So what training program shouldca long covod patient do

The short version: the evidence does not support a high-intensity interval training program for long COVID. It may help some people and harm others.

The 2022 narrative review found that high-intensity interval training improved 6-minute walk distance by 90-221 meters in 22 previously hospitalized patients, reaching 76-91% of predicted values [1]. But those were people recovering from acute COVID, not people with long COVID and post-exertional malaise. The same review warned that exercise can trigger symptom worsening in people with post-exertional malaise [1].

A 2026 RCT of 250 people with long COVID tested a digital pacing app designed to manage energy and prevent crashes. The app did not reduce post-exertional malaise compared to standard care [14]. Both groups improved the same amount. That matters because pacing is the conservative approach for people who crash after exertion. High-intensity interval training is the aggressive approach. If pacing did not beat standard care, there is no reason to think high-intensity training would.

A 2025 cross-sectional study of 159 adults with post-COVID condition found that 29% had low activity with prolonged sedentary time. People with POTS had 18% fewer steps per day and 33% more sedentary time [16]. The study also found that palpitations, higher BMI, and lower lung function predicted less activity [16]. These are the people most likely to be harmed by pushing too hard.

My call: the evidence does not support a high-intensity interval training program for long COVID. It may help people without post-exertional malaise, but the studies that tested it were in recovered patients, not people with long COVID. For people with post-exertional malaise, high-intensity training risks making symptoms worse. Confidence: moderate.