Can sport be a therapeutic approach?
Experts and those affected hold widely differing views on whether regular physical activity can contribute to long-term improvement. Understandably, many people with Long COVID want to "try everything" that promises improvement. This includes structured, training-based therapeutic approaches.
Unlike a pure pacing strategy, which consistently gears activities toward the individual's stress limit and strictly avoids overexertion, training-based concepts aim to gently improve physical resilience in a tailored manner. Rather than following rigid progression schemes, the emphasis is placed on continuous symptom monitoring and flexible adjustment of intensity. There are reports of individuals who have benefited from carefully and gradually increased training. However, there are also numerous reports of deterioration following overexertion, particularly in post-infectious fatigue syndromes such as PEM and ME/CFS.
Therefore, it is important to be aware of the potential risks. Any physical activity or training program should be individualized, closely monitored, and guided by symptoms. Implementing such programs independently, without professional supervision, can lead to a worsening of symptoms. If in doubt, consistent pacing should be prioritized, and any increase in exertion should be approached with caution.
The TRIBAL study: Individualized training for Long COVID
As with many post-viral conditions, only the symptoms of Long COVID can currently be treated. Although a variety of therapeutic approaches exist, such as physiotherapy and respiratory therapy, there is no consensus on which methods are truly effective. Controlled studies on personalized exercize programs remain scarce.
To address this gap, the German S.P.O.R.T. Institute, in collaboration with the German Sport University Cologne, initiated the TRIBAL study. This study aims to alleviate long-term post-COVID symptoms, particularly fatigue, through an individualized training program. Around 60 participants aged between 15 and 83 are enrolled. TRIBAL stands for 'Training-Based Treatment of Long-term effects of Coronavirus Infection'. Participants include younger individuals who competed in triathlons before falling ill, as well as older individuals who were active prior to developing Long COVID. Less athletic individuals with pre-existing conditions have also been included. The program is aimed at post-COVID patients with moderate symptoms and is not suitable for people with PEM or ME/CFS.
The TRIBAL study is based on previous research findings related to red blood cells, which are responsible for supplying oxygen to the body, among other functions. Studies have shown that the oxygen supply can be impaired in people with post-COVID syndrome. Specifically:
- Red blood cells are less deformable.
- Red blood cells tend to clump together more easily.
These changes may persist for months after infection.
Why is this important?
When blood cells move less efficiently and stick together, oxygen distribution throughout the body is impaired. This can lead to symptoms such as fatigue, exhaustion and decreased performance. The TRIBAL study investigates whether targeted training can positively influence these blood cell properties.
How does the study work?
At the start of the program, each participant undergoes a comprehensive assessment, including:
- How severe the long-term symptoms of the virus are.
- Limitations in daily life.
- Current physical resilience.
Based on these findings, participants are categorized according to severity levels ranging from 0 to 4. A significant proportion of participants are categorized into levels 2 or 3, indicating significant impairment, and in some instances, an inability to work or manage everyday life.
Physical fitness is measured using two tests: an endurance test and a sit-to-stand test. The aim of the latter is to stand up and sit down as many times as possible within one minute. An individual training plan is created based on these results.
Participants train two to three times a week on a specialized whole-body ergometer, depending on the severity of their condition. Each session lasts around 15–17 minutes. The training program consists of five clearly defined levels. Progression to the next level occurs only after the current level’s goal has been achieved, helping to prevent overexertion and symptom flare-ups. After each level, tests are carried out to check whether performance has improved and review laboratory values. In addition, participants complete questionnaires about their perceptions, symptoms and quality of life.
What does the result show?
After 12 weeks of controlled training, the participants demonstrated a significant reduction in fatigue symptoms and improvements in physical performance. Everyday activities such as climbing stairs or light gardening became easier, fewer breaks were needed and recovery times improved. Additionally, red blood cell counts were reported to have returned to normal, leading to an improved oxygen supply and better energy provision. However, there has been no evidence-based analysis of this yet.
Reaching the highest training level (5) does not automatically mean a full recovery or restoration of performance to pre-pandemic levels. It rather indicates that everyday life becomes more manageable despite ongoing limitations. Nevertheless, temporary symptom setbacks may still occur.
While programs such as TRIBAL show promising initial results, it remains unclear which training approaches lead to sustained symptom improvement or positively affect blood supply in the long term. TRIBAL therapy is not currently offered in Switzerland. Those interested in trying something similar could contact a physical therapist or specialized rehabilitation center. They will develop individualized training plans tailored to your personal limits. To avoid overexertion and gradually regain your quality-of-life step by step, it is essential to increase slowly, listen to your body, and seek professional guidance.
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