How Long COVID May Be Affecting Your Workouts—And What to Do About It


man extremely tired after working out

man extremely tired after working out


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Fast Facts

  • Long COVID can negatively affect a person's capacity for exercise, new research shows.
  • Researchers say exercise intolerance—or the diminished capacity for exercise—should be considered a symptom of long COVID.
  • People with long COVID who are having difficulty exercising should contact their healthcare provider to come up with a treatment plan.

Long COVID can drastically reduce a person’s capacity for exercise and physical activity—so much so that researchers of a new study say exercise intolerance should be considered another symptom of post-COVID conditions.

The suggestion comes from a recent review published in JAMA Network Open, for which researchers analyzed 38 different studies on how long COVID affects exercise.

Their takeaway: Physical activity can feel much more difficult for people with the condition—sometimes taking away up to a decade’s worth of exercise ability—compared to those who had an acute case of COVID, but recovered.

“[This] roughly translates to the expected decrease in exercise capacity by aging one decade,” lead study author Matthew Durstenfeld, MD, MAS, a cardiologist and clinical researcher in the department of medicine at the University of California, told Health. This could look like going from the ability to do light jogging, to only being able to do a brisk walk, he added.

While this may not be the case for everyone with long COVID, it does show that long COVID’s impact on exercise is varied and can be extreme.

“As this is an average, some people experience no decrease in exercise capacity at all,” said Dr. Durstenfeld, “and others experience a really profound decrease in what activities they can do.”

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Decreased Exercise Capacity and Long COVID

Generally speaking, exercise intolerance is the reduced ability to perform typical physical activity, according to Fidaa Shaib, MD, an associate professor of medicine and director of the Baylor College of Medicine’s Post COVID Clinic. 

It’s associated with heart and lung function, and is a common symptom of many chronic diseases including type 2 diabetes and heart failure.

Regarding long COVID and exercise intolerance, Dr. Durstenfeld said that he and his colleagues looked into the connection after seeing participants of another study—the Long-Term Impact of Infection with Novel Coronavirus study—regularly report that they weren’t able to exercise as much or at the same intensity as they had before having COVID.

“For some, it was going from being an elite cyclist to ‘normal,’ and for others from being able to exercise normally to inability to do their regular activities,” said Dr. Durstenfeld. “We wanted to see what other researchers had found and…compare.”

To do that, researchers analyzed 38 different studies with a total of 2,160 participants, and ultimately homed in on nine studies including 464 individuals with symptoms of long COVID and 359 without. 

The studies relied on cardiopulmonary exercise testing (CPET) to measure exercise capacity—specifically their peak oxygen consumption (V̇o2). 

Researchers found differences in the peak Vo2 among people who had symptoms of long COVID more than three months after a bout of COVID, and those who did not.

This reduced exercise capacity, according to Dr. Durstenfeld, equates to patients exercising at the level they would if they were 10 years older. According to an NPR interview, Dr. Durstenfeld agreed that it could look like a 40-year-old person exercising as though they had the capacity of a 50-year-old.

Researchers also said the reduced exercise capability goes beyond just deconditioning, or the physiological changes that come after a period of inactivity; people also experienced dysfunctional breathing, chronotropic incompetence (inability to increase heart rate during exercise), and impaired oxygen uptake and utilization.

But, like with most information surrounding long COVID, much is still unknown about the condition—including its connection to exercise intolerance. 

“No single mechanism emerged” as to why long COVID contributes to a decrease in exercise capacity, said Dr. Durstenfeld. He and his colleagues concluded that more research needs to be done on the connection, but that exercise intolerance should be considered a potential symptom of long COVID.

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How to Manage Exercise Intolerance Due to Long COVID 

Because reduced exercise capability linked to long COVID is more than a deconditioning problem, people aren’t able to simply begin exercising again and easily work their way back to their pre-COVID levels. 

“It is clear that patients impacted with post-COVID conditions cannot easily go to their baseline level of activity,” said Dr. Shaib. “Going back to exercise should be a gradual but well-informed process.”

A discussion with your healthcare provider may be warranted before you try to jump back in. This could look like a cardiopulmonary exercise test—similar to what was used in the studies—to determine where your reduced capacity is stemming from, and how to tackle the issue in a safe and effective way. 

And when you do finally hop back into exercise, it’s essential to take things as easily as possible—and pay attention to your body.

“We have a lot of patients who get really fatigued with a small amount of activity and can’t do any more activity after that,” Jimmy Johannes, MD, a pulmonologist and critical care medicine specialist at MemorialCare Long Beach Medical Center, told Health. “You really have to meter out your activity.”

While it’s unclear how long exercise intolerance can affect those with long COVID, researchers say as more information about the condition surfaces, so too will potential therapies and treatment options—all of which can help people with long COVID begin moving as they’re used to once again.