“Concern has been raised about the safety of exercise training for patients with Long COVID. This safety concern is centered around the potential exacerbation of postexertional malaise among individuals who are already deconditioned and are experiencing exercise intolerance.“
American Heart Association
Summary
- The American Heart Association (AHA) published a research article supporting tailored exercise programs for patients with Long COVID.
- The ME Association does not endorse the AHA’s exercise approach for managing Long COVID, especially for those with PEM or ME/CFS-like symptoms, citing previous NICE guidance and international consensus cautioning against graded exercise therapy in such cases.
On the 30th June, 2025, the American Heart Association published a research article titled; “Exercise Intolerance and Response to Training in Patients With Postacute Sequelae of SARS-CoV2 (Long COVID): A Scientific Statement From the American Heart Association.” Dr Charles Shepherd has provided comment below, and states this type of exercise programme is not an approach to management that the MEA recommends for Long Covid.
Abstract
The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance.
Emerging data suggest that cardiovascular deconditioning plays a major role in the development of this syndrome and that reductions in functional capacity among patients with Long COVID are comparable to reductions seen among individuals with cardiovascular deconditioning resulting from bed rest.
Concern has been raised about the use of exercise training as part of the management strategy for patients with Long COVID. However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms.
This American Heart Association scientific statement provides a concise yet comprehensive overview of mechanisms contributing to development of Long COVID and methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life. In addition, methods of reintroducing exercise and return to play among athletes affected by COVID-19 are discussed.
Further Extracts
Data from NCAA athletes in the ORCCA Registry (Outcomes Registry for Cardiac Conditions in Athletes) provide a compelling background that rapid return to regular physical activity, at least among competitive athletes, can markedly reduce the risk of developing Long COVID.
That said, concern has been raised about the safety of exercise training for patients with Long COVID. This safety concern is centered around the potential exacerbation of postexertional malaise among individuals who are already deconditioned and are experiencing exercise intolerance. However, as has been previously demonstrated in other populations with similar symptoms, an exercise program modified appropriately to the patient with cardiovascular deconditioning may effectively and safely improve symptoms.
Dr Charles Shepherd, MEA Hon. Medical Adviser Comments:
Although there may be a case for cautiously recommending a more active approach to activity and energy management in some carefully selected people with Long Covid who do not have post exertional malaise (PEM), or other ME/CFS symptoms, this type of exercise programme could easily produce a serious relapse in people with Long Covid who do have PEM or another ME/CFS symptom component.
This is not therefore an approach to management that the MEA can recommend.
I would also point out that following our concerns about graded exercise being recommended for people with Long Covid, NICE issued the following guidance back in 2020:
This position has also been supported by a group of international clinicians and researchers:
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
Further Information
- ME Association Statement on Exercise in ME/CFS and Long Covid | April 21, 2021