The University of Leeds carry out study on the effects of using a structured pacing protocol for PCS

Published on the 2nd December 2022 in the Journal of Medical Virology doi: 10.1002/jmv.28373

‘Effect of using a structured pacing protocol on post-exertional symptom exacerbation and health status in a longitudinal cohort with the post-COVID-19 syndrome’

The abstract of the article and summary points can be read here, but for the full article, please follow the link above.


Post-exertional symptom exacerbation (PESE) is a characteristic symptom of post-COVID syndrome (PCS). This prospective study investigated the effect of a 6-week structured World Health Organization (WHO) Borg CR-10 5-phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long-standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ-5D 5L was completed at the intervention’s beginning and end to measure overall health. Thirty-one participants completed the 6-week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%−24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ-5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2−15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS.

Concluding Points:

  • This is the first time in literature the WHO Borg CR-10 structured pacing protocol has substantially reduced PESE episodes whilst increasing activity levels. 
  • This approach to pacing has the potential to be an effective rehabilitation intervention in PCS.


  • Megan Parker
  • Hannah Brady Sawant
  • Thuvia Flannery
  • Rachel Tarrant
  • Jenna Shardha
  • Rebecca Bannister
  • Denise Ross
  • Stephen Halpin
  • Darren C. Greenwood
  • Manoj Sivan