Top Things to Know: Exercise Intolerance and Response to Training in Patients with Post-Acute Sequelae of SARS-CoV2 (Long COVID)
Published: June 30, 2025
- This Scientific Statement provides a concise yet comprehensive overview of mechanisms contributing to the development of Long COVID, as well as methods by which exercise training may be applied to this unique patient population to alleviate symptoms and improve quality of life.
- Long COVID is a devastating syndrome, impacting up to 25% of individuals previously infected with SARS-CoV-2. While multiple factors contribute to the development of this syndrome, there is accumulating evidence that cardiovascular deconditioning is a central component of the pathophysiology.
- This deconditioning results from a relative reduction in physical activity in the setting of the index infection and its quarantine/confinement, and leads to cardiac atrophy, a reduction in ventricular distensibility and reductions in stroke volume for any given filing pressure.
- Clinically, this phenomenon results in symptoms including lightheadedness and orthostatic intolerance, brain fog/confusion, tachycardia with minimal effort, palpitations, dyspnea on exertion and severe fatigue/exhaustion.
- Reductions in peak oxygen uptake (VO2peak), observed among individuals with Long COVID, are comparable to reductions observed among individuals suffering from cardiovascular deconditioning as a result of bedrest.
- Emerging data indicate that exercise training programs improve key outcomes in Long COVID including VO2peak, six-minute walk distance, and metrics of fatigue, dyspnea or quality-of-life.
- An exercise prescription specifically tailored to the patient with cardiovascular deconditioning may be an effective method of improving symptom severity in these patients.
- Robust data from large registries of US athletes show a low prevalence of cardiac issues post-COVID-19, with no reported acute cardiac deaths or arrests. Therefore, current return-to-play (RTP) guidance suggests cardiac evaluations only for athletes presenting these symptoms.
- A shared decision-making process should be incorporated to determine the best methods for incorporating an exercise program into patient management, as well as diagnostic/clinical evaluation for determining optimal timing for RTP in athletes.
- Further research is necessary to understand mechanisms contributing to the multiple organ systems and symptoms characteristic of this syndrome, which will inform development of additional treatment algorithms to alleviate symptom burden.
Citation
Cornwell WK 3rd, Levine BD, Baptiste D, Bhave N, Desai S, Dineen E, Durstenfeld M, Edward J, Huang M, Jacobsen R, Kim J, Spatz E; on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Hypertension; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Exercise intolerance and response to training in patients with postacute sequelae of SARS-CoV2 (long COVID): a scientific statement from the American Heart Association. Circulation. Published online June 30, 2025. doi: 10.1161/ CIR.0000000000001348