RECOVER-ENERGIZE explores personalized program to help people with Long COVID regain physical activity

For people living with Long COVID, the lasting symptoms can make even simple movements feel overwhelming. Some people with Long COVID experience exercise intolerance, meaning that they experience extreme exhaustion when completing physical activity. This symptom can be especially difficult for people who engaged in some form of physical activity before they became ill with COVID but now are not able to do the activities they used to do. Traditional rehabilitation models present challenges for people with Long COVID for many reasons. Access can be limited, and the system isn’t always equipped to handle Long COVID symptoms, such as shortness of breath and extreme tiredness that may cause the person to need to stop physical activity altogether.

The RECOVER-ENERGIZE Exercise Intolerance (Personalized Cardiopulmonary Rehabilitation) clinical trial is exploring a program that could help people with exercise intolerance improve their quality of life and ability to exercise. The program, called personalized cardiopulmonary rehabilitation, uses a flexible and tailored approach to meet participants where they are. The study includes coaches, or rehabilitation professionals who develop personalized programs, work with participants during their sessions, and consistently monitor participants throughout all study activities.

“Cardiopulmonary rehab is not a one-size-fits-all intervention,” said Barry J. Make, MD, a pulmonologist (a doctor who specializes in lung conditions) and the RECOVER-ENERGIZE principal investigator. “It’s a personalized, guided approach that adapts to each participant’s needs and energy levels.”

A program tailored to the challenges of managing Long COVID symptoms

RECOVER-ENERGIZE Exercise Intolerance (Personalized Cardiopulmonary Rehabilitation) is a clinical trial designed to test a comprehensive program that combines aerobic and resistance training, flexibility exercises, education, and social support. After a screening process, enrolled participants are randomly assigned to receive either personalized cardiopulmonary rehabilitation (the program being studied) or basic exercise education (the control group) for 3 months. The effectiveness of the program is evaluated at 3 months and 6 months after a participant is enrolled in the trial. More than 40 sites across the country are participating in this research and are currently looking for participants to join the study.

Shilpa Krishnan, PhD, PT, one of the cardiopulmonary rehabilitation coaches and a health outcomes researcher at Emory University, said that the emphasis on “personalized” care means tailoring the study intervention to each participant every week, ensuring that they start wherever they are comfortable.

“If someone says, ‘I’m at 40% today,’ we adjust accordingly to match their rate of perceived effort,” she said. “I also integrate breath work (breathing exercises meant to improve mindfulness) into every session, which helps participants stay present and not worry about what’s next. It’s not just physical—it’s about being mindful and grounded in the moment.”

Coaches adjust the intensity of each session based on how participants feel that day, not just on data from the wearable Fitbits they are given as part of the study. Sessions can be conducted virtually or in person and include continuous monitoring of heart rate and perceived exertion. Participants schedule a full hour with a coach 2 to 3 times a week, and they can text or reschedule based on their needs and symptoms. “That kind of access is rare—and powerful,” Dr. Krishnan added.

While tailoring care to each individual study participant is essential, maintaining consistency is just as important to the program’s design. As Dr. Make explained, “Holding multiple sessions each week helps participants build momentum and confidence. It’s not only about physical improvements—it’s about regaining a sense of control and hope.”

This perspective is echoed by Chandler McDonald, DPT, a physical therapist and cardiopulmonary rehabilitation coach at the University of Utah, who specializes in working with people experiencing Long COVID. “Sometimes participants tell me, ‘I did the session again, and it took my mind off everything else,’” he said.

Dr. McDonald also emphasized how cardiopulmonary rehabilitation coaches consider external stressors that may influence a person’s symptoms. “A participant might report a symptom flare-up, but also mention that a family member is hospitalized,” he said. “That kind of stress can be a major factor for their physical symptoms, and we can help them talk through how to manage it.”

Participant safety and monitoring is a top priority

Although the study is still recruiting participants and no conclusions can yet be drawn, the study is designed with participant safety at its core to better understand how tailored movement, education, and support might contribute to recovery.

Each session begins with a check-in. Participants are then closely monitored using both criteria that can be easily measured, like heart rate, as well as more subjective measures, such as how the patient feels and is perceiving their level of exertion.

“We check in every 5 to 6 minutes during a session,” said Dr. Krishnan. “If someone feels extremely tired, we can switch to breath work, flexibility exercises, and stretching to help them recover and stay within their limits.”

Participants also have access to blood pressure monitors, and any signs of overexertion are addressed immediately. This individualized and responsive approach is designed to reduce the risk of symptom flare-ups. 

“We make sure symptoms don’t increase more than 2 points above baseline within 12 to 48 hours after exercise,” said Dr. McDonald. “It’s all about keeping things tolerable so participants can stay engaged in their daily lives.” 

Actively recruiting participants around the US  

As the RECOVER-ENERGIZE study continues, researchers are gathering valuable insights into how personalized cardiopulmonary rehabilitation may support individuals with Long COVID who experience exercise intolerance. By listening closely to participants and adapting to their needs, the RECOVER-ENERGIZE team is helping to shape a responsive and inclusive model of rehabilitation—one centered on the lived experience of people with Long COVID.

The study continues to recruit participants at study sites around the United States. Learn more about RECOVER-ENERGIZE Exercise Intolerance (Personalized Cardiopulmonary Rehabilitation) on the RECOVER Clinical Trials website, by contacting RECOVERresearch@duke.edu, or visiting ClinicalTrials.gov to find a study site near you.