• Book an Appointment

An Approach For Safe Rehabilitation For People With Long COVID

Most people recover completely within a few weeks from COVID. However, some people, even those who had it in a milder form, continue to have symptoms after they have recovered.


What is Long COVID?

Long COVID is a term used to describe the effects of COVID-19 that continue for weeks or months beyond the initial illness. According to World Health Organization (WHO), Long COVID develops in people who have had a history of SARS CoV-2 infection, generally 3 months after the beginning of COVID-19 symptoms that continue for at least 2 months and cannot be explained by another illness.


How common is Long COVID?

1 out of 10 of all cases will have symptoms for at least 12 weeks. Long COVID is a multi-system illness with over 200 symptoms that can occur in a variety of combinations and fluctuate in both predictable and unpredictable flare-ups and remission patterns.


What are the most common symptoms after 6 months?

Extreme exhaustion (fatigue), post-exertional symptom exacerbation (PESE) problems with memory and concentration (brain fog) are some of the most common symptoms of Long COVID.

Fatigue is a feeling of extreme exhaustion and is the most common symptom.

  • It is not easily relieved by rest or sleep
  • It is not the result of unusually difficult activity
  • It can limit functioning in day-to-day activities
  • It negatively impacts the quality of life


Post-exertional symptom exacerbation (PESE) is a disabling and often delayed exhaustion disproportionate to the effort made. The activity that can trigger this worsening of symptoms can be something that was easily tolerated before, such as:

  • A daily activity (Eg. A shower)
  • A social activity
  • Walking (or other exercises)
  • Reading, writing, or working at a desk
  • An emotionally charged conversation
  • Being in a sensory environment (Eg. Loud music or flashing lights)

Other common symptoms include:

What is the Rehabilitation strategy for Long COVID?

The goal of rehabilitation is to provide a collection of therapies that will help people operate better in everyday activities, recover or adjust, reach their full potential, and participate in education, job, enjoyment, and important life roles.

Although rehabilitation for individuals recovering from COVID-19 is different for everyone and should be done under the guidance of an expert, the WHO recommends that Long COVID rehabilitation includes educating people about resuming everyday activities conservatively, at an appropriate pace that is safe and manageable for energy levels within the limits of current symptoms, and exertion should not be pushed to the point of fatigue or symptom exacerbation.


The role of exercise in the rehabilitation strategy for Long COVID includes:

Pacing is a safe self-activity management method that has been effectively used to avoid PESE and symptom triggers.

STOP trying to push your limits. Overexertion may harm your recovery.

REST is your most important management strategy. Do not wait until you feel symptoms to rest.

PACE your daily activities and cognitive activities. 


Although there are many benefits in exercising, exerting yourself without adequate rest can do more harm than good in your recovery journey. Follow these tips to maximize your routine:

1. Learn about your energy reserve/reservoir

  • Your energy reserve is the amount of energy you have each day. Because this varies, it's helpful to establish a baseline by keeping track of your activities and symptoms. Your “baseline” is what you can do fairly easily on a good day and only just do on a bad day
  • You should always aim to leave some energy at the end of the exercise


​2. Learn how much energy you have

  • Your symptom and activity log should start showing some patterns. You may now lower or alter your activity levels to avoid triggering PESE or a "crash." Unless you experience a relapse, this will help you discover a level of activity that you can sustain on both good and bad days
  • To avoid an accident, learn to recognise early indicators of PESE and instantly implement stop, rest, and pace


3. Learn how to use the 4 Ps to help you plan your activities

  • Prioritize what you really need to do in a day or week. Can someone else do it? Can I change the activity so it is easier for me?
  • Plan your main prioritized tasks for the day
  • Pace yourself. Break up your activity into smaller, more manageable tasks with rest breaks
  • Pleasure. Spend some energy on things you enjoy to help improve your quality of life


4. Learn how to save energy

  • Learn to say no
  • Avoid the temptation to “do just a little more”
  • Modify your activities to use less energy
  • Ask for help


5. Learn to rest between activities

  • Rest means absolutely minimal activity and little or no mental stimulation
  • During rest avoid activities that can be stimulating, such as TV and social media
  • Try some meditation and/or breathing exercises instead


Breathing exercises might help your lungs recover after contracting COVID-19. Breathing exercises can help you deal with worry and stress while also restoring diaphragm function and increasing lung capacity. Breathing should be easy and silent; if you can hear yourself breathing, you're probably working too hard.

Our Long Covid Recovery Programme

Our specialized Physiotherapy programme is designed to treat various symptoms of Long COVID.

The programme can be run online via our secure telehealth platform or in person at our centre under the supervision of our experienced physiotherapist who will conduct a thorough assessment and derive a treatment plan based on individual impairment and functional capacities.

Before you start the programme, it is important that you go through an initial screening with a licensed Medical Doctor to ensure that you are suitable to begin a recovery programme.

If you would like us to recommend a suitable doctor who can perform this screening, do reach out to us.


For more information call us on +91-11-42120200 or book an appointment.


Written by: Anurag Ghildiyal (Physiotherapist)

A Delhi University National institute graduate, Anurag is a seasoned Physiotherapist specializing in musculoskeletal domain with expertise in low back pain and neck pain cases. He is a crusader for the ideology of the movement as the medicine of the future.

During the COVID-19 pandemic, he functioned as a tele- rehabilitation expert, guaranteeing that treatment and care are available for everybody in difficult stretches.

Author by Anurag Ghildiyal, Jun 13, 2022,


Come to our Physiotherapy clinic in Niti Bagh, Delhi for a chat with one of our expert physiotherapist to plan the right Physiotherapy treatment for you to get rid of pain in no time.