Chronic Fatigue and Long Covid Recovery

About chronic fatigue and long covid recovery

What it is, why it happens and what helps. Contents:

• What are ME/CFS and long Covid?
• Common symptoms
• The crash: post-exertional malaise
• Who is affected?
• Pacing and energy management
• Your energy envelope
• Keeping an activity diary
• The power of planned rest
• Breathing retraining
• Brain fog
• Sleep
• Calming the nervous system
• Gentle movement
• Food and hydration
• Looking after your emotions
• Work, study and daily life
• A gentle 30-day plan
• How self-help methods fit in
• FAQs

What are ME/CFS and long Covid?

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a long-term condition that affects many body systems. Its main feature is fatigue that isn’t helped much by rest, along with a worsening of symptoms after activity. Long Covid, which the World Health Organization calls post-COVID-19 condition, describes symptoms that continue or develop at least three months after a Covid infection, last at least two months and can’t be explained by another diagnosis. [3] The two conditions overlap: a review in the Mayo Clinic Proceedings notes that some people develop an illness similar to ME/CFS after Covid, and that the same management approaches can help. [4] You can explore related topics in our Health hub, including energy and fatigue and sleep.

Common symptoms

• Deep tiredness that rest doesn’t fully relieve.
• Feeling worse after physical, mental or emotional effort.
• Unrefreshing sleep.
• Brain fog: trouble with concentration, memory and finding words.
• Muscle or joint aches and headaches.
• Dizziness or a racing heart when standing.
• Breathlessness, especially in long Covid.
• Sensitivity to light, noise or temperature.

Symptoms vary from person to person and can change from day to day. If you have new or worsening symptoms, talk to your doctor so other causes can be checked.

The crash: post-exertional malaise

A key feature of ME/CFS, and common in long Covid, is post-exertional malaise (PEM), often called a “crash”. After doing more than your body can manage, symptoms flare, sometimes a day or two later, and can last days or longer. The trigger might be a walk, a busy day at work, a long conversation or an emotional event. Understanding PEM is the first step to managing it, because it explains why pushing through doesn’t work for these conditions, and why pacing does.

Who is affected?

ME/CFS affects millions of people worldwide, many of whom have not yet been diagnosed. [4] A major review estimated that at least 65 million people around the world have long Covid. [5] It can affect people of any age, background or fitness level, including those who were previously very active. Patient organisations in the UK, the US, Canada, Australia, Europe and India offer information and community support.

Pacing and energy management

Pacing means planning and balancing your activities so that you stay within the energy you have, rather than doing as much as you can on good days and crashing afterwards. The UK’s National Institute for Health and Care Excellence (NICE) 2021 guideline on ME/CFS places energy management at the centre of self-care, and advises people to use a flexible, tailored plan that stays within their current energy limits. [1] Specialists now recommend this approach rather than programmes that steadily increase exercise regardless of symptoms. [4] Pacing applies to all kinds of energy: physical, mental and emotional. The Stanford Long COVID video in Videos explains it clearly.

Your energy envelope

Many people find it helpful to picture their energy as an envelope or a bank account. Each activity spends some energy, and rest tops it up. The aim is to stay inside the envelope most of the time, even on good days. Some people use the “spoon theory”, imagining a set number of spoons each day. Others use a heart-rate monitor, guided by their clinic, to notice when they are close to their limit. Over time, staying inside your envelope can bring more stable days, and some people find their envelope gradually grows.

Keeping an activity diary

A simple diary helps you see patterns. Each day, note what you did, how much rest you took, how you slept and how you felt. After a week or two, you may spot what tends to trigger a crash and what helps you feel steadier. Use the diary to set a baseline: an amount of activity you can manage on most days without a flare. Then plan your days around it, breaking tasks into smaller parts and spreading them through the week.

The power of planned rest

Rest works best when it’s planned, not just taken when you’ve run out. Short rest breaks between activities, lying down with your eyes closed and away from screens and noise, can help your energy go further. Deep rest practices such as non-sleep deep rest (NSDR), guided relaxation and gentle body scans are popular ways to rest well. Rest isn’t laziness. For many people with these conditions, it is an active, essential part of recovery.

Breathing retraining

Breathlessness and changed breathing patterns are common in long Covid. In a trial with 150 people referred from UK long Covid clinics, a six-week online breathing and wellbeing programme from the English National Opera, called ENO Breathe, improved the mental health part of quality of life and reduced breathlessness compared with usual care. [2] Participants said the singing and music approach felt enjoyable and helpful. Gentle breathing practices, such as slow nose breathing and a longer out-breath, can also help you feel calmer. Our breathing guide has more techniques, and the ENO Breathe stories are in Videos.

Brain fog

Brain fog can make it hard to concentrate, remember things or follow conversations. Mental effort uses energy too, so pacing applies here as well. Helpful strategies include doing one thing at a time, using lists, calendars and phone reminders, tackling demanding tasks when your energy is best, reducing background noise and taking short breaks during reading or screen time. Be patient with yourself. Many people find brain fog eases as their overall energy becomes more stable.

Sleep

Sleep is often unrefreshing in ME/CFS and long Covid, and it can be tempting to sleep a lot during the day. A steady routine can help: going to bed and getting up at similar times, keeping the bedroom dark, cool and quiet, and winding down with a calming routine. Daytime rest is still important, but some people find it helps to rest without sleeping for long periods. Our sleep guide has more tips.

Calming the nervous system

Many people with ME/CFS and long Covid notice that their body feels “on alert”, with a racing heart, poor sleep or sensitivity to noise and light. Calming practices may help you feel more settled. Relaxation, meditation and mindfulness can be done lying down and adapted to very low energy. Somatic Experiencing uses gentle awareness of body sensations to help the nervous system settle. Start with a few minutes and stop if you feel tired.

Gentle movement

Movement should always stay within your energy envelope. For some people that might mean gentle stretches in bed. For others, it might mean a short, slow walk or a few minutes of restorative or chair yoga. The NICE guideline advises that any physical activity programme should be personalised, flexible and stay within your limits, ideally with support from a specialist physiotherapist. [1] If an activity leads to a crash, scale it back. Listening to your body is a skill that grows with practice.

Food and hydration

A balanced diet supports overall health, and regular small meals and snacks can help keep energy steady. Some people find it easier to prepare meals on better days and freeze portions for harder ones. Staying well hydrated can help, especially if you feel dizzy when standing, and your doctor may suggest further steps for this. Our guides to healthy eating and gut health have more ideas, and our immune health guide covers everyday habits that support your body.

Looking after your emotions

Living with a long-term, fluctuating illness can bring frustration, grief for your old life, worry about the future and feeling misunderstood. These feelings are natural. Talking to people who understand, whether friends, family, a support group or a counsellor, can help. Many people find comfort in online communities of others with ME/CFS or long Covid. Self-compassion matters too: being kind to yourself on hard days rather than criticising yourself for what you can’t do.

Work, study and daily life

Many people need to make changes at work or in education. Options can include a phased return, reduced or flexible hours, working from home, regular rest breaks and adjusting tasks. In many countries, employers and schools are expected to make reasonable adjustments for long-term health conditions. At home, aids such as a shower stool, online shopping and batch cooking can save energy for the things that matter most to you.

A gentle 30-day plan

Go at your own pace, and skip or repeat any week.

Week 1: Notice. Keep a simple diary of activity, rest, sleep and symptoms.

Week 2: Find your baseline. Use your diary to choose an amount of activity you can manage on most days. Add planned rest breaks.

Week 3: Calm. Add a few minutes of relaxation, breathing or meditation each day, lying down if you prefer.

Week 4: Review. Look back at your diary. What helped? What triggered crashes? Adjust your plan gently.

How self-help methods fit in

Relaxation, meditation and breathwork offer gentle ways to rest and calm the body. Somatic Experiencing helps settle a nervous system that feels on alert, and very gentle yoga or qigong can be adapted to your energy. These work best alongside pacing and the care of your doctor or specialist clinic. You can see every method we cover in the full list above.

Frequently asked questions

What is the difference between ME/CFS and long Covid?

ME/CFS is a long-term condition marked by fatigue and worsening after activity. Long Covid describes symptoms lasting months after Covid. They overlap, and similar self-care approaches help. [4]

What is pacing?

Planning and balancing activities so you stay within the energy you have, which is the core self-help approach in the NICE guideline. [1]

What is post-exertional malaise?

A worsening of symptoms after physical, mental or emotional effort, often a day or two later, sometimes called a crash.

Can breathing exercises help long Covid?

An online breathing and singing programme improved wellbeing and breathlessness in people with long Covid. [2]

Should I exercise with chronic fatigue?

Any activity should be gentle, flexible and within your energy limits, ideally guided by a specialist physiotherapist. [1]

How can I manage brain fog?

Do one thing at a time, use lists and reminders, tackle demanding tasks when your energy is best and take regular breaks.

Do people recover from long Covid?

Many people improve over time. Recovery can be gradual and uneven, and pacing and support help many people feel steadier.

The best videos on chronic fatigue and long covid recovery

Hand-picked and checked one by one: TED, TEDx, Stanford Long COVID Collaborative, NHS and news coverage of ENO Breathe.

Understanding ME/CFS and long Covid

Pacing your energy

Breathing and recovery

Books on chronic fatigue and long covid recovery

Free resources

Experts to follow

Get help

For new or worsening symptoms, please see your doctor.

Find a therapist or counsellor

• US and Canada: Psychology Today (US) and (Canada) directories.
• UK: BACP therapist directory.
• Australia: APS Find a Psychologist, and Relationships Australia for couple and family services.
• Elsewhere, including Europe and India: ask your doctor or local health service for a referral, and check that anyone you see is registered or accredited where you live.

This hub is for information, not a substitute for medical or psychological care.

Sources

1. NICE (2021), Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management, guideline NG206
2. Philip et al. (2022), An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19, The Lancet Respiratory Medicine 10(9):851-862
3. Soriano et al. (2022), A clinical case definition of post-COVID-19 condition by a Delphi consensus, The Lancet Infectious Diseases 22(4):e102-e107
4. Bateman et al. (2021), Myalgic encephalomyelitis/chronic fatigue syndrome: essentials of diagnosis and management, Mayo Clinic Proceedings 96(11):2861-2878
5. Davis et al. (2023), Long COVID: major findings, mechanisms and recommendations, Nature Reviews Microbiology 21(3):133-146

Written by Saj Ali. Last updated 3 November 2026. Spotted an error? Tell us and we will fix it.