Published: 18 July 2025
Emerge Australia responds to Medical Republic article about American Heart Association recommendations on exercise and long COVID
Emerge Australia, the national patient organisation for people with myalgic encephalomyelitis, long COVID and other energy limiting diseases, joins Prof David Putrino and Assoc Prof Bernard Shiu, urging extreme caution in promoting exercise for long COVID without first screening for post exertional malaise (PEM). The risks of symptom worsening are real, well-documented, and potentially long-lasting.
What’s happened:
- On June 30, 2025 the American Heart Association published official guidance about how to rehabilitate patients after COVID.
- On 14 July, 2025, online Australian publication Medical Republic published an article in response to the AHA’s article titled “Exercise recommended for long COVID”.
Our concerns:
Medical Republic’s article claims that exercise is beneficial and safe for people with long COVID, citing the American Heart Association (AHA) and referencing deconditioning as a contributing factor. Emerge Australia acknowledges that exercise can be beneficial for some people with long COVID. However, promoting exercise broadly as a treatment for long COVID, without screening for PEM or considering disease subtypes, risks doing real harm to patients.
“Any guidance around physical activity must be anchored in up-to-date, nuanced evidence, not outdated models of fatigue management or assumptions about deconditioning” said Dr David Putrino, Professor of Rehabilitation and Human Performance at the Icahn School of Medicine at Mount Sinai and Emerge Australia Ambassador.
“The science on PEM is now clearer than ever: it is a physiological phenomenon that is biologically distinct from cardiovascular deconditioning. It cannot be cured or improved with graded exercise therapy” Professor Putrino added.
Associate Prof Bernard Shiu, Clinical Director of Banksia Medical Centre and Geelong Long COVID Clinic in Victoria provided the following guidance regarding management of patients in-clinic: “for people with long COVID, especially those at risk of post-exertional malaise, safety starts with listening to the patient, recognising disease subtypes, and following latest evidence.”
Emerge Australia recommends:
- Screening all long COVID patients for post exertional malaise (PEM) before prescribing physical activity, using validated tools (e.g. DePaul Symptom Questionnaire).
- Avoiding graded exercise therapy (GET) and other incremental activity programs in those who screen positive for PEM. For those who don’t screen positive, still use caution.
- Adopting energy management and pacing strategies, with a focus on stabilisng the condition and preventing exacerbation, rather than promoting performance.
Emerge Australia has a range of RACGP-approved GP and patient education modules available about long COVID, ME/CFS, PEM and pacing.
