5 Exercises to Restore Muscle Strength and Endurance After Long COVID

5 Exercises to Restore Muscle Strength and Endurance After Long COVID


Kevin Shelley
Kevin Shelley


Updated: 3/27/2024


Long COVID can affect anyone, regardless of their original capabilities. A hallmark sign of long COVID is a decrease in exercise tolerance, also known as post-exercise malaise. Post-exercise malaise is associated with impaired daily function and can greatly impact your quality of life.
People with long COVID tend to restrict their daily activities, which can lead to a natural reduction in strength and endurance and a more sedentary, avoidant lifestyle.
Long COVID can indeed be long—years in some cases—and thus, must often be considered a part of everyday life for the afflicted. The resultant inactivity from long COVID can usher in problems of its own: increased weakness with a decreased ability to address it.
So what’s the solution?
In rehab, I’ve generally found that compound movements involving fewer repetitions, lighter weights, and more intense holds can thread the needle between a lack of activity and overexertion.
Keep in mind that this isn’t a “no pain, no gain” presentation easily approached by simply exercising hard because long COVID and post-exercise malaise do not respond well to high-intensity exercise, which can actually provoke it.
The following exercises have proven effective in restoring strength and endurance for my patients without exacerbating their symptoms.

5 Exercises to Restore Strength and Endurance

Given the highly variable nature of long COVID and the different physical starting points between individuals, it’s essential to approach these exercises with caution. Start with a few of them, then build up as your tolerance allows. You may advance quickly or slowly—either is fine. It all depends on how your body responds. It can also be helpful to seek medical advice before initiating these exercises to ensure you’ll be as safe and successful as possible.

1. Walking

One of the safest ways to explore post-COVID activity tolerance is simply to start with walking. It’s easy to scale, easy to pace, and works a combination of muscles instead of placing a strong emphasis on only a few.
Step 1: Start walking slowly at half your normal speed for 5 minutes.
Step 2: If you tolerated the first 5 minutes well, increase your walking speed for 5 additional minutes while carefully monitoring your tolerance.
Step 3: Slow down to half your normal speed before stopping.
Pay particular attention to what your body tells you, especially after exercise. If you’d like, you can start with only a few minutes of walking and increase the time according to your tolerance.

2. Leg Slides/Overhead Reach

This exercise allows you to perform movements while sitting, with a gentle physical challenge due to the low and high reaching.
There are two components to this exercise:
  • Sliding your hands down to your ankles and back
  • Reaching your hands over your head and back
Depending on your tolerance level, you can perform this exercise empty-handed or use small weights to increase the intensity.
(Chung I Ho/The Epoch Times)

(Chung I Ho/The Epoch Times)

Step 1: Sit straight up on the edge of a stable chair with your feet flat on the floor and your hands on your knees.
Step 2: Slowly slide your hands down the front of your legs to your ankles while bending over. Hold for 1 second.
Step 3: Slide your hands back up to your knees and sit up tall. Reach overhead toward the ceiling, then place your hands back on your knees.
Step 4: This counts as 1 repetition. Try to perform 1 set of 10 repetitions. You can carefully increase the repetitions and sets as your tolerance allows.

3. Chair Scooting

This exercise takes something most of us do naturally and turns it into a dedicated exercise by extending the movement time. You can increase or decrease the intensity, depending on your level of exercise tolerance.
(Chung I Ho/The Epoch Times)

(Chung I Ho/The Epoch Times)

Step 1: Sit at the front edge of a sturdy chair with your hands on your knees.
Step 2: Begin “walking” your bottom to the back of the chair by “stepping” back with the right side of your pelvis/bottom and repeating the movement with your left side. The idea is to “walk” to the back of the chair cushion with your bottom. Be sure to keep your hands on your knees and avoid using your arms for assistance.
Step 3: When you reach the back of the chair, slowly “walk” back to the front by reversing the motion.
Step 4: This is considered 1 repetition. Try to complete 12 total repetitions.
This exercise can be challenging, especially after performing several repetitions. One advantage of this exercise is that you’re already sitting if you get tired and need to rest.

4. Arm Lift/Leg Lift

This exercise adds leg movements to the leg slides/overhead reach.
(Chung I Ho/The Epoch Times)

(Chung I Ho/The Epoch Times)

Step 1: Sit upright in a chair with your hands on your knees.
Step 2: In a single move, reach your arms straight up overhead until your elbows are straight, and extend your knees and feet straight out. Take 1 or 2 seconds to move into position.
Step 3: Slowly lower your legs and arms back into the starting position.
Step 4: This counts as 1 repetition. Try to perform 12 repetitions if well-tolerated.
This is a mild exercise that allows you to explore your endurance limits. Observe how your body responds to the first few movements, and increase or decrease the number of repetitions and sets accordingly.

5. Seated March

The seated march allows you to focus on your core muscles and hip flexors while in a seated position. I like it because, like the other exercises, it will enable you to carefully explore your exercise limits as you work to maintain your strength and endurance.
(Chung I Ho/The Epoch Times)

(Chung I Ho/The Epoch Times)

Step 1: Sit upright all the way back into a chair.
Step 2: Lift a knee straight toward the ceiling without extending it; instead, keep it bent.
Step 3: Once you lift your knee as high as it can go, slowly lower it back down to the floor and repeat the movement with your other leg.
Step 4: This counts as 1 repetition. Try to perform 20 repetitions (10 per leg) per set. Start with 1 set and try to work up from there.
This exercise can be scaled easily by increasing or decreasing the number of repetitions and sets, depending on your tolerance.
When approached carefully, these exercises can increase your strength and endurance if you suffer from long COVID and its associated post-exertion malaise. I encourage you to explore these exercises cautiously to see how they work for you. If you experience extreme symptoms, seek medical advice to help you find a more customized solution for your specific needs.

Kevin Shelley is a licensed occupational therapist with over 30 years of experience in major health care settings. He is a health columnist for The Epoch Times.

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