IMAGE DESCRIPTION: An image of blue Covid virus with a graphic of white people exercising. With the wording: "Gradual exercise prescribed for people with Long Covid" and the ME Association logo (bottom right).

bylinetimes: Are We Giving the Wrong Advice To People with Long COVID?

The bylinetimes has an article questioning the advice being given to people with long COVID.


The idea that exercise is a useful treatment for people with chronic illnesses is not new. Chronic fatigue syndrome (ME/CFS), which like Long COVID is most prevalent in women, has historically been dismissed by medical professionals, often attributed to laziness or mental-health issues. A gradual increase in physical activity, known as graded exercise therapy (GET), was promoted as a cure, as was cognitive behavioural therapy. 

The National Institute for Care Excellence (NICE), which outlines best practice for different conditions, used to recommend GET for ME/CFS patients but guidance, after a long review period, was updated in November 2021 to exclude GET. The guidance also notes that “some people with ME/CFS have found that [exercise programmes] can make their symptoms worse”.

According to Asad Khan, a pulmonary consultant living with Long COVID himself, “post-exertional malaise is now very well documented in Long COVID… and we have to learn from the history of other post-viral illnesses”.

GET is not mentioned in the Long COVID treatment guidance, which is limited, reflecting how new the condition is, but a spokesperson for NICE said that it “does not recommend either [cognitive behavioural therapy] or GET in the management of post-COVID-19 syndrome”, which is another name for Long COVID.

And yet, the idea that exercise is always beneficial remains prevalent in medical circles. Dr Clare Gerada, President of the Royal College of GPs, told BBC Breakfast in January 2021 that “There is nothing that isn’t made better through exercise… No matter what age, what condition, exercise will always improve it, but within moderation.”

Promoting exercise as a response to Long COVID is widespread in NHS treatment. This has been institutionalised through the ‘Your COVID Recovery’ programme, commissioned by NHS England and developed by University Hospitals Leicester, intended for patients recovering from severe illness after a stint in hospital, possibly on a ventilator. However, it is also recommended for “people with persisting symptoms due to COVID-19 but who didn’t require hospital admission.”

Your COVID Recovery was based on similar recovery plans for patients with heart and lung conditions and has been endorsed by a range of medical organisations, including the British Thoracic Society (BTS). A BTS spokesperson noted that NICE “considers careful self-pacing of exercise to be an important element of self-management”.

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