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Use of symptom-guided physical activity and exercise rehabilitation for COVID-19 and other postviral conditions
  1. Peter Ladlow1,2,
  2. R Barker-Davies1,3,
  3. O Hill4,5,
  4. D Conway5,6 and
  5. O O'Sullivan1,7
  1. 1Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
  2. 2Department for Health, University of Bath, Bath, UK
  3. 3School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
  4. 4Specialist Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
  5. 5Department of Cancer and Surgery, Imperial College London, London, UK
  6. 6Pulmonary and COVID-19 Rehabilitation, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
  7. 7Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Peter Ladlow, Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough LE12 5BL, UK; peter.ladlow100{at}


There are many similarities in symptoms between postviral conditions, including clinical features such as fatigue, reduced daily activity and postexertional symptom exacerbation. Unfavourable responses to exercise have influenced the wider debate on how to reintegrate physical activity (PA) and exercise while simultaneously managing symptoms during recovery from post-COVID-19 syndrome (or Long COVID). This has resulted in inconsistent advice from the scientific and clinical rehabilitation community on how and when to resume PA and exercise following COVID-19 illness. This article provides commentary on the following topics: (1) controversies surrounding graded exercise therapy as a treatment modality for post-COVID-19 rehabilitation; (2) evidence supporting PA promotion, resistance exercise and cardiorespiratory fitness for population health, and the consequences of physical inactivity in patients with complex rehabilitation needs; (3) population-based challenges for UK Defence Rehabilitation practitioners for the management of postviral conditions; and (4) ‘symptom guided PA and exercise rehabilitation’ as an appropriate treatment option for managing individuals with multifaceted medical needs.

  • COVID-19

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  • Contributors PL, RB-D, OH, DC and OO'S conceived the study idea and were involved in article planning. PL wrote the first draft. OO'S reviewed the first draft. PL, RB-D, OH, DC and OO'S reviewed, contributed to and approved the final manuscript. PL and OO'S are responsible for the overall content and act as the guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.