Rethinking Exercise for Long COVID Recovery

In the context of Long COVID and exercise, people need a new approach to physical activity in order to support recovery.

Traditional Exercise and the Long COVID Dilemma

Exercise is often viewed as a cornerstone of good health, but for those with Long COVID and other post-infection conditions, it can feel like a double-edged sword. Traditional exercise protocols emphasize pushing physical limits to build strength and fitness. This philosophy works well for healthy individuals because the body adapts to stress by growing stronger. However, in the context of Long COVID, these same protocols can backfire. For many, including Katie, these approaches worsened symptoms rather than improving them, leaving people with something called Post Exertional Malaise – PEM. Understanding why this happens — and how to adapt — is vital for recovery.

Why Post-Exertional Malaise (PEM) Happens

PEM, or post-exertional malaise, is a common challenge for people with Long COVID. But what exactly causes it? When individuals with post-infection conditions overexert themselves, mentally or physically, the body’s energy systems struggle to recover. This leads to an exaggerated inflammatory response, impaired cellular repair, and worsening symptoms that can last days, weeks, or even longer. It can make people feel sluggish or land them back in bed, unable to do even simple daily activities. Because of this experience, people with post-infection conditions are sometimes incredibly wary of any exertion and feel like their only option to keep symptoms at bay is to rest as much as possible. Recognizing the impact of PEM is the first step in rethinking how we approach physical activity during recovery. 

Gentle Exercises that Support Healing

Instead of high-intensity workouts, think small and intentional. Exercises that focus on gentle movement, blood flow, and maintaining functionality are best. For example - Activated stretches: Simple stretches paired with activated muscles and deep breathing can help loosen fascia and connective tissues, calm the nervous system and allow body functions through better posture and flow. They are low impact, don’t take much energy, and focus on supporting nervous system alignment to reduce your involuntary nervous system’s fight or flight response. Targeted movements can also be done seated or lying down: Rotating your wrists or ankles, or even lifting your arms, can encourage blood flow without overexertion. Other examples are short walks or mobility exercises: A two-minute stroll around your room or some joint movements can promote recovery without triggering PEM. These movements may seem minimal, but they lay the groundwork for resilience without overwhelming the body.

Not feeling like exercising

When facing health challenges and experiencing PEM, it’s common to feel like exercising is the last thing you want to do. This is known as sickness behavior — the body’s way of conserving energy so it can focus on healing. When you’re unwell, whether from an infection, Long COVID, or another illness, your body sends signals to your brain to slow down so it can use energy to repair and heal. This can make you feel tired, less social, and even suppress your appetite. It’s not just in your head; it’s a natural and protective response.

For most infections, this immune-driven response typically resolves within about 21 days. Once you are healed, your body stops sending those sickness signals and you start to feel less pain and more energetic. Any muscle loss during that time can be relatively easy to rebuild. However, with long-term conditions like Long COVID, the body may remain stuck in this energy-conserving mode, with continued sickness behavior signaling. Therefore, it is important to incorporate gentle, intentional exercise to help nudge your body out of this mode. 

Why include exercise in a symptom management approach

People with Long COVID face elevated risks for conditions such as cardiovascular disease, type II diabetes, dementia, Alzheimer’s, and cancer. While not all of these are exclusively linked to a sedentary lifestyle, inactivity is a risk factor itself. The less we move, the more tired we often feel, creating a cycle of fatigue and inactivity, on top of post-infection symptoms. Breaking this cycle with simple, appropriate movements can spark an upward spiral of recovery.

Appropriate exercise and activity like that in the PEDAL™ approach supports blood flow throughout the body and brain, which can feel refreshing when done correctly. It also aids in improving sleep quality, a symptom often disrupted in Long COVID. Regular movement encourages a healthy appetite and better hydration while improving mood and reducing feelings of anxiety or stress. On a hormonal level, exercise positively influences insulin for blood sugar regulation and brain chemicals like serotonin, norepinephrine, and dopamine, which help regulate mood and energy.

Additionally, muscles are part of the endocrine system, producing hormones that play a role in various bodily processes. Keeping muscles active is essential to maintaining their function and supporting overall health. Exercise is a powerful example of how movement can directly benefit both the body and the brain.

PEDAL™: our approach for sustainable symptom management

Exercising the right way is a critical part of managing Long COVID and post-infection conditions, which is why it’s a key pillar in our PEDAL™ approach. PEDAL™ stands for Pacing, Exercise, Diet, Alignment, and Loosen, with each pillar playing a vital role in supporting recovery. You can read more about the full framework in our blog post A Deep Dive into the PEDAL™ Approach for Long COVID Symptom Management. Together, these pillars create a roadmap for gradual, sustainable improvement.

Exercise, as one part of this approach - emphasizes low-impact activities tailored to the body’s current capacity. These small, intentional steps build a strong foundation and support people to increase strength and resilience over time, empowering individuals to feel more in control of their recovery, regain vitality and increase ability.

Warmly,
Katie & Andrea