Long COVID: The Four Ps

What Is Long COVID Fatigue?

Many factors contribute to fatigue - meaning you lack energy and strength and feel tired or exhausted. Some of them are obvious, like intense workouts, long work hours, or poor sleep. 

Chronic fatigue is different - it is often associated with medical conditions, and may last for weeks or months. This type of fatigue is a common symptom in those with long COVID.

Another type of fatigue in people with long COVID is called post-exertional malaise (PEM). Although you may not have heard of PEM, you may have experienced it. It is when you have worsening fatigue (and/or other symptoms) after physical and mental activities - even those requiring little effort.


With PEM even seemingly easy tasks, like the list that follows, can cause extreme tiredness.

  • Bathing, dressing, using your phone, or other daily activities

  • Reading mentally challenging articles or books

  • Being late or unprepared increases stress

  • Watching and listening to television impacts your senses

  • Staying in the same body position or overuse of muscles causes fatigue

With long COVID you may have one or the other, or both types, of fatigue. Both types create challenges every day and are disabling for many.

Cycle Of Fatigue

With long COVID, what happens when you feel well, for an hour, a few hours, or the whole day? You may take advantage of those good times/days and try to accomplish a lot. But, what can happen? It may lead to a repeating cycle with increasing and ongoing fatigue.

When you do too much or are overactive, it can lead to worsening long COVID fatigue and other symptoms. With post-exertional malaise (PEM), even minimal activity can have the same result.

You may have to rest more in order to participate in activities. You may feel frustrated because you are unable to do more. After you rest, instead of pacing, you may again overdo it/increase activity.

Although there is no cure for long COVID fatigue, you can take steps to help manage it, prevent extreme episodes (when you crash or are completely wiped out), and work towards regaining your health.

The Four Ps

The Four Ps (planning, pacing, prioritizing, and positioning) is an approach that has been effective with people who have chronic conditions with the symptom of severe fatigue like chronic fatigue syndrome - CFS, rheumatoid arthritis, multiple sclerosis, etc. 

The Four Ps are adaptable based on your changing symptoms, daily activities, and life events. Using the approach is essential to your recovery.


Of course, we all know the meaning of planning. Planning is particularly important when it comes to living with fatigue. You will receive our Long COVID Activity Planner to support the process.


Activity Pacing

  • Simplify activities

  • Plan the amount of activity

  • Rest between tasks

Pacing means that you balance rest and activity and easy and difficult tasks throughout the day.

  • Take frequent, brief rests throughout the day - try a relaxation technique 

  • When you have days, or times of the day, when you feel better, don’t allow yourself to do too much

  • Plan to rest - before you feel tired


You will need to prioritize your activities - i.e. what is most important (in the context of what you can accomplish).

  • You may need to reconsider your priorities - think about ways to simplify or eliminate tasks

  • Ask for help with high-priority activities

  • Prioritizing now will allow you to progress to doing more


Your body position, as well as the placement of items around you,  can both add to and lessen your fatigue

  • To lessen the stress on your muscles, change positions throughout the day - sit for a while, lie down, then walk around for a few minutes

  • Regardless of your position, make sure you are using good posture/positioning

  • Ask someone to help you reorganize your space so you are able to carry, lift, and bend less

An example of how the 4 Ps might work:

You plan to lie down to rest in the afternoon following lunch (pacing) and you’ve prioritized a rest even though there is laundry to do. However, you have an unscheduled meeting or phone call that requires your attention. 

So you reprioritize and change your plan (You sit with a small pillow to support your lower back for your meeting/phone call - i.e. position). You lie down for a rest once your meeting or call ends.

Getting Started

It may be challenging to start planning and pacing your activities. Are you ready?

Some Important Points

  • Remember to pay attention to your pattern of fatigue

  • Notice what helps and what worsens it

  • Consider making some changes based on the Four Ps

  • Use your Goodpath Activity Planner

  • Contact your coach for support and help with making the changes