Edward, Justin A, Peruri, Adithya, Rudofker, Eric et al. · Journal of cardiopulmonary rehabilitation and prevention · 2023 · DOI
Long COVID causes severe fatigue and difficulty exercising, affecting 25-30% of people who had COVID-19. This review suggests that carefully designed exercise programs—tailored to avoid making symptoms worse—may help Long COVID patients recover better. The authors argue that much of Long COVID comes from the body becoming deconditioned (out of shape) from inactivity, and that gentle, personalized exercise can help reduce symptoms.
This study addresses a critical gap in Long COVID management by proposing structured, symptom-informed exercise approaches rather than standard rehabilitation protocols. For ME/CFS patients—many of whom experience PEM similar to Long COVID—understanding how to safely integrate exercise while respecting post-exertional limits is essential for developing evidence-based management strategies.
This review does not provide new primary evidence that exercise training reduces Long COVID symptoms; it synthesizes existing literature. It does not establish what proportion of Long COVID is truly due to deconditioning versus other mechanisms (metabolic, immunologic, neurological), nor does it demonstrate that PEM in Long COVID is identical to cardiac deconditioning. The claim that 20 hours of inactivity causes deconditioning is presented but not rigorously validated in the Long COVID population.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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