Fatigue is a feeling of extreme exhaustion and is the most common symptom of Long COVID. It: 

• is not easily relieved by rest or sleep 

• is not the result of unusually difficult activity 

• can limit functioning in day-to-day activities

• negatively impacts quality of life 


 Post-exertional symptom exacerbation (PESE) is a disabling and often delayed exhaustion disproportionate to the effort made. It is sometimes described as a “crash”. 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 exercise) 

• reading, writing or working at a desk 

• an emotionally charged conversation 

• being in a sensory environment (eg loud music or flashing lights) 

PESE is most often triggered by physical activity and exercise. Nearly 75% of people living with Long COVID still experience PESE after 6 months.

 The symptoms worsened by exertion can include: 

• disabling fatigue/exhaustion

 • cognitive dysfunction or “brain fog” 

• pain 

• breathlessness 

• heart palpitations 

• fever 

• sleep-disturbance 

• exercise intolerance 

Symptoms typically worsen 12 to 48 hours after activity and can last for days, weeks or even months.

Your physiotherapist can guide you in pacing as an activity management tool that is also used successfully for people with ME/CFS to prevent triggering PESE. 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. This is a safe approach to navigate triggers to symptoms.

Physiotherapy helps with the following:

  • Breathing exercises can help your lungs recover after COVID-19. They help with feelings of anxiety and stress, help restore diaphragm function and increase lung capacity.
  • Rehabilitation is different for everyone. We can plan your rehabilitation depending on your symptoms, goals and preferences.
  • Pacing is a self-management strategy during activity to avoid post-exertional symptom exacerbation (PESE). When pacing you do less activity than you have energy for, keeping activities short, and resting often.