Rest, not exercise for Long Covid

Long Covid Physiotherapy

A discussion with Respiratory Physiotherapist Ruth Ainley about management of Long Covid.

Ruth recommends that if you think you have Long Covid, go to the Physios for ME website:

Long Covid is characterized by fatigue;

  • central fatigue, at the brain level
  • peripheral fatigue, at the muscle level

Ruth makes the point that exercise is NOT the answer in patients with Long Covid symptoms; “By pushing yourself when your energy pathways are not working – it’s futile really. This is why we’re encouraging rest.”
She uses the analogy of a phone battery: “When you keep pushing it, it’s like trying to use a phone where the battery only gets up to 5%”.

Patients are encouraged to monitor their symptoms, possibly using an app such as the Bearable app for monitoring your symptoms.

Evie points out that musculoskeletal physios are so used to the idea that “training will make it better” and that we MSK physios need to remember that the answer is not always exercise.

Given what we know about the effect of the coronavirus on many different body systems, Ruth emphasises the importance of a detailed assessment including questions about urinary tract infections, gastrointestinal symptoms, neurological symptoms and others.

Ruth states that for physiotherapy management of Long Covid there must be a focus on

  • planning
  • pacing
  • prioritizing

“The most important thing is to get your patient to rest”.
We know that for some people this is very difficult, especially for those who don’t have a support mechanism.

Evie and Ruth agree that in their experience, it can be very difficult for patients to truly rest from their normal work and home duties:
“It’s very difficult. There’s an awful lot of guilt”.

Ruth’s clinic is at

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