As I sit at home recovering from Covid, I thought it was worthwhile to re-visit this blog. Luckily my symptoms have been quite mild, with symptoms such as a scratchy throat, runny nose and a headache.  However, I am still testing positive 8 days after the symptoms first showed themselves so no early release for me from self-isolation.  In my close contact work despite good ventilation and an air filter I just cannot take the risk  as some of my clients are very vulnerable.

You would expect to be lacking in energy for a few days until your body recovers  after catching a virus. But in some cases this tiredness persists long after the virus has cleared up. This is a fairly common occurrence, known in the medical world as ‘post-viral fatigue’. The condition has been under the spotlight recently as many people have suffered ‘Long Covid’, when symptoms of coronavirus persist for more than a month. One of these symptoms is indeed a persistent fatigue.

This blog will consider how exercise – balanced with rest – can help alleviate symptoms of post-viral fatigue, in order to help you make a full recovery.

Symptoms and Causes

Symptoms of post-viral fatigue can vary from person to person, and can fluctuate in severity. As well as the obvious tiredness, someone with post-viral fatigue may experience anything from headaches and muscle pain, to poor sleep and flu-like symptoms such as dizziness and poor temperature control. (For a full list of symptoms read our newsletter which you can access here). 

In this way, it is very similar to the big three stress related conditions of Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome (IBS) and Fibromyalgia (FMS). All have similar and overlapping symptoms which can occur at the same time and diagnosed by predominance. One theory of the underlying mechanism for these conditions is central sensitisation, where the central nervous system ramps up the experience of pain that is not equal to any external stimulus/or any known factor.

However, it is widely agreed that post-viral fatigue is caused when the immune response to a virus continues in the body once the virus has passed. Chemicals known as cytokines that are released to fight off a virus remain present, causing inflammation and preventing the body from functioning as normal. Unlike CFS, it is possible in most cases to make a relatively quick recovery from post-viral fatigue, when a carefully managed recovery programme is followed. Key to this is a good balance of exercise and rest.

Exercise as a Recovery Strategy from Post Viral Fatigue

As a profession, we are normally the first to shout about the benefits of exercise: getting the body moving again within a pain free range after an injury can help speed up the recovery process, and the benefits of a good endorphin rush to everything from sleep to general wellbeing cannot be overstated. So it might sound a little strange to hear us saying that when it comes to exercise to alleviate post-viral fatigue, you should proceed with caution.

The reason for this is that when suffering from post-viral fatigue, your body is particularly susceptible to ‘post-exertional malaise’. As your energy levels can fluctuate from day to day, you might feel like you can take on your normal 5k one day, only to find you feel much worse the next. Sometimes it only takes a very minimal level of activity to provoke symptoms of post-viral fatigue; certainly doing too much too soon can actually impede your recovery. For this reason, we would recommend adopting a ‘Graded Exercise Therapy’ approach or Pacing. Again we have a leaflet on this, which you can download here, but in essence this involves the following steps:

– Find your baseline level (i.e. what you can comfortably do every day, even on a bad day). Note this might be much less than you would normally be used to doing. Gentle stretching and walking are good ways to start.
– Commit to doing this every day. (It helps if the exercise is something you enjoy).
– Build up in small steps as you are ready.

This pacing also relates to activities that require mental exertion such as work, daily chores or socialising.

It can help to set yourself goals, but make sure these are achievable and realistic in order to keep yourself motivated. It doesn’t matter how long it takes to regain your fitness – the most important thing is to exercise frequently.


When suffering from post-viral fatigue, the rest you take is just as important as the exercise you do. It might seem strange, but in this condition that makes you feel tired all the time, the quality of your sleep is often one of the areas that suffers most. Luckily, there are some simple steps you can take to improve your ‘sleep hygiene’. 

Having a regular bedtime routine in place that involves relaxing activities such as a bath or perhaps some breathing exercises can help ‘train’ your body to sleep. It is important to avoid too much stimulation before bed, so try and turn off screens (that includes your phone!) at least an hour before you go down.

It is also a good idea to establish a morning routine. Set an alarm and commit to getting up at the same time each day, no matter how tired you might feel. The sleep you get after hitting the snooze button is rarely restorative, and can result in that ‘groggy’ morning feeling. Finally, no matter how tired you might feel during the day, avoid taking naps. The aim is to establish a solid sleeping pattern, ideally around eight hours, in which your body has the deep, restorative rest it needs. We’ve covered sleep hygiene in more detail at this link.

Related Article

Become A Super Sleeper: 10 Tips On How To Improve Sleep

Other Considerations

We have focused on the physical areas of exercise and rest in this post, though it should be acknowledged that post-viral fatigue is considered a ‘biopsychosocial’ condition, meaning that while it may originate biologically, it affects – and can be affected by – our mental state and social conditions as well. For this reason it might be worth considering some alternative ways to look at treating the condition.


Cognitive behavioural therapy is a form of talking therapy that can help you realise when and how your thoughts might not be helping you achieve the outcomes you desire. The underlying theory behind CBT is that our patterns of thought are extrinsically linked to our feelings, behaviour and physical sensations. This is not to suggest that post-viral fatigue is ‘all in the mind’; rather, exploring CBT as a way to aid recovery from the condition is to acknowledge that it can have an affect on your mental state as well.

We’ve produced a leaflet covering CBT for post-viral fatigue here at this link.


It is also important to acknowledge the effect that social support can have on recovery from post-viral fatigue. The symptoms of PVF can leave you feeling reluctant to socialise and like you want to withdraw until you feel better. However, it is important to maintain some social activity, as isolation can add to feelings of fatigue and have a negative impact on your wellbeing. If seeing your friends feels like too much, it may be worth considering a support group for those with PVF.

In Summary

In summary, post-viral fatigue is a very real, and debilitating condition that affects those suffering in a variety of different ways. If not managed correctly, it can lead to the more serious, long term Chronic Fatigue Syndrome. However, research has shown that massage has a positive effect on depression and somatic symptoms “The depression, anxiety, and pain not only decreased immediately after receiving the 1st massage, but continued to decrease over the 5-wk treatment period. Massage Therapy helped alleviate not only fatigue symptoms but other somatic symptoms associated with CFS.

By taking a proactive approach to managing the condition, and with help and support the condition will usually abate over time.

For advice on any other aspect of the topics we have covered today or to have a chat about how massage and reflexology can help download our free resource pack here or give us a call and we’ll be happy to chat about building a therapeutic alliance that best fits your current condition and goals.

References: Field, Tiffany & Sunshine, William & Hernandez-Reif, Maria & Quintino, Olga & Schanberg, Saul & Kuhn, Cynthia & Burman, Iris. (2011). Massage Therapy Effects on Depression and Somatic Symptoms in Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome. 3. 43-51. 10.1300/J092v03n03_03.