Reeves, Jack, Daynes, Enya, Janaudis-Ferreira, Tania et al. · Brazilian journal of physical therapy · 2026 · DOI
This guideline describes how physiotherapists can manage Long-COVID using evidence-based approaches. The recommendations include assessment of fatigue, post-exertional malaise, breathing problems, cognitive symptoms, and orthostatic intolerance, followed by tailored management such as pacing, energy conservation, breathing retraining, and return-to-work planning. The authors emphasise the importance of validating patient experiences and individualising care, though the evidence base for these specific approaches in Long-COVID remains under development.
Long-COVID and ME/CFS share key clinical features—including post-exertional malaise, fatigue, and cognitive symptoms—that warrant cautious consideration of overlap. By analogy, this guideline's emphasis on screening for red flags before exercise-based interventions and the recommendation to prioritise pacing and energy conservation may be relevant to ME/CFS management. However, Long-COVID remains a distinct population; relevance to ME/CFS should not be assumed without explicit comparative evidence.
This guideline does not establish causal mechanisms in Long-COVID or ME/CFS. It does not report efficacy data from randomised controlled trials, and does not demonstrate that any specific physiotherapy intervention improves outcomes in Long-COVID or ME/CFS cohorts. It does not clarify whether Long-COVID and ME/CFS share identical pathophysiology or whether management strategies effective in one condition will transfer to the other.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Reeves, Jack, Daynes, Enya, Janaudis-Ferreira, Tania, Agarwal, Kriti, Spencer, Lissa, Tsai, Ling-Ling, et al. (2026). Physiotherapy management of Long-COVID: an evidence-based approach.. Brazilian journal of physical therapy. https://doi.org/10.1016/j.bjpt.2026.101609
BibTeX
@article{mecfsatlas-reeves-2026-physiotherapy-management,
author = {Reeves, Jack and Daynes, Enya and Janaudis-Ferreira, Tania and Agarwal, Kriti and Spencer, Lissa and Tsai, Ling-Ling and Alison, Jennifer A},
title = {Physiotherapy management of Long-COVID: an evidence-based approach.},
journal = {Brazilian journal of physical therapy},
year = {2026},
doi = {10.1016/j.bjpt.2026.101609},
note = {PubMed: 42320154},
url = {https://www.mecfsatlas.com/evidence/reeves-2026-physiotherapy-management},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-07-08. https://www.mecfsatlas.com/evidence/reeves-2026-physiotherapy-management
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