“We need to be believed": A qualitative interview study on the Hertfordshire Long Covid and Physical Activity Programme

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This qualitative study evaluates the impact of a physical exercise programme on individuals with Long Covid in Hertfordshire. Methods A semi structured qualitative interview study was conducted with eleven participants and stakeholders. The data corpus was collected from December 2023 to August 2024, focusing on the lived experiences of individuals with Long Covid and the influence of physical activity on their symptoms. Results The programme highlighted the importance of tailored physical activities, multidisciplinary collaboration, and community engagement. Participants reported improvements in physical and mental health, though challenges such as post-viral fatigue and systemic barriers were noted. Conclusion The findings suggest that structured and personalised physical activity programmes may benefit individuals with Long Covid. Sustainable funding and continuous support are essential for the success of such initiatives. COVID-19 Long Covid physical activity qualitative multidisciplinary collaboration Introduction The Covid-19 pandemic has had public health ramifications which will persist for decades to come. One feature of the pandemic was the emergence of Long Covid. According to WHO, Long Covid is defined as a constellation of long-term symptoms, lasting for at least 2 months 1 . The most commonly reported symptoms of Long Covid include chest pain, fatigue, dyspnoea, cough and excess sputum production. Other non-respiratory symptoms include joint pain, myalgia, headache, palpitations, anosmia, hair loss and cognitive symptoms such as memory or concentration issues “brain fog” 2 . The prevalence of self-reported Long Covid in the UK was greatest in women, people aged 35 to 69 years, those in more deprived areas, those working in social care and those with another health condition or disability that limited their activity 3 . In the East of England in 2024, ONS data estimated that there were 206,000 cases of self-reported Long Covid 4 . Data from the Hertfordshire Community NHS Trust, Covid-19 Rehabilitation service (Decommissioned September 2024) showed that between July 2020 and August 2022 they accepted 953 referrals with Long Covid. Accepted referrals ranged between 5 and 72 per month with a peak in April 2021. Since April 2021 referrals remained steady with an average of 33 accepted each month (range 23–44). In Central London Community Healthcare NHS Trust, Lond Covid Service, 1383 referrals for Long Covid were accepted between December 2020 and September 2022 (Locally collected data). A 12-month feasibility project was conducted by the Herts Sports & Physical Activity Partnership (HSP) in collaboration with Hertfordshire’s two NHS Covid Rehabilitation Services and Public Health, Hertfordshire to understand the impact of physical activity on people with Long Covid. The project explored and mapped a range of suitable physical activity opportunities, provided upskilling and development opportunities to activity providers where the community showed need and connected service users to suitable activity opportunities, offering follow up calls to discuss progress and next steps. The use of physical activity to improve the symptoms of Long Covid has shown mixed results and more research is required in this area. It is hoped that this qualitative study can provide useful information to shape future physical activity and Long Covid support services in the UK. Methods Semi-structured qualitative interviews were conducted with service users and stakeholders from December 2023 to August 2024, (See Table 1 ). Service users and health professionals were purposively recruited by the HSP Physical Activity Coordinator. Three health professionals and six service users were interviewed through Microsoft Teams while two additional service users were interviewed face to face. The interview guide was developed from the aims of the study and with discussions with the HSP team. Findings from earlier interviews were used iteratively to inform subsequent data collection and questions were refocused and adopted to evolving themes. Data collection continued until no more important novel responses were received. Prior to each interview/focus group the researcher provided the participant with verbal information regarding the project and reasons why the data was important, its purpose and how it would be stored. The interviews lasted on average 30 minutes for each participant. The interviews were digitally recorded (Olympus DS-2500), transcribed in full by a professional transcriber and anonymised with only the researchers knowing the identity of each participant. The transcripts were compared with the original recorded audio file and were amended as required. NVivo v.13® was used to manage the data corpus. The analytic approach in this study was thematic analysis. Thematic analysis is commonly used in research situations. All transcripts were coded on a line-by-line basis by two researchers. Transcripts were compared with the original recording, and any errors were amended. Table 1 Participant characteristics of interview participants Participant Type and Gender Number of participants Service users 8 Male 5 Female 3 Health professionals 3 Male 1 Female 2 Total 11 Results Twenty people were approached of whom eleven participated in an interview. The themes were developed from analysis of the data corpus. There was a significant amount of rich data in this project therefore the focus was on those themes relevant to the aim of the study. Three overarching themes were identified in this study: Leadership, Collaboration and Community Engagement Tailored and Holistic Approaches Barriers, Stigma and Lack of Recognition Leadership, Collaboration and Community Centred Care Effective leadership and proactive initiatives by key individuals played a crucial role in the initiation and development of the physical activity programme (Table 2 , Quote 1). Staff described high levels of motivation and engagement due to the potential of the programme to improve their patients’ health (2). Engaging the community and involving patients in the planning process fostered a sense of ownership and participation. Once the initial direction was set, collaboration between different healthcare providers and services was critical to ensure patients experienced cohesive and well-supported care and smooth pathways (3). Once the programme was established, the emphasis was on providing sustainable and comprehensive community-centred care, to help patients transition from medical management to community-based self-care (4). Participants highlighted the opportunity for community-based programmes such as this to alleviate pressure on the NHS (5). The programme was felt to be valuable for both patients and staff, fostering a sense of shared purpose and collaboration (6). Table 2 Leadership, Collaboration and Community-Based Care Quotes Quote Number Supporting Quote Participant Quote 1 "Will and I started talking about it and then started having monthly meetings, and included Doctor Master, and Alison came to a few of those, and we just got going from there." Paula, health professional Quote 2 "It was that real feeling of, 'If we make this happen, I know my patients can then improve and get to that place.'" Paula, health professional Quote 3 "It’s important that you take people with you and all the services are aligned and supporting your pathway and your patients." Sabine, health professional Quote 4 "We need to shift people from that medical model and management into a community self-care management." Paula, health professional Quote 5 “The NHS is at bursting point. It doesn’t have capacity, it doesn’t have the funding.” Sabine, health professional Quote 6 "It's been a really valuable experience both for our patients and sort of the staff…" Simon, health professional Holistic and tailored approaches Patients involved in the programme often had multiple health conditions (7) (Table 3 , Quote 1). Mental health issues were a significant barrier to patient engagement (8) and participants faced interrelated challenges of social isolation and reduced physical fitness (9). These complex health needs required comprehensive support and an integrated approach to rehabilitation, including consideration of mental health and social wellbeing. Using a holistic model ensured that both physical and psychological factors were addressed, building confidence and enabling individuals to reintegrate into work and social environments (10). Participants reported that being able to connect with and relate to others who shared similar experiences was valuable (11). Participants stressed that whilst physical activity can support recovery, it must be tailored to individual needs (12). Managing post-viral fatigue was a significant challenge, requiring a balance between exercise and rest (13). In some cases, specific physical activities were detrimental and led to a deterioration in symptoms (14). However, it was possible to identify physical activities that suited individuals and allowed them to be active without exacerbating symptoms (15). Identifying meaningful activities that matched individual preferences improved engagement and wellbeing (16). Table 3 Tailored and Holistic Approaches Quotes Quote Number Supporting Quote Participant Quote 7 "More often than not, a lot of these patients are multi comorbid patients with more than one health condition." Paula, health professional Quote 8 "A big barrier in patients even engaging with us as an NHS based service is their state of mental health.” Sabine, health professional Quote 9 "I have become quite isolated work wise, socially… weight gain, my muscles and my fitness isn’t really as good as it was pre-long COVID." Joanne, service user Quote 10 “ It’s not just the physical side… giving me the confidence to go back to work, to interact with people again.” Molly, service user Quote 11 “I’ve realised how nice it is to talk to someone who understands because they’ve got it as well… it’s just fantastic because they’re like, ‘Yeah, I know that, that’s how I feel.’” Juliet, service user Quote 12 “It’s got to be tailored, I don’t think there is a one size fits all solution to any of it really.” John, service user Quote 13 "At the moment long Covid and post viral fatigue, big issue regards do you or don’t you exercise." Paula, health professional Quote 14 “I tried going to the gym but it actually made me really ill” Dave, service user Quote 15 "It doesn't because it's walking. It's not strenuous and there's no pressure on the chest." James, service user Quote 16 "I much prefer the athletic side of sport so I enjoy walking and things like that… looking at the Herts Walking Group." John, service user Barriers, Stigma and Lack of Recognition Participants with Long Covid faced a wide range of interconnected physical, mental and social challenges. They described debilitating chronic symptoms including fatigue, pain, brain fog, breathlessness and mental health issues, which significantly impacted daily functioning, employment and social engagement (17) (Table 4 , Quote 1). For some individuals, the fluctuating and unpredictable nature of symptoms caused frustration and increased the difficulty associated with managing the condition (18). The challenge of coping with these symptoms was compounded by a widespread lack of recognition and belief faced by participants. In some cases, the invisible nature of symptoms made it difficult to obtain recognition and understanding (19). This pervasive lack of awareness acted as a barrier to accessing support (20). Individuals experienced stigma and stereotyping attached to being labelled with long COVID or similar functional somatic syndromes (21). One participant in particular was highly critical of the systemic lack of belief and support for long Covid patients (22). Participants described variable levels of support from healthcare professionals. Whilst some positive relationships enhanced the patient experience (23), other experiences suggested a lack of knowledge and understanding from healthcare professionals, whose attitudes and advice were perceived as dismissive (24). The lack of recognition of Long Covid was reflected in the discontinuation of funding for treatment programmes, suggesting that patients are being left behind by the healthcare system (25). Table 4 Barriers, Stigma and Lack of Recognition Quotes Quote Number Supporting Quote Participant Quote 17 "I had had various sickness periods off work and every time I tried to go back, things weren’t really going the way that I hoped.” Joanne, service user Quote 18 “Frustrating, really frustrating, you feel ok one day and then so you go and do something… and then the next day, it’s really hard to get out of bed.” Juliet, service user Quote 19 “It’s very hard to explain that you get completely tired… it’s really hard to put that across to people, especially when you don’t look ill.” Steve, service user Quote 20 "It’s hard to get support for long COVID because there seems to be still so much of a lack of awareness of how much it’s affected people.” Jake, service user Quote 21 “There’s always been people have a typical view of what the old CFS and fibromyalgia population is.” Sabine, health professional Quote 22 "We need to be believed… the support and the help and we’re just behind the times, it’s disgraceful." John, service user Quote 23 “Some doctors have been great, it’s been very much a mixed bag. In fact, a lot of the professionals that have been great have not been doctors, it’s been more people like Sarah and some others.” Steve, service user Quote 24 “In the initial while it was mostly quite dismissive and quite like, it was sort of like ‘Oh, just rest.’” Joanne, service user Quote 25 "It's a shame to hear that some of the programmes are probably going to be made redundant." Molly, service user Discussion Main findings in this study The Long Covid and Physical Activity programme in Hertfordshire explored the impact of physical activity on individuals with Long Covid. The programme's success was attributed to effective leadership, multidisciplinary collaboration, and community engagement. Participants emphasised the importance of tailored physical activities that accommodate individual health conditions, which facilitated rehabilitation and improved quality of life. Engagement and Collaboration: The programme's leadership and proactive initiatives were crucial for its success. Collaboration among healthcare professionals ensured a comprehensive approach to patient care, while community engagement fostered a sense of ownership and participation. Patient-Centred Care: Empowering patients through education and support enabled them to make informed decisions about their health. Addressing complex health needs and enhancing patient engagement were key components of the programme, leading to improved health outcomes. Physical and Mental Health: The programme positively impacted both physical and mental health by offering social interaction and building confidence. Addressing mental health barriers was essential for patient engagement, and consistent participation in physical activities was crucial for rehabilitation. Holistic Approaches: Tailored physical activities that consider individual preferences and needs were found to be beneficial. Managing post-viral fatigue was a significant challenge, requiring a balance between exercise and rest. Challenges and Adaptability: Systemic barriers such as deconditioning and lack of awareness about local resources posed challenges to the programme's implementation. Overcoming these barriers required innovative solutions and active community engagement. Future Directions: Participants expressed concern about the discontinuation of the Long Covid Service and the need for continuous funding and support. Structured and progressive physical activity programmes, along with group activities, were suggested to enhance the programme's effectiveness. Conclusion The Long Covid and Physical Activity programme in Hertfordshire demonstrated that tailored and structured physical activity programmes can significantly benefit individuals with Long Covid. The programme's success was driven by effective leadership, multidisciplinary collaboration, and community engagement. Addressing both physical and mental health needs, along with managing post-viral fatigue, were critical components of the programme. Sustainable funding and continuous support are essential for the continuity and success of such initiatives. Future programmes should focus on increasing awareness and support for Long Covid, integrating preventative health measures, and providing comprehensive care that includes social support. The findings from this study can inform the development of future physical activity and Long Covid support services, ultimately improving the quality of life for individuals affected by Long Covid. What is already known on this topic Emerging research suggests that physical activity interventions can alleviate symptoms like dyspnoea, fatigue, physical function thereby enhancing quality of life for individuals with Long Covid. Personalised and tailored support and advice are essential for helping individuals with Long COVID resume physical activities that enhance their well-beingalthough a cautious approach is warranted 5 . What this study adds This study adds valuable insights to the existing literature by demonstrating the benefits of tailored and structured physical activity programmes for individuals with Long Covid. It emphasises the importance of effective leadership, multidisciplinary collaboration, and community engagement in the success of such initiatives. The study emphasises the need for personalised approaches that address both physical and mental health needs, manage post-viral fatigue, and provide comprehensive support. Additionally, it underscores the necessity of sustainable funding and continuous support to ensure the long-term success of these programmes, offering a model for future interventions aimed at improving the quality of life for those affected by Long Covid Limitations of this study Although every effort was made to recruit a diverse range of participants in this study, it is acknowledged that there may be response bias as the sample interviewed were wholly positive about the HSP programme. Non responders were not contacted to provide a reason for non-participation in the study and therefore it is not possible to speculate on their personal choices. Declarations Authors’ contribution ML and RL conceptualised and designed the study and were involved in interpreting the data. ML and RL were involved in data analysis. ML and RL drafted the manuscript. All authors reviewed the manuscript, approved the final content, and met authorship criteria. Funding This work was supported by Public Health, Hertfordshire County Council. The views expressed are those of the authors and not necessarily those of HSP, Hertfordshire County Council, or the University of Southampton. The funders had no role in the design of the study, collection, analysis, and interpretation of the data, or in writing the manuscript. Acknowledgements ML works as a Senior Research and Evaluation Officer at Hertfordshire County Council, Public Health and is a Visiting Research Fellow at the University of Southampton, School of Medicine. RS works as a Public Health Registrar for Public Health, Hertfordshire County Council WS works as the Strategic Lead for Health at the Herts Sport & Physical Activity Partnership, University of Hertfordshire. SK worked as the Physical Activity Coordinator at the Herts Sport & Physical Activity Partnership, University of Hertfordshire. Conflict of Interest None declared Ethics approval and consent to participate Approvals to conduct the interviews/focus groups were gained from the Public Health Ethics and Data protection boards at Hertfordshire County Council (28/07/23). Informed consent was obtained from all participants in the study. This research study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not Applicable. Availability of data The data underlying this article will be shared on reasonable request to the corresponding author. References Post COVID-19 condition (Long COVID) . (n.d.). Retrieved May 28, 2024, from https://www.who.int/europe/news-room/fact-sheets/item/post-COVID-19-condition Signs and symptoms | Diagnosis | Long-term effects of coronavirus (long COVID) | CKS | NICE . (n.d.). Retrieved May 28, 2024, from https://cks.nice.org.uk/topics/long-term-effects-of-coronavirus-long-covid/diagnosis/signs-symptoms/ Greenhalgh, T., Sivan, M., Perlowski, A., & Nikolich, J. (2024). Long COVID: a clinical update. The Lancet , 404 (10453), 707–724. https://doi.org/10.1016/S0140-6736(24)01136-X/ASSET/CAE1F60F-053E-4437-A0CE-753F1BC67EB5/MAIN.ASSETS/GR2.JPG Self-reported long COVID and labour market outcomes, UK: 2022 - Office for National Statistics . (n.d.). Retrieved May 28, 2024, from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlong covidandlabourmarketoutcomesuk2022/selfreportedlongcovidandlabourmarketoutcomesuk2022 McDowell, C. P., Tyner, B., Shrestha, S., McManus, L., Comaskey, F., Harrington, P., Walsh, K. A., O’Neill, M., & Ryan, M. (2025). Effectiveness and tolerance of exercise interventions for long COVID: a systematic review of randomised controlled trials. BMJ Open , 15 (3), e082441. https://doi.org/10.1136/BMJOPEN-2023-082441 Wright, J., Astill, S. L., & Sivan, M. (2022). The Relationship between Physical Activity and Long COVID: A Cross-Sectional Study. International Journal of Environmental Research and Public Health , 19 (9), 5093. https://doi.org/10.3390/IJERPH19095093/S1 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6674440","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492971225,"identity":"705a57fe-e53f-46bf-af9f-31de75ca07f8","order_by":0,"name":"Martin Logue","email":"data:image/png;base64,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","orcid":"","institution":"Hertfordshire County Council","correspondingAuthor":true,"prefix":"","firstName":"Martin","middleName":"","lastName":"Logue","suffix":""},{"id":492971226,"identity":"a864411b-6688-494b-b9d3-3944b165dc61","order_by":1,"name":"Rosanna Lyus","email":"","orcid":"","institution":"Hertfordshire County Council","correspondingAuthor":false,"prefix":"","firstName":"Rosanna","middleName":"","lastName":"Lyus","suffix":""},{"id":492971227,"identity":"e7d2f180-487d-4527-b06e-88da7ee5e862","order_by":2,"name":"Will Slemmings","email":"","orcid":"","institution":"University of Hertfordshire","correspondingAuthor":false,"prefix":"","firstName":"Will","middleName":"","lastName":"Slemmings","suffix":""},{"id":492971228,"identity":"b8cc5877-7167-4076-9483-76d8c19a45c1","order_by":3,"name":"Sarah Keen","email":"","orcid":"","institution":"University of Hertfordshire","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Keen","suffix":""}],"badges":[],"createdAt":"2025-05-15 16:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6674440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6674440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87994164,"identity":"841d12dc-f280-4b12-a2d0-a06f6dc8f323","added_by":"auto","created_at":"2025-07-31 09:03:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656286,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6674440/v1/ae6de3f9-9569-483e-899d-4e2059f056ab.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"“We need to be believed\": A qualitative interview study on the Hertfordshire Long Covid and Physical Activity Programme","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Covid-19 pandemic has had public health ramifications which will persist for decades to come. One feature of the pandemic was the emergence of Long Covid. According to WHO, Long Covid is defined as a constellation of long-term symptoms, lasting for at least 2 months\u003csup\u003e1\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe most commonly reported symptoms of Long Covid include chest pain, fatigue, dyspnoea, cough and excess sputum production. Other non-respiratory symptoms include joint pain, myalgia, headache, palpitations, anosmia, hair loss and cognitive symptoms such as memory or concentration issues \u0026ldquo;brain fog\u0026rdquo;\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe prevalence of self-reported Long Covid in the UK was greatest in women, people aged 35 to 69 years, those in more deprived areas, those working in social care and those with another health condition or disability that limited their activity\u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the East of England in 2024, ONS data estimated that there were 206,000 cases of self-reported Long Covid\u003csup\u003e4\u003c/sup\u003e. Data from the Hertfordshire Community NHS Trust, Covid-19 Rehabilitation service (Decommissioned September 2024) showed that between July 2020 and August 2022 they accepted 953 referrals with Long Covid. Accepted referrals ranged between 5 and 72 per month with a peak in April 2021. Since April 2021 referrals remained steady with an average of 33 accepted each month (range 23\u0026ndash;44). In Central London Community Healthcare NHS Trust, Lond Covid Service, 1383 referrals for Long Covid were accepted between December 2020 and September 2022 (Locally collected data).\u003c/p\u003e \u003cp\u003eA 12-month feasibility project was conducted by the Herts Sports \u0026amp; Physical Activity Partnership (HSP) in collaboration with Hertfordshire\u0026rsquo;s two NHS Covid Rehabilitation Services and Public Health, Hertfordshire to understand the impact of physical activity on people with Long Covid. The project explored and mapped a range of suitable physical activity opportunities, provided upskilling and development opportunities to activity providers where the community showed need and connected service users to suitable activity opportunities, offering follow up calls to discuss progress and next steps.\u003c/p\u003e \u003cp\u003eThe use of physical activity to improve the symptoms of Long Covid has shown mixed results and more research is required in this area. It is hoped that this qualitative study can provide useful information to shape future physical activity and Long Covid support services in the UK.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eSemi-structured qualitative interviews were conducted with service users and stakeholders from December 2023 to August 2024, (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Service users and health professionals were purposively recruited by the HSP Physical Activity Coordinator. Three health professionals and six service users were interviewed through Microsoft Teams while two additional service users were interviewed face to face.\u003c/p\u003e \u003cp\u003eThe interview guide was developed from the aims of the study and with discussions with the HSP team. Findings from earlier interviews were used iteratively to inform subsequent data collection and questions were refocused and adopted to evolving themes. Data collection continued until no more important novel responses were received.\u003c/p\u003e \u003cp\u003ePrior to each interview/focus group the researcher provided the participant with verbal information regarding the project and reasons why the data was important, its purpose and how it would be stored. The interviews lasted on average 30 minutes for each participant. The interviews were digitally recorded (Olympus DS-2500), transcribed in full by a professional transcriber and anonymised with only the researchers knowing the identity of each participant. The transcripts were compared with the original recorded audio file and were amended as required. NVivo v.13\u0026reg; was used to manage the data corpus.\u003c/p\u003e \u003cp\u003eThe analytic approach in this study was thematic analysis. Thematic analysis is commonly used in research situations. All transcripts were coded on a line-by-line basis by two researchers. Transcripts were compared with the original recording, and any errors were amended.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics of interview participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant Type and Gender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of participants\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService users\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e8\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e3\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e2\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTwenty people were approached of whom eleven participated in an interview. The themes were developed from analysis of the data corpus. There was a significant amount of rich data in this project therefore the focus was on those themes relevant to the aim of the study. Three overarching themes were identified in this study:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLeadership, Collaboration and Community Engagement\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTailored and Holistic Approaches\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBarriers, Stigma and Lack of Recognition\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eLeadership, Collaboration and Community Centred Care\u003c/h3\u003e\n\u003cp\u003eEffective leadership and proactive initiatives by key individuals played a crucial role in the initiation and development of the physical activity programme (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Quote 1). Staff described high levels of motivation and engagement due to the potential of the programme to improve their patients\u0026rsquo; health (2). Engaging the community and involving patients in the planning process fostered a sense of ownership and participation. Once the initial direction was set, collaboration between different healthcare providers and services was critical to ensure patients experienced cohesive and well-supported care and smooth pathways (3).\u003c/p\u003e \u003cp\u003eOnce the programme was established, the emphasis was on providing sustainable and comprehensive community-centred care, to help patients transition from medical management to community-based self-care (4). Participants highlighted the opportunity for community-based programmes such as this to alleviate pressure on the NHS (5). The programme was felt to be valuable for both patients and staff, fostering a sense of shared purpose and collaboration (6).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLeadership, Collaboration and Community-Based Care Quotes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote Number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupporting Quote\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"Will and I started talking about it and then started having monthly meetings, and included Doctor Master, and Alison came to a few of those, and we just got going from there.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaula, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It was that real feeling of, 'If we make this happen, I know my patients can then improve and get to that place.'\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaula, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It\u0026rsquo;s important that you take people with you and all the services are aligned and supporting your pathway and your patients.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSabine, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"We need to shift people from that medical model and management into a community self-care management.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaula, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The NHS is at bursting point. It doesn\u0026rsquo;t have capacity, it doesn\u0026rsquo;t have the funding.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSabine, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It's been a really valuable experience both for our patients and sort of the staff\u0026hellip;\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSimon, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eHolistic and tailored approaches\u003c/h3\u003e\n\u003cp\u003ePatients involved in the programme often had multiple health conditions (7) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Quote 1). Mental health issues were a significant barrier to patient engagement (8) and participants faced interrelated challenges of social isolation and reduced physical fitness (9). These complex health needs required comprehensive support and an integrated approach to rehabilitation, including consideration of mental health and social wellbeing. Using a holistic model ensured that both physical and psychological factors were addressed, building confidence and enabling individuals to reintegrate into work and social environments (10). Participants reported that being able to connect with and relate to others who shared similar experiences was valuable (11).\u003c/p\u003e \u003cp\u003eParticipants stressed that whilst physical activity can support recovery, it must be tailored to individual needs (12). Managing post-viral fatigue was a significant challenge, requiring a balance between exercise and rest (13). In some cases, specific physical activities were detrimental and led to a deterioration in symptoms (14). However, it was possible to identify physical activities that suited individuals and allowed them to be active without exacerbating symptoms (15). Identifying meaningful activities that matched individual preferences improved engagement and wellbeing (16).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTailored and Holistic Approaches Quotes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote Number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupporting Quote\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"More often than not, a lot of these patients are multi comorbid patients with more than one health condition.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaula, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"A big barrier in patients even engaging with us as an NHS based service is their state of mental health.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSabine, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"I have become quite isolated work wise, socially\u0026hellip; weight gain, my muscles and my fitness isn\u0026rsquo;t really as good as it was pre-long COVID.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJoanne, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt\u0026rsquo;s not just the physical side\u0026hellip; giving me the confidence to go back to work, to interact with people again.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMolly, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve realised how nice it is to talk to someone who understands because they\u0026rsquo;ve got it as well\u0026hellip; it\u0026rsquo;s just fantastic because they\u0026rsquo;re like, \u0026lsquo;Yeah, I know that, that\u0026rsquo;s how I feel.\u0026rsquo;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJuliet, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s got to be tailored, I don\u0026rsquo;t think there is a one size fits all solution to any of it really.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJohn, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"At the moment long Covid and post viral fatigue, big issue regards do you or don\u0026rsquo;t you exercise.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaula, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I tried going to the gym but it actually made me really ill\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDave, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It doesn't because it's walking. It's not strenuous and there's no pressure on the chest.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJames, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"I much prefer the athletic side of sport so I enjoy walking and things like that\u0026hellip; looking at the Herts Walking Group.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJohn, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eBarriers, Stigma and Lack of Recognition\u003c/h3\u003e\n\u003cp\u003eParticipants with Long Covid faced a wide range of interconnected physical, mental and social challenges. They described debilitating chronic symptoms including fatigue, pain, brain fog, breathlessness and mental health issues, which significantly impacted daily functioning, employment and social engagement (17) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Quote 1). For some individuals, the fluctuating and unpredictable nature of symptoms caused frustration and increased the difficulty associated with managing the condition (18).\u003c/p\u003e \u003cp\u003eThe challenge of coping with these symptoms was compounded by a widespread lack of recognition and belief faced by participants. In some cases, the invisible nature of symptoms made it difficult to obtain recognition and understanding (19). This pervasive lack of awareness acted as a barrier to accessing support (20).\u003c/p\u003e \u003cp\u003eIndividuals experienced stigma and stereotyping attached to being labelled with long COVID or similar functional somatic syndromes (21). One participant in particular was highly critical of the systemic lack of belief and support for long Covid patients (22).\u003c/p\u003e \u003cp\u003eParticipants described variable levels of support from healthcare professionals. Whilst some positive relationships enhanced the patient experience (23), other experiences suggested a lack of knowledge and understanding from healthcare professionals, whose attitudes and advice were perceived as dismissive (24).\u003c/p\u003e \u003cp\u003eThe lack of recognition of Long Covid was reflected in the discontinuation of funding for treatment programmes, suggesting that patients are being left behind by the healthcare system (25).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBarriers, Stigma and Lack of Recognition Quotes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote Number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupporting Quote\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipant\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"I had had various sickness periods off work and every time I tried to go back, things weren\u0026rsquo;t really going the way that I hoped.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJoanne, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Frustrating, really frustrating, you feel ok one day and then so you go and do something\u0026hellip; and then the next day, it\u0026rsquo;s really hard to get out of bed.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJuliet, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It\u0026rsquo;s very hard to explain that you get completely tired\u0026hellip; it\u0026rsquo;s really hard to put that across to people, especially when you don\u0026rsquo;t look ill.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSteve, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It\u0026rsquo;s hard to get support for long COVID because there seems to be still so much of a lack of awareness of how much it\u0026rsquo;s affected people.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJake, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;There\u0026rsquo;s always been people have a typical view of what the old CFS and fibromyalgia population is.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSabine, health professional\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"We need to be believed\u0026hellip; the support and the help and we\u0026rsquo;re just behind the times, it\u0026rsquo;s disgraceful.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJohn, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Some doctors have been great, it\u0026rsquo;s been very much a mixed bag. In fact, a lot of the professionals that have been great have not been doctors, it\u0026rsquo;s been more people like Sarah and some others.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSteve, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;In the initial while it was mostly quite dismissive and quite like, it was sort of like \u0026lsquo;Oh, just rest.\u0026rsquo;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJoanne, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQuote 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\"It's a shame to hear that some of the programmes are probably going to be made redundant.\"\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMolly, service user\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eMain findings in this study\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Long Covid and Physical Activity programme in Hertfordshire explored the impact of physical activity on individuals with Long Covid. The programme\u0026apos;s success was attributed to effective leadership, multidisciplinary collaboration, and community engagement. Participants emphasised the importance of tailored physical activities that accommodate individual health conditions, which facilitated rehabilitation and improved quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEngagement and Collaboration:\u003c/strong\u003e The programme\u0026apos;s leadership and proactive initiatives were crucial for its success. Collaboration among healthcare professionals ensured a comprehensive approach to patient care, while community engagement fostered a sense of ownership and participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient-Centred Care:\u003c/strong\u003e Empowering patients through education and support enabled them to make informed decisions about their health. Addressing complex health needs and enhancing patient engagement were key components of the programme, leading to improved health outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhysical and Mental Health:\u003c/strong\u003e The programme positively impacted both physical and mental health by offering social interaction and building confidence. Addressing mental health barriers was essential for patient engagement, and consistent participation in physical activities was crucial for rehabilitation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHolistic Approaches:\u003c/strong\u003e Tailored physical activities that consider individual preferences and needs were found to be beneficial. Managing post-viral fatigue was a significant challenge, requiring a balance between exercise and rest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChallenges and Adaptability:\u003c/strong\u003e Systemic barriers such as deconditioning and lack of awareness about local resources posed challenges to the programme\u0026apos;s implementation. Overcoming these barriers required innovative solutions and active community engagement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFuture Directions:\u003c/strong\u003e Participants expressed concern about the discontinuation of the Long Covid Service and the need for continuous funding and support. Structured and progressive physical activity programmes, along with group activities, were suggested to enhance the programme\u0026apos;s effectiveness.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Long Covid and Physical Activity programme in Hertfordshire demonstrated that tailored and structured physical activity programmes can significantly benefit individuals with Long Covid. The programme's success was driven by effective leadership, multidisciplinary collaboration, and community engagement. Addressing both physical and mental health needs, along with managing post-viral fatigue, were critical components of the programme.\u003c/p\u003e\n\u003cp\u003eSustainable funding and continuous support are essential for the continuity and success of such initiatives. Future programmes should focus on increasing awareness and support for Long Covid, integrating preventative health measures, and providing comprehensive care that includes social support. The findings from this study can inform the development of future physical activity and Long Covid support services, ultimately improving the quality of life for individuals affected by Long Covid.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is already known on this topic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmerging research suggests that physical activity interventions can alleviate symptoms like dyspnoea, fatigue, physical function thereby enhancing quality of life for individuals with Long Covid. Personalised and tailored support and advice are essential for helping individuals with Long COVID resume physical activities that enhance their well-beingalthough a cautious approach is warranted\u003csup\u003e5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adds valuable insights to the existing literature by demonstrating the benefits of tailored and structured physical activity programmes for individuals with Long Covid. It emphasises the importance of effective leadership, multidisciplinary collaboration, and community engagement in the success of such initiatives. The study emphasises the need for personalised approaches that address both physical and mental health needs, manage post-viral fatigue, and provide comprehensive support. Additionally, it underscores the necessity of sustainable funding and continuous support to ensure the long-term success of these programmes, offering a model for future interventions aimed at improving the quality of life for those affected by Long Covid\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of this study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough every effort was made to recruit a diverse range of participants in this study, it is acknowledged that there may be response bias as the sample interviewed were wholly positive about the HSP programme. Non responders were not contacted to provide a reason for non-participation in the study and therefore it is not possible to speculate on their personal choices.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors’ contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eML and RL conceptualised and designed the study and were involved in interpreting the data. ML and RL were involved in data analysis. ML and RL drafted the manuscript. All authors reviewed the manuscript, approved the final content, and met authorship criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Public Health, Hertfordshire County Council. The views expressed are those of the authors and not necessarily those of HSP, Hertfordshire County Council, or the University of Southampton. The funders had no role in the design of the study, collection, analysis, and interpretation of the data, or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eML works as a Senior Research and Evaluation Officer at Hertfordshire County Council, Public Health and is a Visiting Research Fellow at the University of Southampton, School of Medicine.\u003c/p\u003e\n\u003cp\u003eRS works as a Public Health Registrar for Public Health, Hertfordshire County Council\u003c/p\u003e\n\u003cp\u003eWS works as the Strategic Lead for Health at the Herts Sport \u0026amp; Physical Activity Partnership, University of Hertfordshire.\u003c/p\u003e\n\u003cp\u003eSK\u0026nbsp;worked as the Physical Activity Coordinator at the Herts Sport \u0026amp; Physical Activity Partnership, University of Hertfordshire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApprovals to conduct the interviews/focus groups were gained from the Public Health Ethics and Data protection boards at Hertfordshire County Council (28/07/23). Informed consent was obtained from all participants in the study. This research study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data underlying this article will be shared on reasonable request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePost COVID-19 condition (Long COVID)\u003c/em\u003e. (n.d.). Retrieved May 28, 2024, from https://www.who.int/europe/news-room/fact-sheets/item/post-COVID-19-condition\u003c/li\u003e\n\u003cli\u003eSigns and symptoms | Diagnosis | Long-term effects of coronavirus (long COVID) | CKS | NICE\u003c/em\u003e. (n.d.). Retrieved May 28, 2024, from https://cks.nice.org.uk/topics/long-term-effects-of-coronavirus-long-covid/diagnosis/signs-symptoms/\u003c/li\u003e\n\u003cli\u003eGreenhalgh, T., Sivan, M., Perlowski, A., \u0026amp; Nikolich, J. (2024). Long COVID: a clinical update. \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e404\u003c/em\u003e(10453), 707\u0026ndash;724. https://doi.org/10.1016/S0140-6736(24)01136-X/ASSET/CAE1F60F-053E-4437-A0CE-753F1BC67EB5/MAIN.ASSETS/GR2.JPG\u003c/li\u003e\n\u003cli\u003eSelf-reported long COVID and labour market outcomes, UK: 2022 - Office for National Statistics\u003c/em\u003e. (n.d.). Retrieved May 28, 2024, from https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/selfreportedlong\u003cbr/\u003ecovidandlabourmarketoutcomesuk2022/selfreportedlongcovidandlabourmarketoutcomesuk2022\u003c/li\u003e\n\u003cli\u003eMcDowell, C. P., Tyner, B., Shrestha, S., McManus, L., Comaskey, F., Harrington, P., Walsh, K. A., O\u0026rsquo;Neill, M., \u0026amp; Ryan, M. (2025). Effectiveness and tolerance of exercise interventions for long COVID: a systematic review of randomised controlled trials. \u003cem\u003eBMJ Open\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(3), e082441. https://doi.org/10.1136/BMJOPEN-2023-082441\u003c/li\u003e\n\u003cli\u003eWright, J., Astill, S. L., \u0026amp; Sivan, M. (2022). The Relationship between Physical Activity and Long COVID: A Cross-Sectional Study. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(9), 5093. https://doi.org/10.3390/IJERPH19095093/S1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Long Covid, physical activity, qualitative, multidisciplinary, collaboration","lastPublishedDoi":"10.21203/rs.3.rs-6674440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6674440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe Covid-19 pandemic has led to the emergence of Long Covid, characterised by persistent symptoms lasting for at least two months. This qualitative study evaluates the impact of a physical exercise programme on individuals with Long Covid in Hertfordshire.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA semi structured qualitative interview study was conducted with eleven participants and stakeholders. The data corpus was collected from December 2023 to August 2024, focusing on the lived experiences of individuals with Long Covid and the influence of physical activity on their symptoms.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe programme highlighted the importance of tailored physical activities, multidisciplinary collaboration, and community engagement. Participants reported improvements in physical and mental health, though challenges such as post-viral fatigue and systemic barriers were noted.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings suggest that structured and personalised physical activity programmes may benefit individuals with Long Covid. Sustainable funding and continuous support are essential for the success of such initiatives.\u003c/p\u003e","manuscriptTitle":"“We need to be believed\": A qualitative interview study on the Hertfordshire Long Covid and Physical Activity Programme","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 08:46:53","doi":"10.21203/rs.3.rs-6674440/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d9dcb21-83f0-44e0-a023-8604876a3bc4","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-31T08:46:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 08:46:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6674440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6674440","identity":"rs-6674440","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}