forms of progressive muscle relaxation. Emotional loosening is equally important, and while we recommend techniques like journaling, we also emphasize the strong body-brain connection and using the body in different ways to help process and release stress.

The Synergy of P.E.D.A.L.

Each of these pillars is powerful on its own, but their true potential is unlocked when they are used together. The P.E.D.A.L. approach is a system designed to support recovery and Long Covid symptom management by addressing the body and brain comprehensively.

The synergy of these practices ensures a balanced and impactful approach. By integrating Pacing, Exercise, Diet, Alignment, and Loosening, you create a supportive environment for feeling better in the near term and a platform for sustainable improvement. This holistic approach ensures that each component positively reinforces the others, leading to more effective symptom management, and quicker results. The tools we share can be implemented in just a few minutes a day and develop into new habits that support ongoing progress over time. Many of these tools are also used by elite athletes to support their own high-end performance. We love that they are effective for lower energy levels who are trying to heal, as well as for people operating at the high-end. Simply put, it means you don’t need to re-learn new tools as you get better. The habits you develop using P.E.D.A.L. will continue to support increased ability and wellbeing as you continue to improve. 

If you have more questions, please feel free to reach out. It is important to us that you understand your options and that there are tools available to help you feel better. We love questions because they help us understand the community better and continue to meet their needs, so we can help as many people as possible to regain their health and feel more like themselves. 

Warmly,
Katie & Andrea