Is it safe to exercise with long COVID? I have heard exercise can make it worse.

You are right to be cautious - graded exercise therapy that pushes through symptoms is now actively cautioned against in the NICE guidance because of post-exertional malaise. R1SE's approach is the opposite: start with our zero-effort therapies (Red Light, Compression, HBOT, infrared sauna), and only add gentle Yin yoga or Mat Pilates if and when your energy envelope reliably allows it. We pace with you, not at you. Always involve your GP or long COVID clinic in any new programme.

What is post-exertional malaise (PEM) and how do I know if I have it?

PEM is a delayed worsening of symptoms 12-48 hours after physical, cognitive, or emotional exertion - sometimes called 'payback' or 'crashes.' If a walk on Monday wipes you out on Wednesday, you are in PEM territory. The presence of PEM is the single most important reason to avoid any 'push through it' rehabilitation. Our recovery-focused therapies (HBOT, Red Light, Compression) are PEM-safe; movement is added only when your envelope is stable.

How many HBOT sessions do I need for long COVID?

The published RCT used a protocol of 40 sessions over 8-10 weeks (5 sessions/week, 90 minutes at 2.0 ATA). Most members report meaningful improvements in fatigue and brain fog within the first 10-15 sessions, but the full neurological adaptations - particularly improvements in brain perfusion and tissue oxygenation - typically need the full course. We can discuss a personalised plan, including reduced-frequency options for those with severe fatigue.

I have POTS or autonomic symptoms with long COVID. What should I avoid?

Avoid cold immersion, hot saunas above 70°C, and any session involving rapid postural change (vinyasa flows, sudden inversions) until you have stabilised. Compression therapy is excellent for POTS - it directly addresses venous pooling. Mat Pilates (supine) and HBOT (lying down) are also POTS-safe. Ask the team and we will adapt every session for you.

Can I combine multiple therapies safely?

Yes, and most of our long COVID members do - HBOT 2-5x/week, Red Light 2-3x/week, Compression after any exertion, and gentle yoga or Pilates as energy allows. The combination is often more effective than any single therapy. We will help you build a schedule that respects your energy budget rather than depleting it.

Do I need a referral from my doctor?

No referral is needed for any of our services. However, if you are under active medical care - long COVID clinic, cardiology, neurology, or a private specialist - we strongly recommend discussing your R1SE programme with them, particularly the HBOT protocol. We are happy to share information directly with your clinical team.

How long until I feel a difference?

It varies enormously by severity. Members with mild long COVID often report meaningful changes in fatigue and clarity within 2-4 weeks of HBOT and Red Light Therapy. More severe presentations - particularly those with strong PEM and POTS - typically need 8-12 weeks before stable improvement is visible, and the trajectory is rarely linear. Patience is part of the protocol.

Is R1SE suitable if I am housebound or only able to do one session a week?

Yes. Many of our long COVID members started by visiting once a week for a single Red Light or Compression session. We have parking close to the door, comfortable rest spaces between treatments, and instructors trained to recognise when you need to stop. If a single visit involving HBOT is what you can manage, that is enough to start.

Will any of this help with long COVID brain fog specifically?

Brain fog is one of the most-improved symptoms in our long COVID members. HBOT is the most targeted therapy - the Tel Aviv RCT showed measurable improvements in processing speed, attention, and memory on neuropsychological testing, with corresponding changes on brain perfusion imaging. Red Light Therapy and gentle breathwork support cognitive recovery alongside.

Health & Wellbeing

Long COVID Recovery

Breathe. Heal. Rebuild.

Important: R1SE services are complementary wellness support, not medical treatment. Always consult your healthcare provider before starting any new programme, especially if you are under active medical care.

Long COVID can leave you with fatigue that sleep does not fix, brain fog that makes simple decisions exhausting, breathlessness, post-exertional malaise, and a body that no longer feels like your own. The emerging clinical evidence is clear about what helps and what makes things worse - and at R1SE Sheffield we combine HBOT, Red Light Therapy, Compression, and carefully paced gentle movement into a recovery protocol that respects your energy envelope and rebuilds capacity over months, not days.

Long COVID is now understood as a multi-system condition involving microclots, mitochondrial dysfunction, neuroinflammation, autonomic dysregulation, and persistent inflammation - not deconditioning. That distinction matters, because the rehabilitation approaches that work for ordinary deconditioning (graded exercise pushed too hard) actively make long COVID worse through post-exertional malaise (PEM). Our approach follows what the research and patient communities (NICE, ME Association, Long COVID Physio) actually support: pacing, oxygen-based therapies (HBOT), mitochondrial support (red light), inflammation reduction (compression), and only the gentlest reconditioning when energy permits. We will never push you past your envelope.

Recommended for You

Hyperbaric Oxygen Therapy Red Light Therapy Compression Therapy

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Your Multi-Therapy Plan

How R1SE Can Help

Hyperbaric Oxygen Therapy

Recovery

HBOT is currently the most evidence-backed therapy for long COVID. A 2022 RCT published in Scientific Reports demonstrated significant improvements in cognitive function, fatigue, sleep, and quality of life after 40 sessions. Pressurised oxygen reaches tissues that compromised circulation cannot, addresses the microclots and hypoxia increasingly recognised as central drivers, and stimulates stem cell mobilisation for tissue repair.

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Red Light Therapy

Recovery

Mitochondrial dysfunction is now considered a core feature of long COVID. Red and near-infrared light at 660-850nm restores mitochondrial membrane potential, increases ATP production, and reduces the cellular energy deficit that drives post-exertional malaise. Zero physical exertion required - ideal for low-energy days.

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Compression Therapy

Recovery

Sequential pneumatic compression enhances venous and lymphatic return, reduces the inflammatory cytokine burden (notably IL-6) elevated in long COVID, and supports the autonomic system through gentle peripheral input. Particularly useful for the orthostatic intolerance and POTS-like symptoms many sufferers experience.

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Hot Yoga

Movement

Only when your energy envelope allows. Gentle Yin or Hatha yoga in the heated room rebuilds breathing capacity, supports vagal tone (commonly disrupted in long COVID), and provides a low-impact reconditioning stimulus - but only at an intensity you can recover from within 24 hours. Skip if you are in a flare.

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Mat-Based Pilates

Movement

Slow, breath-led, supine Pilates is one of the safest entry points for long COVID. No standing required, no sustained cardiovascular load, and the breath emphasis directly addresses the dysfunctional breathing pattern that affects up to 50% of long COVID patients.

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Fire & Ice Thermal Cycling

Recovery

Cautious use only, late in recovery. Heat exposure has anti-inflammatory and BDNF-raising effects, but cold exposure can trigger autonomic instability in active long COVID and POTS. We recommend infrared sauna alone (no cold) until you have a stable energy envelope, then introducing brief cold under guidance.

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The Science

Evidence-based insights supporting our approach.

A 2022 randomised controlled trial published in Scientific Reports (Zilberman-Itskovich et al.) found that 40 HBOT sessions significantly improved cognitive function, fatigue, sleep, psychiatric symptoms, and pain in long COVID patients versus sham, with measurable improvements on brain perfusion imaging.

Up to 70% of long COVID patients show evidence of microclots and persistent endothelial dysfunction - mechanisms that HBOT and compression therapy directly address (Pretorius et al., Cardiovascular Diabetology).

Mitochondrial dysfunction in skeletal muscle is now a confirmed feature of long COVID. Red light therapy at 660nm has been shown to restore mitochondrial membrane potential and increase ATP production by up to 40% (Hamblin, Photobiomodulation).

NICE long COVID guidance (NG188) explicitly cautions against graded exercise therapy that pushes through symptoms, and recommends pacing and energy management as the foundation of rehabilitation.

Post-exertional malaise (PEM) - a worsening of symptoms 24-48 hours after exertion - affects up to 89% of long COVID patients and is the cardinal symptom that distinguishes it from ordinary deconditioning. Any reconditioning programme must be sub-PEM threshold.

Compression therapy reduces inflammatory cytokines including IL-6 and TNF-alpha, which are persistently elevated in long COVID and linked to fatigue severity (Frontiers in Immunology, 2022).

Vagal tone (heart rate variability) is reduced in 60-70% of long COVID patients. Slow nasal breathing, gentle yoga, and red light therapy all support vagal recovery without provoking PEM.

Photobiomodulation has emerging evidence for transcranial application in post-COVID brain fog, with pilot studies showing improvements in processing speed and verbal memory.

Common Questions

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Chronic Fatigue & ME

ME/CFS is one of the most misunderstood conditions - and the worst advice anyone can give is to push through it. At R1SE Sheffield, we offer pacing-compatible recovery therapies that support your body without depleting your limited energy reserves.

Move through it.

Anxiety & Depression

When your mind feels heavy, moving your body can feel like the last thing you want to do - but the science is unambiguous: structured movement, breathwork, and controlled stress exposure are among the most powerful evidence-based interventions for anxiety and depression. A 2023 BJSM meta-analysis found exercise was 1.5x more effective than antidepressant medication or CBT for depressive symptoms. R1SE Sheffield gives you a non-clinical, judgement-free space where that evidence becomes part of your daily life.

Breathe deeper.

Respiratory Health

Whether you live with asthma, reduced lung capacity, or respiratory issues from a past illness, the ability to breathe fully and confidently is transformative. At R1SE Sheffield, we combine breathwork training, oxygen therapy, and gentle movement to rebuild your respiratory strength and confidence.

The root cause of almost everything. Addressed here.

Chronic Inflammation

Chronic low-grade inflammation is now recognised as the driving factor behind cardiovascular disease, type 2 diabetes, Alzheimer's, autoimmune conditions, depression, chronic pain, and accelerated ageing. Unlike acute inflammation (which heals you), chronic inflammation silently damages tissues over years and decades. At R1SE Sheffield, we offer the most comprehensive anti-inflammatory therapy protocol in the region - HBOT, Red Light Therapy, contrast therapy, compression, and targeted exercise - each independently shown to reduce inflammatory markers, and together addressing inflammation from every pathway simultaneously.

You are not lazy. You are depleted. There is a difference.

Burnout Recovery

Clinical burnout is not just being tired - it is a recognised occupational syndrome characterised by emotional exhaustion, depersonalisation, and a collapse of personal efficacy that makes even simple tasks feel impossible. An estimated 1 in 4 UK workers experience burnout, yet most try to push through rather than rebuild. At R1SE Sheffield, we combine Fire & Ice contrast therapy, HBOT, Red Light Therapy, Hot Yoga, and Reformer Pilates into a structured recovery protocol that addresses burnout at every level - nervous system, hormonal, cognitive, and physical - because burnout breaks you at every level, and recovery requires rebuilding at every level.

Ready to Start?

Whether you want to book a session, explore our recovery therapies, or speak to someone about a personalised plan - we are here for you.

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Long COVID Recovery

How R1SE Can Help

Hyperbaric Oxygen Therapy

Red Light Therapy

Compression Therapy

Hot Yoga

Mat-Based Pilates

Fire & Ice Thermal Cycling

The Science

Common Questions

Chronic Fatigue & ME

Anxiety & Depression

Respiratory Health

Chronic Inflammation

Burnout Recovery

Ready to Start?

Long COVID Recovery

How R1SE Can Help

Hyperbaric Oxygen Therapy

Red Light Therapy

Compression Therapy

Hot Yoga

Mat-Based Pilates

Fire & Ice Thermal Cycling

The Science

Common Questions

Speak to Our Team

Chronic Fatigue & ME

Anxiety & Depression

Respiratory Health

Chronic Inflammation

Burnout Recovery

Ready to Start?

Speak to Our Team