Breaking Through the Barrier: How NYC Physical Therapists Are Revolutionizing Long COVID Exercise Intolerance Recovery in 2025
For millions of Americans still grappling with post-COVID symptoms, exercise intolerance has emerged as one of the most debilitating and misunderstood aspects of long COVID recovery. The postacute sequelae of SARS-CoV-2, also known as Long COVID, may affect 10% to 25% of individuals diagnosed with SARS-CoV-2. More than 100 symptoms have been reported among patients with Long COVID, but almost all patients report severe fatigue, orthostatic intolerance, shortness of breath, and reductions in exercise tolerance. As we move through 2025, New York City’s physical therapy community has developed increasingly sophisticated approaches to address this complex condition, moving beyond traditional rehabilitation models to create specialized protocols that acknowledge the unique challenges of long COVID recovery.
Understanding Post-COVID Exercise Intolerance: More Than Just Deconditioning
Recent research has fundamentally changed how healthcare professionals understand exercise intolerance in long COVID patients. “Our findings contradict that hypothesis, and instead support the idea that there is a clear physiologic abnormality underpinning the symptoms experienced by our patients,” explains Yale researchers who conducted advanced invasive cardiopulmonary exercise testing. While iCPET revealed that impaired oxygen extraction was a common occurrence among the post-COVID patients in the study, the test is invasive, time intensive, and not offered in most medical centers. “Our findings not only provide the beginnings of a mechanistic insight into exercise intolerance in those with post-COVID exertional intolerance but also provide an opportunity to consider less invasive diagnostic testing and begin a renewed focus on targeted therapies,” said Kahn.
The post-acute sequalae of SARS-CoV-2, also known as “Long COVID,” is characterized by profound fatigue, impaired functional capacity with post-exertional malaise, orthostatic intolerance, and tachycardia. This constellation of symptoms requires a fundamentally different approach than traditional post-viral rehabilitation, as among a sample of 477 people living with Long COVID, 74.84% reported physical activity made symptoms worse.
The Specialized NYC Approach: Caution Meets Innovation
New York City’s physical therapy community has emerged as a leader in developing evidence-based protocols for long COVID exercise intolerance. Long COVID Physio advocates for extreme caution with exercise and appropriate risk stratification, to exclude post-exertional symptom exacerbation, potential cardiac involvement, exertional destauration, and orthostatic intolerance, before commencing exercise as a rehabilitation intervention. This cautious approach reflects the growing understanding that traditional graded exercise therapy may be contraindicated for many long COVID patients.
Leading NYC facilities have developed comprehensive screening protocols that go far beyond standard fitness assessments. Exercise Training: Tailored exercise programs can improve cardiovascular fitness, muscle strength, and overall stamina. For individuals with POTS (Postural Orthostatic Tachycardia Syndrome), specific exercise considerations include the use of supine and cardio programs. These programs are carefully monitored with frequent vital checks to ensure safety and effectiveness.
Innovative Treatment Modalities in NYC
NYC physical therapists treating long COVID have integrated cutting-edge techniques that address the multisystem nature of the condition. Craniosacral Therapy: This gentle, hands-on technique focuses on relieving tension in the central nervous system. By working on the craniosacral system (the membranes and fluid surrounding the brain and spinal cord), therapists can help reduce stress and promote overall relaxation, which may alleviate some symptoms of dysautonomia.
The most successful programs combine multiple therapeutic approaches. The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Results from such comprehensive programs show promise, with the patient’s muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance.
The NY Spine Medicine Difference: Holistic Care for Complex Conditions
At NY Spine Medicine, the approach to post-COVID exercise intolerance reflects the practice’s core philosophy that comprehensive, individualized care yields the best outcomes. The core belief of our practice is that surgery should be a last resort for treatment of your pain. We exhaust all possible medical options to help our patients recover from their pain as safely and as painlessly as possible. This conservative, patient-first approach aligns perfectly with the careful management required for long COVID recovery.
Our holistic approach encompasses minimally invasive procedures to relieve pain, promote healing, and prevent future injury. At NY Spine Medicine, we are dedicated to the treatment of pain and spine conditions and utilize the most advanced technology and treatment options available in a brand new, state-of-the-art facility. For patients dealing with post-COVID exercise intolerance, this comprehensive approach means access to Physical Therapy NYC services that integrate pain management expertise with specialized rehabilitation protocols.
At NY Spine Medicine, we believe in personalized care. We take the time to listen to your concerns, understand your goals, and develop a customized treatment plan that addresses your specific needs. Our multidisciplinary approach combines the expertise of pain management specialists, physical therapists, and other healthcare professionals to provide you with comprehensive care every step of the way.
Evidence-Based Progress: What the Research Shows
Recent systematic reviews demonstrate the growing evidence base for physical therapy in long COVID management. The results obtained have positive implications for the advancement of physical activity as a therapeutic intervention for individuals with long COVID-19 and the conceptualization of evidence-based treatment protocols. Statistically significant results have been observed in studies of at least 6 weeks duration, in which inspiratory muscle training exercises are proposed.
The key to success lies in careful patient selection and monitoring. Similarly, a meta-analysis of 23 studies (1,579 individuals) suggested that physical exercise-based rehabilitation programs were potential effective therapeutic strategies against PCS, as they resulted in significant improvements in dyspnea, fatigue, exercise capacity, and quality of life when properly implemented.
Looking Forward: The Future of Long COVID Care in NYC
As we progress through 2025, NYC’s approach to post-COVID exercise intolerance continues to evolve. However, many city clinics and hospitals are on the leading edge of understanding and treating it. NYC Health + Hospitals has three Covid-19 centers in the Bronx, Queens, and Brooklyn, offering care for Long Covid. This expanding network of specialized care ensures that patients throughout the metropolitan area have access to expert treatment.
The integration of advanced diagnostic tools with personalized rehabilitation protocols represents the future of long COVID care. However, exercise training appropriately tailored to the patient with cardiovascular deconditioning may be an effective strategy to facilitate improvement in symptoms. Exercise training is increasingly recognized as a potential therapy for management of Long COVID. when combined with proper screening and monitoring protocols.
For individuals struggling with post-COVID exercise intolerance, the message from NYC’s leading physical therapy professionals is clear: recovery is possible, but it requires specialized care that respects the unique challenges of long COVID. Exercise and physical activity may be beneficial for some people recovering from acute COVID-19 and living with Long COVID, but we must do no harm. Therefore caution is advisable, until research is available to guide best practice, on when and for who exercise and physical activity is safer. With the right therapeutic approach, patients can gradually rebuild their exercise tolerance and reclaim their quality of life, one carefully monitored step at a time.