Long COVID - Heart 2 Heart Cardiac physiotherapy



As we move into another phase of COVID 19 its remnants remain for many individuals with long COVID syndrome. It is an emerging condition that is not yet well understood but can be severely disabling, impacting people regardless of hospitalisation or severity of acute COVID-19. It affects many of the systems in the body and is characterised by fatigue, chest pressure or tightness, breathlessness, headache and cognitive impairment with some individuals experiencing extreme brain fog which worsens with fatigue.

Symptoms of long COVID

As we have all travelled over the course of the last two years so has long COVID leaving some debilitated struggling to maintain independence. It is difficult to understand long COVID but working with clients with long COVID there are key areas that are emerging that will respond to rehabilitation:


  • The fatigue is debilitating and very difficult to quantify – for those of you who may have ran a marathon this is the wall that you hit at the twenty second mile – your body has reached its limit and you are pushing through to the end. Long COVID is like running the last 4.2 miles on a continuum.  With long COVID it is  very different because the recovery is hugely uncertain.  Navigating activities can be challenging as the fear of post exertional fatigue is real and its duration uncertain.  There are a number of factors that contribute to this.
    • In response to activity your arteries around your body widen to allow oxygenated blood to feed the muscles to produce energy. In long COVID this is severely restricted but correct exercise training can enhance the release of nitric oxide in the vessels which allows less resistance to oxygenated blood delivery. This is a very graduated exercise training regime.
    • Exercising past your capability on a continuum causes you to build up waste products in your system. These waste products cause the sensation of fatigue. Continually completing activities past your capability means you are continually building waste products in you system compounding fatigue.
  • Breathlessness: Another symptom is breathlessness which can be more terrifying
    • The waste products also stimulate the breathing centre which gives you a heightened shortness of breath which may be disproportionate to your activity
    • In long COVID we also see significant diaphragmatic dysfunction. The diaphragm is the main muscle that we use to breath.  This dysfunction can mean that individuals have significant breathlessness on low levels of activity but also have reduced capacity to catch their breath.  Also there will be a significant tiring in conversation as the diaphragm tires and there is therefore a reduction in the flow of air through the vocal cords.
  • Brain fog: This can be the most perturbing part of the long COVID syndrome.
    • With a very low exercise capacity all your energy is reserved for activities that preserve you like getting up getting dressed and showered. The lack of exercise capacity can cause some of the cognitive dysfunction but not always.


What to do if you have long COVID?

Seek professional assistance – it is important to know your exercise capacity exactly so you can pace yourself according to this.  Have your cognitive function assessed and commence their recommended training sessions.  Consider a rehabilitation programme where all symptoms can be addressed.

What a cardiac physiotherapist can help you with –

  • Provide a specific graduated exercise programme for you
  • Assess and treat diaphragmatic dysfunction
  • Advise on pacing in line with your exercise capacity

If you are experiencing chest tightness or palpitations it is important that you consult with your GP.


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