Exercise Prescriptions for Long COVID?

Lilian White, MD
February 23, 2026

Long COVID is estimated to have affected more than 65 million people worldwide. Approximately 10% to 34% of patients experience long COVID following an initial infection with SARS-CoV-2. The World Health Organization defines long COVID as a “condition that typically arises within 3 months after an acute COVID infection, with symptoms lasting for a minimum of 2 weeks and cannot be explained by alternative diagnosis.” 

Treatment of long COVID is multifactorial and continues to be an area of active study. Treatment options range from low-dose naltrexone to antivirals to supplements, and more. Exercise prescription, in particular, has shown promise for treatment, although some guidelines have recommended against exercise because of the increased risk of postexertional malaise and worsening symptoms. 

In June 2025, the American Heart Association released a statement recommending personalized exercise prescriptions as an integral part of treating cardiovascular deconditioning in patients with long COVID. Mitochondrial dysfunction is among the known pathophysiologic sequelae of long COVID. Low-intensity resistance training recruits slow-twitch muscle fibers, which contain a higher percentage of mitochondria. This leads to increased capacity of mitochondria and, subsequently, more energy for the patient. 

Several studies have demonstrated the benefit of exercise for long COVID. A randomized crossover trial involving 89 men and women demonstrated improvements in muscle strength, lean mass, memory, quality of life, cognitive performance, and reduced depression and psychological distress. A 6-week personalized exercise intervention was used. The intervention involved 2 days of resistance and moderate-intensity aerobic training and 1 day of light-intensity continuous training per week. Resistance training comprised three sets of eight repetitions of four exercises (squat, bench press, deadlift, and bench pull). Moderate-intensity aerobic training (4-6 sets × 3-5 min at 70%-80% heart rate [HR] reserve/2-3 min at 55%-65% HR reserve), where HR reserve is the maximum heart rate minus the resting heart rate. Light-intensity continuous training comprised 30-60 minutes at 65% to 70% of HR reserve. 

Exercise interventions for patients after prolonged bedrest have also demonstrated an improvement in ventricular remodeling of the heart and orthostatic intolerance.

As may be expected, the main adverse effects of the exercise interventions are muscle strain and palpitations. Personalizing exercise routines and remaining within the HR reserve may prevent acute or reinjury and postexertional malaise. 

Personalized exercise programs paced by a patient’s symptoms and exercise tolerance are recommended over standardized graded exercise programs. Caution is recommended in patients with more severe symptoms due to the increased risk of worsening symptoms of long COVID.