Can exercise help to manage long Covid?

We don’t know much about long Covid yet but new research suggests that exercise could play a beneficial role in speeding up recovery. Writer Bridie Wilkins investigates.

For every one in three people who catch Covid-19, their symptoms persist for as long as nine months. And according to a paper published by Trinity College Dublin in September 2020, two-thirds of the people coping with unrelenting fatigue – a common symptom – as a result of the disease are women. 

This condition has been coined ‘long Covid’, and while medics have been able to draw a few parallels with similar respiratory diseases and post-viral fatigue syndromes, the reason why it hits some people harder than others remains much of a mystery. What we do know, though, is that exercise could help. 

A study by the National Institute for Health Research (NIHR) in Leicester showed that a combination of graded strength training and aerobic exercise improved the recovery of people with lasting Covid symptoms. 

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Enya Daynes, lead author of the study and a physiotherapist in pulmonary rehabilitation, tells Stylist that upon completing the six-week study, the end results showed promising progress: patients could walk further and faster, they weren’t out of breath post-exercise, and they no longer felt totally exhausted. 

But there are caveats. Long Covid is a seriously debilitating disease, and while exercise could work wonders for one person, it could exacerbate symptoms for another. Here’s everything you need to know about exercising to help with recovery.

How does long Covid affect people?

Daynes tells us the most common signs are:

• Extreme fatigue or tiredness
• Breathlessness
• Brain fog (affecting memory and concentration)
• Chest pain
• Heart palpitations
• Aching joints

It’s key to note that, while these symptoms have been most frequently reported, research is ongoing. Such clouded knowledge only adds to the frustration and confusion in those battling the illness, but in June 2021, NHS England pledged to provide £100 million to support long Covid survivors, which will help put a finger on specific symptoms.

Nicola Geary, a participant in NIHR’s exercise programme, has lived with symptoms of Covid since April 2020. For her, the overwhelming fatigue was most prominent in the long Covid stage – until she took part in the exercise scheme. 

“I had no energy to move – I could barely make it to the bathroom,” she tells us. “I have two flights of stairs in my house, and I stayed upstairs for the first three weeks of contracting the illness, as climbing the stairs felt like climbing a mountain. I was totally exhausted.”

Can exercise help with long Covid recovery?

The simple answer is: yes. Like most diseases, however, it varies from case to case. Rebecca Robinson, a sports and exercise medicine consultant, has worked with long Covid patients ranging in age from 18 to 80, with entirely different fitness levels. On the whole, a graded and symptom-driven approach (ie guided by how your symptoms react when you work out – a flare-up is a sign to scale back) has proved successful. 

“It’s about each individual patient recognising how to pace themselves, and knowing when to rest,” she says. “See what you can tolerate without symptoms flaring the next day. If you haven’t exercised at all since being infected, try a 10-minute walk (or less, if that’s too much) one day, and if you’re all good, wait another day, then repeat. Consider upping this once you can complete it without any symptoms flaring.”

The journey is anything but linear, and you may find you need to ease off exercise for weeks at a time. Patients of the NIHR study were each set individual exercise regimes to reflect their needs and abilities, and Daynes says the ebb and flow of symptoms meant that they were intensified and made easier several times throughout the six-week timeframe.

How can exercise help with long Covid symptoms?

How exercise helps long Covid, scientifically, is about maintaining some level of activity to prevent your body from becoming complacent. “There are theories that, like other post-viral fatigue syndromes, long Covid can affect our mitochondria – the little batteries within our cells,” Robinson says. 

“The fight against Covid can use up all of their power, and this might mean backing off from exercise completely when symptoms are at their worst.” Contradictorily, though, Robinson adds that “we need dense mitochondria in our cells to give us energy and look after our immune systems, and exercise is the only way to recharge these ‘batteries’, while rest depletes their density further.”

Strength-wise, Robinson says we could fall subject to “muscular deconditioning as a side effect of inactivity”. Daynes explains: “The inevitable period of bed rest will weaken your muscles, meaning your body is less able to do the things you used to. Exercise can strengthen this, and while it may feel like symptoms such as breathlessness and fatigue are stopping you from doing so, your body will eventually adapt and it should become easier. If you give in too soon, your muscles may get used to not exercising, and so when you come to try training again, you’ll find you can no longer do so.”

After completing the NIHR’s six-week programme, Geary experienced the benefits first-hand. “I noticed that from walking just 300-600 steps daily and feeling exhausted, I could then easily manage over 2,000. Now, I’m walking four times a week (between 3,000-8,000 steps each time), and weight training at least twice a week. I still get painful legs and muscles, but the more I move, the better they are.” 

Understandably, exercising with long Covid – a life-upending respiratory fatigue disease – is a contentious issue, and skepticism is rife. Nonetheless, Geary strongly believes that it helps. “Follow the expert advice,” she says. “And listen to your body. It’s about learning to push ourselves without causing harm. 

“I still struggle, but I make my exercises easier to avoid worsening my symptoms, and to stop myself giving up.”

When should I consider starting to exercise after Covid?

In the same way that we can’t say that exercise will soothe long Covid symptoms for everyone, we can’t give you a dead-cert date to start trying after contracting the disease. Robinson recommends waiting “until symptoms stabilise”. That is, you’ll have been managing the same ones for two or more weeks, with no sign of flare-ups. 

“Then go steadily,” Robinson adds. “Monitor how you feel in terms of daily energy, how sore your muscles are, how tired you are, and the quality of your sleep.”

Daynes reiterates that knowing when to start moving with long Covid is totally unique to each person. “It’s important to allow your body to rest while symptoms are at their worst,” she says. “Some people may feel better quickly, whereas others may need longer. Either way, it’s important to gradually build up your activity, rather than overdoing it.” 

Unsure? Your GP or a healthcare professional will be able to give you more precise guidance in line with your own experience.

What are the best forms of exercise for long Covid recovery?

Tailoring your exercise routine to reflect how the disease has affected you is essential. There’s no good in going hell for leather, whether you were able to pre-infection or not, and it’s this kind of precautionary method that worked for Daynes. The NIHR’s exercise programme consisted of a combination of basic aerobic exercise (five-10 minutes on a treadmill, and five-10 minutes cycling on a static bike), and strength training. 

Both were increased or decreased in line with symptoms – “If they stayed the same, we would reduce the amount of exercise, and we’d increase only if symptoms improved,” Daynes says.

She adds that incorporating aerobic exercise and strength training together is important, since they strengthen both parts of the body that take a hit from long Covid: the heart and lungs through aerobic work, and your muscles through strength training.

Geary was able to complete 10 minutes on an exercise bike and 10 minutes on a treadmill twice a week, as well as weight training three times a week. She admits that, at the start, she’d often feel “totally worn out” and would fall asleep “as soon as she sat down”, but after six weeks of work, she is now walking four times a week, and weight-lifting at least twice per week. 

Her biggest challenge? “Walking uphill is still hard,” she says. “But it’s getting easier, and I can now walk on flat ground like it’s completely normal, whereas before a few steps felt like a marathon.”

Best strength training exercises for long Covid

For Daynes’ study, patients would perform the following exercises to strengthen the main parts of the body: arms, legs and core.

• Bicep curls
• Pull-ups
• Sits-to-stands
• Step-ups

They were given the option to use free weights (weight depending on each person’s ability), but began with bodyweight, which Daynes advises is a solid place to start. 10 reps of each move were completed for three rounds, twice a week, and the study’s results suggest this is a good way to go.

Daynes says: “These kinds of exercises were chosen based on a modified pulmonary rehab programme used for patients with lung disease prior to the pandemic. The evidence showed that they helped with the condition, and so, considering that long Covid affects the lungs in a similar way, we applied the principles to our own programme.” 

Of course, long Covid comes with its own complications, and so making modifications according to your symptoms and how tired you’re feeling is imperative. 

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