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If you experience symptom flares after any kind of exertion, a therapist may recommend that you manage your daily activity levels or keep a diary to help anticipate which activities may be too mentally or physically draining. This self-pacing technique, often used by those with chronic fatigue syndrome (also known as myalgic encephalomyelitis, or ME/CFS), assumes that people have a set quota of energy they can spend each day. So small tasks, like showering or getting dressed, may use up less of their energy, whereas vacuuming or walking to the end of the driveway may drain their energy much faster, leading to something called post-exertional malaise.
Conserving energy throughout the day can help reduce post-Covid fatigue while patients recover, Ms. Ridgway said. “It’s a little bit of a different treatment approach than a lot of other physical therapies, but we really want to make sure we’re doing everything that we can to empower these patients.”
Sitting aerobic and strength exercises
Doctors and therapists agree that people with long Covid need to return to exercising at a very slow pace, often by starting with relearning basic aerobic conditioning and doing recumbent strength training before advancing to more intense, upright movement. This may involve trying to activate your core while in a supine or sideways position, performing balance exercises or doing seated cardio on a recumbent bike or rowing machine. A health care provider will likely monitor your heart rate, blood pressure and oxygen levels while you perform these exercises and ensure that you don’t experience a skipping heart beat or any other cardiovascular symptoms, Dr. Titano said.
Walking and other upright aerobic exercises
Eventually, you may feel comfortable trying an elliptical or walking on a treadmill. Your doctor or physical therapist may also ask you to count your steps or attempt to climb the stairs in your home a certain number of times every day. One of the goals that Ms. Fagan’s cardiologist set was to walk 5,000 steps a day — a target the specialist suggested in October 2021. “It’s March now and I just reached it,” she said.
Progress in managing long Covid symptoms can be excruciatingly slow, so it is often encouraging to be able to see your improvements over time. People may track their data using a heart rate monitor in a smartwatch, a blood pressure cuff or pulse oximeter if they have one at home. Health care providers may advise that you enlist a family member or friend to help you use some of these devices, and to ensure that you remain safe while performing any exercises. “It’s nice to be able to track progress,” Ms. Fagan said. “It personally helps me because the progress is so incredibly slow. You just don’t see it day to day. You do not even see it month to month. It’s more yearlong progress.”
If you experience really debilitating symptoms that prevent you from doing everyday tasks — like the laundry, going to work or taking care of your kids, for example — you may need additional help from prescription medication and closer monitoring by a health care professional, Dr. Hayek said. Depending on your individual heart disease risk and current symptoms, certain blood pressure medications like beta blockers or calcium channel blockers can help alleviate extreme dizziness and treat chest pain and abnormal heart rhythms, he said. And these drugs can be tapered off once your cardiovascular symptoms abate.
Adolescents and young children with long Covid, however, are not eligible for many heart drugs. When seeing young patients, Dr. Sindhu Mohandas, an infectious disease expert at Children’s Hospital Los Angeles, said she tends to recommend more lifestyle changes that, in addition to physical therapy, may help patients focus in school and rebuild their endurance for sports.