Yoga & Mindfulness for Long COVID: Practice-Based Evaluation

Study overview

 

Title

Practice-Based Evaluation of an 8-Week Yoga and Mindfulness Program for People with Long COVID

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Authors

Marlies Tobias, MSc(c)
Yoga Academy You are the Buddha, Breda · Vivekananda Yoga University, United States

Geertruid Marres, MD, PhD
Albert Schweitzer Hospital, the Netherlands

 

Design

A mixed-methods, practice-based evaluation without a control group.

Participants

75 adults with Long COVID referred by two physical therapy practices in the Netherlands.

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Program

Eight weeks, with one 60-minute group session each week.

 

Aim

To evaluate the feasibility and participant-reported experiences and outcomes of a pacing-informed yoga and mindfulness program for people with Long COVID.

The evaluation was not designed to establish that the program treats or cures Long COVID.

 

Why the program was developed

People with Long COVID may experience fatigue, cognitive symptoms, sensory overload, orthostatic intolerance, and post-exertional malaise or post-exertional symptom exacerbation.

Capacity can fluctuate from day to day. An activity that appears manageable at the time may lead to increased symptoms several hours or a day later.

The program was therefore not based on fitness training, fixed progression, or the assumption that participants should continually do more.

 

Its main principles were:

• beginning with the participant’s available energy;

• using calm and adaptable practices;

• minimizing unnecessary changes of position;

• making full participation while lying down possible;

• treating pausing as a valid form of participation;

• recognizing early signs of overexertion;

• using mindfulness, breath awareness, and supported rest;

• focusing on quality of life and self-management within existing limits.

We describe this approach as pacing-informed: practices and dosage are adapted to current capacity without imposing a fixed progression.

 

What did the program include?

Sessions combined:

• a brief symptom and energy check-in;

• gentle adapted movement;

• breath awareness and carefully dosed breathing practices;

• mindfulness meditation;

• guided relaxation and supported rest;

• body awareness;

• pacing and energy-management education;

• yoga philosophy within weekly themes;

• reflection and peer contact.

Practices could be performed lying down, seated, or standing. Participants could pause, adapt a posture, listen, or leave out a practice at any time.

 

Pausing is participating.

 

Participants and data

In the final evaluation:

• 75 adults with Long COVID were included;

• 92% of participants were women;

• 74 of 75 participants completed the program;

• 1,659 session forms were collected;

• questionnaires, brief ratings, and open evaluation questions were used.

Not every question was asked in every cohort or answered by every participant. Evaluation questions were refined during the real-world program. The number of respondents therefore differs across outcomes.

Each result is presented with its own denominator and should not be generalized to all 75 participants.

 

What did participants report?

Among the participants who answered the relevant questions:

• 33 of 33 reported that the program had helped them;

• 17 of 17 reported reduced stress or anxiety;

• 31 of 35 reported being better able to manage fatigue;

• 15 of 17 reported improved mental well-being and resilience;

• 21 of 25 reported improved quality of life;

• 17 of 17 would recommend the program to other people living with post-COVID symptoms.

These are self-reported outcomes from the participants who answered each question.

Perceived energy within sessions

For 65 participants, 297 paired ratings of perceived energy before and after sessions were available.

On a five-point scale, average self-reported energy increased within sessions from:

2.2 before the session to 2.7 after the session.

For 69% of these participants, average post-session energy ratings were higher than pre-session ratings. The difference was statistically significant in a participant-level Wilcoxon signed-rank analysis (p < 0.001).

This was an immediate within-session observation. It does not demonstrate lasting improvement in energy, health, recovery, or overall capacity. Weekly symptom scores did not show consistent improvement.

The relevant observation is therefore not that the program produced recovery, but that many participants did not experience the sessions as depleting and, on average, reported higher perceived energy immediately afterward.

 

What did participants value?

Qualitative feedback included themes such as:

• breath awareness and relaxation;

• greater awareness of physical signals;

• recognizing the need for rest earlier;

• participating without pressure to perform;

• social recognition and peer support;

• adapting practices to available energy;

• feeling taken seriously and welcomed;

• having a weekly space where tiredness was accepted.

 

Participants described the program in their own words:

 

“A place where it’s okay to be tired.”

 

“This gives me energy, while everything else only costs energy.”

 

“It became the most important moment of my week because I knew I wouldn’t be pushed beyond my limits.”

These quotations provide insight into participant experiences. They are not evidence of medical effectiveness.

 

What do the findings mean?

A carefully adapted, patient- and pacing-informed Yoga & Mindfulness program may, for selected people with Long COVID:

• be feasible;

• be followed within individual energy limits;

• be experienced positively;

• support relaxation and self-management;

• help participants manage fatigue;

• provide an environment in which resting and adapting are valid ways to participate.

The word support is important. The evaluation examined feasibility, participant experiences, and self-reported outcomes. It was not designed to establish recovery or causal effects.

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What can we not conclude?

The findings do not prove that the program:

• treats or cures Long COVID;

• changes the underlying biological mechanisms;

• prevents PEM or post-exertional symptom exacerbation;

• produces clinical recovery;

• leads to a lasting increase in capacity;

• is safe or appropriate for every person with Long COVID;

• is more effective than other forms of support.

There was no control group or random allocation. Outcomes were primarily self-reported, and not every participant answered every question.

 

Further limitations include:

• a predominantly female sample;

• possible selection bias;

• no systematic long-term follow-up;

• limited access for people who were housebound or bedbound;

• no prospective protocol for systematically recording PEM and adverse events.

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Next steps for research

Claims about effectiveness require prospective and controlled research with:

• predefined outcome measures;

• an appropriate comparison condition;

• systematic follow-up;

• consistent monitoring of PEM, symptom exacerbation, and possible adverse events;

• differentiation between Long COVID and PAIS subgroups;

• appropriate measures of quality of life, self-management, and capacity;

• options for home-based participation to include more severely affected people.

 

This practice-based evaluation is not definitive evidence, but it provides a grounded starting point for further development and research.