Effect of using a structured pacing protocol on post‐exertional symptom exacerbation and health status in a longitudinal cohort with the post‐COVID‐19 syndrome

Post‐exertional symptom exacerbation (PESE) is a characteristic symptom of post‐COVID syndrome (PCS). This prospective study investigated the effect of a 6‐week structured World Health Organization (WHO) Borg CR‐10 5‐phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long‐standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ‐5D 5L was completed at the intervention's beginning and end to measure overall health. Thirty‐one participants completed the 6‐week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%−24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ‐5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2−15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS.