Lifestyle Medicine and Long COVID in Viet Nam: Pacing, Rehabilitation Safety, and the Limits of Exercise

Lifestyle Medicine and Long COVID in Viet Nam: Pacing, Rehabilitation Safety, and the Limits of Exercise

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

Someone recovering from COVID-19 may manage a short walk, prepare a meal, or return to work for a few hours and feel reasonably well afterward. The difficulty may come the following day, when overwhelming fatigue, increased pain, dizziness, or difficulty concentrating makes even ordinary activities harder than before.

For many health conditions, reduced physical capacity is addressed through a gradual return to activity. Exercise is also one of the established pillars of Lifestyle Medicine. Yet this familiar approach presents a particular challenge in Long COVID: some people experience significant worsening of symptoms after physical or cognitive exertion, even when the activity initially seemed manageable.

Encouraging these patients to increase exercise without understanding their symptom patterns may cause setbacks rather than improvement.

This does not mean that exercise is inappropriate for everyone with Long COVID. Some people may benefit from carefully selected rehabilitation training, while others need different approaches to managing symptoms and daily activities. The challenge is identifying who may benefit from exercise, who requires further clinical assessment, and when increasing activity could be harmful.

For the Vietnam Lifestyle Medicine Alliance (VLMA), Long COVID offers an important example of why evidence-based Lifestyle Medicine requires clinical judgment, individualized care, and an understanding of the limits of general lifestyle advice.

Long COVID Is Not Simply a Problem of Reduced Fitness

Long COVID, also known as post-COVID-19 condition, is a complex condition that can affect multiple organ systems following infection with severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19.

People may experience persistent or recurring fatigue, breathlessness, cognitive difficulties, sleep disturbances, muscle or joint pain, dizziness, and reduced ability to manage everyday activities. Symptoms may fluctuate, improve, return, or emerge after the initial infection has resolved.

The World Health Organization's clinical case definition describes post-COVID-19 condition as occurring in people with a history of probable or confirmed infection, usually three months after the onset of COVID-19, with symptoms lasting at least two months that cannot be explained by another diagnosis.

This definition provides a common reference for clinical care and research, although terminology and diagnostic frameworks differ between organizations.

Long COVID can develop after either mild or severe acute illness. Some people have persistent respiratory or physical limitations following hospitalization, while others experience substantial fatigue, cognitive difficulties, or intolerance to activity despite having had a relatively mild initial infection.

Reduced physical capacity does not necessarily have a single explanation. Physical deconditioning may contribute to weakness and reduced exercise tolerance, particularly after prolonged hospitalization or inactivity. However, it should not be assumed to explain every case of persistent fatigue, breathlessness, or difficulty tolerating exertion.

Cardiovascular or respiratory complications, autonomic dysfunction, sleep disorders, and other medical conditions may contribute to symptoms and require appropriate assessment.

The US Centers for Disease Control and Prevention, in its clinical guidance updated on March 9, 2026, emphasizes that no single laboratory test can definitively diagnose or exclude Long COVID. Normal routine investigations do not, by themselves, establish that a person's symptoms are insignificant or unrelated to illness.

At the same time, clinicians should remain alert to alternative diagnoses, complications, and treatable coexisting conditions.

A careful clinical history should therefore explore not only which symptoms a person experiences, but also how those symptoms change over time, what appears to trigger them, and how they affect daily functioning.

Why Symptoms After Exertion Change the Rehabilitation Approach

One of the most important considerations in Long COVID rehabilitation is post-exertional symptom exacerbation. The related term post-exertional malaise is also widely used in clinical guidance and research.

These terms describe overlapping patterns of worsening symptoms following physical, cognitive, emotional, or other exertion that the person would previously have tolerated.

The response may not occur immediately. According to the US Centers for Disease Control and Prevention, symptoms commonly worsen 12 to 48 hours after activity and may persist for days or even weeks.

A person might complete a rehabilitation session without obvious difficulty but become significantly more fatigued the following day. Another might manage several hours of concentrated work before experiencing increased cognitive difficulties, pain, or other symptoms that require prolonged recovery.

The triggering activity does not necessarily have to be strenuous. Household tasks, prolonged standing, social commitments, mental concentration, or a combination of activities may contribute to symptom exacerbation.

This pattern differs from ordinary tiredness after exercise or the temporary discomfort that someone with reduced physical conditioning might experience when beginning an appropriate training program.

For healthcare professionals, the important question is not only whether someone can complete an activity, but what happens afterward.

Does the person experience worsening symptoms later that day or the following day? How long does recovery take? Have previous attempts to increase activity caused prolonged setbacks? Does the person repeatedly alternate between relatively active days and periods of significant deterioration?

These questions may reveal a pattern that is not apparent during a brief clinical appointment.

Recognizing post-exertional symptom exacerbation is particularly important before recommending progressive exercise. A patient who experiences delayed deterioration after modest activity may respond very differently from someone whose main limitation is physical deconditioning without this symptom pattern.

Applying the same exercise progression to both patients may expose the more vulnerable person to unnecessary harm.

Pacing: Managing Activity Within Current Capacity

Pacing is an approach to activity management intended to help people balance activity and rest within their current capacity while reducing episodes of symptom exacerbation.

It involves recognizing individual limits, identifying activities associated with deterioration, and adjusting the amount, duration, or timing of activity accordingly.

Importantly, pacing is not limited to physical exercise. Cognitive work, social interactions, emotional demands, household responsibilities, and other everyday activities may all contribute to the overall burden experienced by someone with Long COVID.

A person who becomes exhausted after completing household tasks in one morning may benefit from dividing those tasks into shorter periods or distributing them across several days. Someone who experiences dizziness or fatigue after prolonged standing may need to modify how they prepare meals or perform other household activities.

For a person returning to work, pacing may involve shorter working periods, scheduled breaks, adjustments to responsibilities, or changes in working hours based on actual symptom tolerance.

The goal is not permanent inactivity. It is to reduce repeated episodes of overexertion while preserving as much meaningful activity and independence as safely possible.

The World Health Organization's June 2025 clinical management guideline includes a conditional recommendation supporting education and skills training in energy conservation, including pacing approaches, for people with post-COVID-19 condition who experience post-exertional symptom exacerbation.

This recommendation draws largely on expert evidence, patient experiences, and related clinical knowledge rather than direct randomized trials establishing the effectiveness of specific pacing strategies in Long COVID. That limitation should be considered when discussing the expected benefits.

Pacing should not be confused with a fixed program of progressively increasing exercise regardless of symptoms. Its starting point is the person's current capacity and response to activity, rather than a predetermined requirement to increase physical effort.

The World Health Organization specifically advises against rehabilitation programs based on fixed incremental increases in physical activity for people experiencing post-exertional symptom exacerbation.

Pacing also needs to remain flexible. Some people experience substantial variation in symptoms from day to day. A relatively good day may create an understandable desire to complete activities that have accumulated during periods of illness. However, attempting to compensate for previous inactivity may trigger another episode of deterioration.

A simple record of activities, symptoms, and recovery may help identify patterns that are otherwise difficult to recognize. Such records should remain practical and should not create additional fatigue or psychological burden.

Pacing is not a cure for Long COVID. Its potential value lies in supporting activity management, reducing avoidable overexertion, and helping people understand how their symptoms respond to different demands. The most effective approaches for different patient groups and their long-term outcomes remain areas requiring further research.

Rehabilitation Safety Comes Before Exercise Progression

Before recommending structured physical exercise training, healthcare professionals need to consider whether the planned activity could expose the patient to additional risk.

The World Health Organization's June 2025 living guideline includes a strong recommendation that exertional oxygen desaturation and cardiac impairment following COVID-19 should be ruled out and appropriately managed before physical exercise training is considered.

The guideline also recognizes that post-exertional symptom exacerbation and orthostatic intolerance require modifications to rehabilitation interventions.

Although this is a strong safety recommendation, its supporting evidence is largely expert-informed rather than derived from high-certainty randomized clinical trials. It reflects the potentially serious consequences of overlooking relevant cardiovascular or respiratory problems before introducing additional physical demands.

This does not mean that everyone with Long COVID requires extensive investigations before undertaking ordinary daily activities. Clinical assessment should be proportionate to the person's symptoms, medical history, examination findings, and the type of rehabilitation being considered.

Persistent or disproportionate breathlessness, chest discomfort, palpitations, significant dizziness, or symptoms that worsen when standing may warrant further evaluation.

New or severe chest pain, fainting, marked respiratory distress, or other acute warning signs require urgent medical assessment rather than continued exercise.

Orthostatic intolerance deserves particular attention. Some people experience dizziness, palpitations, weakness, fatigue, or other symptoms when standing or remaining upright. These symptoms may be associated with autonomic dysfunction and can make prolonged standing or upright exercise difficult to tolerate.

For such patients, rehabilitation may require changes in posture, activity duration, and the type of exercise or functional training used.

The assessment process itself also needs careful consideration. Physical performance tests can provide useful information in selected patients, but exertional assessments may provoke significant symptom exacerbation in people with post-exertional malaise.

Testing should therefore have a clear clinical purpose and be selected according to the individual's condition and ability to tolerate the procedure. When significant post-exertional symptom exacerbation is present, exercise-based tests may need to be modified, deferred, or avoided.

The objective is to obtain information necessary for safe clinical decisions without imposing an unnecessary physical burden or provoking avoidable deterioration.

When Exercise May Help, and When It May Not

Recognizing post-exertional symptom exacerbation should not lead to the opposite assumption that exercise is inappropriate for everyone with Long COVID.

For selected patients without post-exertional symptom exacerbation and without unresolved clinical contraindications, carefully planned rehabilitation may improve physical capacity, breathlessness, and aspects of quality of life.

The World Health Organization supports cautious, symptom-guided physical exercise training for selected rehabilitation needs in the absence of post-exertional symptom exacerbation.

A clinical practice guideline published in the European Respiratory Journal in July 2026 similarly suggests personalized rehabilitation training for adults with Long COVID, following appropriate screening to exclude patients with post-exertional malaise from the recommended exercise-based approach, under the guidance and supervision of healthcare professionals.

This is a conditional recommendation supported by low-certainty evidence.

That qualification matters because average improvements observed in clinical studies do not establish that every patient with Long COVID will benefit from the same intervention.

Research has included different patient populations, rehabilitation methods, outcome measures, and follow-up periods. Some studies have also inadequately assessed or reported post-exertional malaise, making it difficult to determine whether their findings apply to people with significant exertional symptom exacerbation.

An evidence-based review published in the Brazilian Journal of Physical Therapy in June 2026 emphasizes individualized assessment, screening for clinical warning signs, and recognizing post-exertional malaise before exercise is prescribed.

For patients who can safely participate in exercise-based rehabilitation, the type, intensity, duration, and progression of activity should reflect their symptoms, functional limitations, clinical findings, and recovery response.

Monitoring should extend beyond what happens during an exercise session. Delayed worsening of fatigue, pain, cognitive symptoms, or other problems may indicate that the current program needs to be reconsidered.

For people experiencing post-exertional symptom exacerbation, activity management and symptom stabilization may be more appropriate than structured exercise training aimed at progressively increasing endurance. Carefully selected movements or essential functional activities may still be considered within individual tolerance, but they should not become a fixed progression that continues despite deterioration.

Some severely affected individuals may need assistance with basic daily activities and symptom management before more demanding rehabilitation can be contemplated.

These distinctions are not arguments against rehabilitation. They reflect the need to select an appropriate form of rehabilitation based on the patient's clinical presentation and response.

Rehabilitation Is Broader Than Physical Exercise

The impact of Long COVID often extends beyond walking distance, muscle strength, or exercise endurance.

One person may be able to walk a reasonable distance but struggle to concentrate long enough to complete a work assignment. Another may tolerate ordinary movement at home but experience dizziness during prolonged standing. Others may have persistent breathlessness, disturbed sleep, pain, or difficulties returning to social and family activities.

These limitations may require different forms of rehabilitation and supportive care.

Depending on clinical needs, interventions may include education on symptom management, occupational therapy, appropriate breathing strategies, cognitive rehabilitation approaches, energy conservation, psychological support, and assistance with returning to everyday activities.

Some patients may also require specialist assessment or treatment for respiratory, cardiovascular, neurological, autonomic, or other medical conditions.

Psychological support can be valuable when chronic symptoms affect emotional well-being, relationships, or daily functioning. However, offering psychological support should not imply that Long COVID is primarily psychological in origin or that persistent physical symptoms result from insufficient motivation.

The 2026 European Respiratory Journal guideline conditionally suggests cognitive behavioral therapy for selected adults with Long COVID-related fatigue, based on low-certainty evidence. The guideline explicitly distinguishes potential symptomatic benefits from any claim that the underlying condition is psychologically caused.

For healthcare professionals, this distinction is important. Mental health needs deserve appropriate attention, but they should not be used to dismiss physical symptoms or replace necessary medical assessment.

The World Health Organization also recognizes the role of assistive products, environmental modifications, and individualized support for returning to daily activities.

Meaningful rehabilitation should therefore consider the person's ability to function and participate in everyday life, rather than focusing only on improvements in physical performance tests.

Returning to Work Requires More Than a Successful Trial Day

Returning to work can be particularly challenging for people whose symptoms fluctuate or worsen after exertion.

A person may manage several hours at work and appear ready to resume normal duties, only to experience significant fatigue, pain, or cognitive difficulties afterward. The ability to complete a task once does not necessarily demonstrate the ability to repeat it consistently throughout a working week.

Physical demands, concentration requirements, commuting, prolonged standing, irregular schedules, and limited opportunities for rest may all influence whether a return is sustainable.

The World Health Organization's rehabilitation guidance supports individualized and flexible phased return-to-work planning. Depending on the person's circumstances, this may include modified working hours, adjusted responsibilities, scheduled breaks, or changes to the workplace environment.

A suitable plan should consider both the demands of employment and the patient's responsibilities outside work.

Someone may be able to perform several hours of office work but have little capacity remaining for household responsibilities or caregiving. Another may struggle with a physically demanding occupation despite being able to complete basic activities at home.

Employers and healthcare professionals may need to communicate, where appropriate and with due regard for the patient's wishes and applicable confidentiality requirements, to identify feasible adjustments.

For the patient, the objective is not necessarily to return to previous working hours as quickly as possible. It is to achieve a sustainable level of participation without repeatedly triggering deterioration.

This requires follow-up and a willingness to revise the plan when symptoms, functional capacity, or work demands change.

Where Lifestyle Medicine Fits

Lifestyle Medicine can contribute to the care of people living with Long COVID, but its role needs to be understood within the wider clinical picture.

Adequate nutrition, restorative sleep, avoidance of tobacco and other harmful substances, emotional well-being, and positive social connections remain important aspects of health. These approaches may also help manage coexisting chronic conditions and some of the broader consequences of prolonged illness.

However, the presence of a Lifestyle Medicine pillar does not mean that the same intervention is suitable for every patient.

Physical activity recommendations require particular caution when exertion provokes significant symptom exacerbation. Sleep advice should recognize that persistent sleep disturbances may require assessment for an underlying disorder. Nutritional support should reflect the patient's appetite, gastrointestinal symptoms, nutritional status, and other clinical needs rather than promote restrictive diets or unproven products.

Stress management may support coping and emotional well-being, but it should not be used to imply that recovery depends primarily on maintaining a positive attitude.

Social connection also needs to be considered realistically. A person who experiences symptom exacerbation after social activities may need flexibility and support rather than pressure to participate in more activities than they can tolerate.

There is currently insufficient evidence to claim that a particular diet, supplement, exercise regimen, or combined lifestyle program can reliably cure Long COVID.

Some interventions have shown potential symptomatic benefits in selected studies, but their findings must be interpreted according to the populations studied, the outcomes measured, and the certainty of the evidence.

The contribution of Lifestyle Medicine is best understood as individualized support that responds to the person's clinical condition and complements appropriate medical assessment, symptom management, and rehabilitation.

In this context, evidence-based care sometimes means encouraging an intervention. At other times, it means modifying, delaying, or avoiding that intervention until it can be undertaken more safely.

Long COVID Care in Viet Nam: Connecting Existing Guidance With New Evidence

Viet Nam has existing national resources addressing rehabilitation and self-care following COVID-19.

On May 18, 2022, the Ministry of Health issued Decision No. 1242/QĐ-BYT, promulgating guidance on rehabilitation and self-care for conditions associated with recovery from COVID-19.

The document was developed to support people recovering after COVID-19 and healthcare workers involved in post-COVID care, particularly in home and primary healthcare settings.

It provides a Vietnamese reference for rehabilitation and self-care following infection. However, understanding of Long COVID has continued to evolve since 2022, and newer international recommendations place greater emphasis on identifying post-exertional symptom exacerbation, evaluating exercise-related risks, and adapting rehabilitation to different clinical presentations.

Healthcare organizations reviewing their post-COVID rehabilitation materials should therefore consider newer scientific evidence alongside applicable Vietnamese professional requirements.

This does not mean that earlier national guidance should be disregarded. It means that clinical interpretation and implementation should account for subsequent evidence, particularly when exercise progression may pose risks to selected patients.

Research from Viet Nam also provides information about persistent symptoms in specific populations.

A study by Hoàng Thị Hải Vân and colleagues, published in Tạp chí Y học Dự phòng (Vietnam Journal of Preventive Medicine), examined Long COVID-related symptoms among 447 healthcare workers in Bắc Ninh and Nghệ An using data collected during 2021–2022.

The study appeared in Volume 35, Issue 4, designated 2025, with its online publication record dated July 24, 2026.

Among the surveyed healthcare workers, fatigue was reported by 43.4%, difficulty concentrating by 49.9%, and different sleep-related symptoms at frequencies ranging from 38.9% to 56.7%. Other reported problems included respiratory symptoms, pain, and cardiovascular-related complaints.

These findings illustrate the range of persistent symptoms experienced by participants and their potential relevance to daily functioning and professional responsibilities.

However, the study used a cross-sectional design, involved a defined population of healthcare workers, and examined experiences from an earlier stage of the pandemic. It cannot establish the current national prevalence of Long COVID or determine which rehabilitation interventions are effective and safe.

The study also does not provide a national assessment of post-exertional symptom exacerbation or the availability of specialized rehabilitation services.

These limitations reinforce the need for further local research rather than broad assumptions about the current burden of Long COVID or the capacity of Vietnamese healthcare services.

Practical Considerations for Vietnamese Healthcare Services

Not every healthcare facility needs to establish a dedicated Long COVID rehabilitation program. However, people with persistent symptoms should be able to receive appropriate clinical assessment and referral when their needs exceed the capabilities of the service they initially attend.

For primary care clinicians, a useful starting point is a careful history of symptoms, functional limitations, associated conditions, and the patient's response to physical and cognitive exertion.

When symptoms suggest cardiovascular, respiratory, neurological, autonomic, or other clinically significant problems, appropriate investigation or specialist referral may be necessary.

For rehabilitation professionals, assessment should distinguish patients who may benefit from carefully supervised exercise from those whose symptoms require pacing, symptom stabilization, or further medical evaluation.

Communication between referring clinicians and rehabilitation teams is particularly important when post-exertional symptom exacerbation has been identified.

A referral describing a patient as fatigued or physically deconditioned may not convey the information needed to select a safe rehabilitation approach. Information about delayed symptom deterioration, recovery time, orthostatic symptoms, and previous reactions to activity may be clinically relevant.

The patient's working and living circumstances also influence whether a management plan is feasible.

Someone whose job involves prolonged standing, manual labor, or irregular shifts may have limited opportunities to rest or adjust activities. A person with caregiving responsibilities may find it difficult to reduce exertion even when symptoms are severe.

Financial constraints, transportation requirements, family support, and access to rehabilitation services may further affect the practicality of follow-up.

These circumstances do not necessarily determine what treatment is clinically indicated, but they can influence whether the proposed approach is realistic and sustainable.

Healthcare professionals should also avoid assuming that every patient needs wearable technology, specialized exercise testing, or digital monitoring.

Careful history-taking, appropriate clinical assessment, practical activity planning, and follow-up remain valuable even when resources are limited. Digital tools may support selected patients and services, but their use should have a clear clinical purpose and should not replace professional judgment or create additional monitoring burdens.

Professional Responsibilities and Data Protection in Viet Nam

Clinical management of Long COVID must remain consistent with Vietnamese healthcare legislation and the authorized professional activities of practitioners and healthcare facilities.

The Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides the principal legal framework governing medical examination and treatment, professional licensing, and healthcare facility responsibilities.

Assessment of persistent symptoms, medical investigations, treatment decisions, evaluation of exercise-related risks, and specialized rehabilitation must be undertaken by appropriately qualified and authorized healthcare professionals and facilities within their applicable scopes of practice.

International Lifestyle Medicine education, rehabilitation training, or professional certification does not independently authorize a person to diagnose Long COVID, prescribe medicines, perform medical investigations, or provide specialized clinical treatment beyond their existing professional authorization.

The collection and use of personal health information also require attention.

The Law on Personal Data Protection No. 91/2025/QH15 and Government Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements for processing and protecting personal data in Viet Nam.

Where healthcare organizations collect symptom diaries, functional assessments, rehabilitation records, wearable-device information, or other identifiable health data, they need to consider applicable requirements concerning lawful processing, transparency, security, access, retention, and disclosure.

If information is shared with rehabilitation providers, employers, digital platforms, or other parties, the applicable legal basis, professional confidentiality obligations, and safeguards should also be considered.

The use of international digital health tools does not remove these obligations.

For organizations involved in professional education, it is important to distinguish discussing rehabilitation approaches from independently operating clinical rehabilitation services or collecting identifiable patient information for clinical purposes.

Measuring Recovery Without Creating Additional Harm

Evaluating rehabilitation in Long COVID requires particular care because apparent improvement during an activity does not always reflect improvement in the patient's overall condition.

A person may walk farther during a supervised session but experience several days of increased fatigue, pain, or cognitive difficulties afterward. If these delayed effects are not captured, the program may appear more successful than it is.

Assessment should therefore consider both immediate performance and the patient's subsequent response.

Relevant outcomes may include the frequency and severity of post-exertional symptom exacerbations, recovery time after activities, ability to manage everyday responsibilities, participation in employment or education, sleep, quality of life, and other goals identified by the patient.

For someone who has repeatedly experienced setbacks after ordinary activities, achieving a more stable pattern of daily functioning may represent meaningful progress. For another patient without post-exertional symptom exacerbation, improved physical endurance or mobility may be an appropriate rehabilitation outcome.

These differences illustrate why evaluation needs to reflect individual clinical presentations.

Standardized questionnaires and functional assessments may be useful when appropriately selected, but they should not become an additional source of unnecessary burden. Likewise, performance testing should not be undertaken solely because a rehabilitation program routinely includes it.

Follow-up is particularly important because delayed symptoms may not be visible during an appointment. Patients should have opportunities to report deterioration and discuss whether their management plans need adjustment.

For healthcare organizations, this creates an important quality-of-care question.

Counting rehabilitation sessions, patient attendance, or completed exercise targets provides information about service activity, but these measures do not independently establish that care was beneficial.

A more meaningful evaluation considers whether patients were appropriately assessed before exercise, whether post-exertional symptom exacerbation and other risks were identified, whether plans were adapted when necessary, and whether patients experienced meaningful functional improvement without avoidable harm.

Such evaluation can support safer and more accountable rehabilitation services while identifying areas where further evidence and professional development are needed.

Implications for the Vietnam Lifestyle Medicine Alliance

Long COVID illustrates an important limitation of applying general lifestyle recommendations without sufficient clinical context.

Physical activity is an established component of Lifestyle Medicine, but its therapeutic use depends on the condition being treated and the individual's response.

For some people with Long COVID, carefully selected exercise-based rehabilitation may be appropriate. For others, particularly those experiencing post-exertional symptom exacerbation, energy conservation, activity management, and support with daily functioning may need to take priority.

This distinction requires professional assessment and attention to evidence rather than assumptions that all fatigue results from inactivity or that recovery necessarily requires progressively greater exertion.

For VLMA, an appropriate contribution is to support healthcare professionals in understanding these issues through evidence-based professional education and scientific knowledge exchange.

The Lifestyle Medicine Core Competencies: 2025 Update also reinforces the need to consider social determinants of health when applying lifestyle interventions. In Long COVID, a person's work, income, caregiving responsibilities, access to healthcare, and available support may influence what recommendations are feasible.

Future educational resources could examine recognition of post-exertional symptom exacerbation, pacing, rehabilitation safety, orthostatic intolerance, functional assessment, and the interpretation of emerging Long COVID research.

Such activities would benefit from collaboration with appropriately qualified clinicians and rehabilitation specialists and should remain consistent with Vietnamese professional and legal requirements.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its direction is to support evidence-based Lifestyle Medicine through professional education, capability development, scientific knowledge exchange, and collaboration.

VLMA does not independently provide Long COVID diagnosis, medical treatment, exercise testing, individualized rehabilitation, or other clinical services.

Its contribution lies in helping healthcare professionals critically understand the available evidence, recognize its limitations, and consider how appropriate interventions may be integrated into authorized healthcare services.

Recovery Should Be Guided by the Person, Not a Fixed Exercise Target

Long COVID challenges a familiar assumption in rehabilitation: that improving physical capacity generally requires progressively increasing physical effort.

For some patients, appropriately selected and supervised exercise can contribute to recovery. For others, particularly those whose symptoms worsen after exertion, the same approach may lead to repeated setbacks.

The important issue is not whether exercise should be encouraged or discouraged as a general principle. It is whether the proposed intervention is appropriate for the person receiving it.

Recovery may involve improving physical endurance, but it may also mean being able to prepare meals without prolonged exhaustion, return to work sustainably, manage cognitive demands, or participate in family life without repeated episodes of symptom deterioration.

These outcomes deserve attention even when progress is slow or fluctuating.

Evidence-based Lifestyle Medicine can contribute through individualized support, appropriate health behaviors, and recognition of the factors affecting daily functioning. Its interventions, however, must remain responsive to the patient's symptoms and integrated with necessary medical assessment and rehabilitation.

For people living with Long COVID, progress should not be judged simply by how much more activity they can perform. It should be judged by whether care helps them function more safely, manage symptoms, and return to meaningful activities without avoidable setbacks.

That is a more appropriate foundation for rehabilitation than assuming everyone needs to do a little more.

Selected References

1. World Health Organization. A Clinical Case Definition of Post COVID-19 Condition by a Delphi Consensus. October 6, 2021.

2. World Health Organization. Clinical Management of COVID-19: Living Guideline, June 2025. Published July 15, 2025.

3. World Health Organization. Post COVID-19 Condition. Clinical information and rehabilitation recommendations.

4. US Centers for Disease Control and Prevention. Long COVID Clinical Guidance. Updated March 9, 2026.

5. Cao B, Soriano JB, Wang Q, et al. Clinical Practice Guideline for Long COVID Prevention and Treatment. European Respiratory Journal. 2026;68(1):2502611. Published online July 23, 2026. DOI: 10.1183/13993003.02611-2025.

6. Reeves J, Daynes E, Janaudis-Ferreira T, et al. Physiotherapy Management of Long-COVID: An Evidence-Based Approach. Brazilian Journal of Physical Therapy. 2026;30(4):101609. Published online June 19, 2026. DOI: 10.1016/j.bjpt.2026.101609.

7. Nygren-Bonnier M, Holland AE. Physiotherapy Management of Long COVID in Adults. Journal of Physiotherapy. 2026;72(2):94–105. DOI: 10.1016/j.jphys.2026.03.001.

8. Ministry of Health of Viet Nam. Decision No. 1242/QĐ-BYT Issuing Guidance on Rehabilitation and Self-Care for Conditions Associated With Recovery From COVID-19. May 18, 2022.

9. Hoang THV, Tran NA, Tran TTT, Le MG. Some Long COVID-19 Symptoms Among Healthcare Workers Assessed by the SBQ-LC Tool. Vietnam Journal of Preventive Medicine. 2025;35(4). Published online July 24, 2026. DOI: 10.51403/0868-2836/2025/2544.

10. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. January 9, 2023, as amended. Consolidated Document No. 26/VBHN-VPQH, February 26, 2026.

11. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

12. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Selected Provisions and Implementation Measures of the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

13. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. DOI: 10.1177/15598276251379821.

Editorial and Professional Scope Note

This article presents an educational and professional perspective of the Vietnam Lifestyle Medicine Alliance on the potential contribution and limitations of evidence-based Lifestyle Medicine in Long COVID care, based on information reviewed through October 30, 2026.

It is intended for professional information, education, and scientific knowledge exchange. It does not constitute a clinical practice guideline, individualized medical advice, a Long COVID diagnostic or treatment protocol, exercise prescription, rehabilitation plan, or authoritative interpretation of Vietnamese law.

Vietnam Lifestyle Medicine Alliance (VLMA) is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. VLMA is not a licensed medical examination or treatment facility, Long COVID treatment provider, specialized rehabilitation provider, medical licensing authority, or healthcare accreditation organization. It does not independently diagnose Long COVID, prescribe medication, perform exercise testing, provide individualized rehabilitation, or manage medical complications.

Clinical assessment, diagnosis, treatment, rehabilitation, and follow-up must be undertaken by appropriately qualified and authorized healthcare professionals and facilities within their applicable scopes of practice and in accordance with relevant Vietnamese requirements.

Lifestyle-related interventions should not delay or replace necessary medical assessment, treatment of complications, specialist evaluation, or appropriate rehabilitation services. Physical exercise training should not be prescribed or progressed without adequate consideration of post-exertional symptom exacerbation, exertional oxygen desaturation, cardiac impairment, orthostatic intolerance, and other relevant clinical risks.

International clinical guidelines, research findings, and professional frameworks are cited for educational purposes. Their inclusion does not imply that they automatically have regulatory force in Viet Nam or that VLMA has independently adopted, delivered, validated, endorsed, or certified any Long COVID management or rehabilitation program discussed in this article.

The illustrative patient situations are hypothetical and do not describe actual VLMA clinical activities or identifiable patients.