Sarah Thompson is a mother of three children, a part-time real estate agent and an avid runner. Last October, Sarah contracted COVID-19, which caused the characteristic signs and symptoms of fever, fatigue, cough, shortness of breath and loss of taste. After several weeks, Sarah was able to return to her job and usual activities. However, she was surprised to find that she could no longer run without shortness of breath and that episodes of fatigue left her struggling to keep up with activities of daily living. Like 66 percent of individuals with positive SARS-CoV-2 test results (Wanga et al, 2021), Sarah was experiencing persistent symptoms more than four weeks after the initial infection.

Long COVID-19 is a syndrome occurring four or more weeks after COVID-19 infection and lasting for months or years. Occupational and physical therapy play a vital role in the patient’s recovery and return to prior functional levels.


Fatigue is the most common symptom of long COVID-19. Patients with severe or extended disease are more likely to develop chronic fatigue. Occupational and physical therapists can guide, educate and reassure the patient, helping them gradually return to activities through graded functional mobility and ADL training, aerobic exercise and activity pacing (Gaber, 2021)

Respiratory Function

Poor respiratory function limits participation in activities of daily living, work duties and movement around the house. Patients who were previously recreational joggers may have shortness of breath climbing the stairs. Respiratory secretions, diminished air entry and lung scarring are all possible with patients with long COVID-19, even if the patient’s vital signs appear normal during therapy. Deep breathing and core stability exercises with a focus on chest wall expansion can improve respiratory function. Instructing the patient to lift arms above head during inhalation can facilitate chest wall expansion. Physical and occupational therapists should encourage patients to eat a balanced diet and drink plenty of fluids.

Cardiac Endurance

Even patients with mild COVID-19 illness can experience up to 50 percent reduction in cardiac endurance. In a recent case study, a woman with long COVID-19 improved by 60 percent after participating in light to moderate aerobic training under the supervision of a physical therapist.  (Mayer et al, 2021) Activities of interest to patient should be selected (such as dancing, bicycling, aquatic therapy) to improve engagement. Oxygen saturation needs to be monitored throughout the aerobic training sessions and intensity reduced or rests taken if it falls below 94 percent. 

Long COVID-19 is a new syndrome with little published rehabilitation research. Physical and occupational therapists (PT and OT) can draw knowledge and treatment ideas from research on other diseases and conditions such as chronic fatigue syndrome and pneumonia to develop an evidenced-based plan of care. To arm your OTs and PTs with the latest clinal evidence and decision support information to deliver exception patient care, turn to Dynamic Health™.

Dynamic Health is an evidence-based tool designed to help nurses and allied health professionals master skills, obtain fast answers to questions and foster a culture of evidence-based practice and critical thinking leading to improved patient outcomes.


Gaber, Tarek Assessment and management of post‐COVID fatigue. Progress in Neurology & Psychiatry, Jan-Mar2021; 25(1): 36-39. 4p. ISSN: 1367-7543

Mayer, Kirby P; Steele, Angela K; Soper, Melissa K; Branton, Jill D; Lusby, Megan L; Kalema, Anna G; Dupont-Versteegden, Esther E; Montgomery-Yates, Ashley A.  Physical Therapy Management of an Individual With Post-COVID Syndrome: A Case Report. Physical Therapy, Jun2021; 101(6): 1-8.

Wanga V, Chevinsky JR, Dimitrov LV, et al. Long-Term Symptoms Among Adults Tested for SARS-CoV-2 — United States, January 2020–April 2021. MMWR Morb Mortal Wkly Rep 2021;70:1235–1241. DOI: icon