Perceptions, acceptability and experiences of yoga to support long-COVID: A survey of people living with long-COVID

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Yoga offers a potential solution to reduce the burden of long-COVID, demonstrating positive impacts on the biological mechanisms implicated in long-COVID, key long-COVID symptoms and associated mental health challenges. Yoga interventions can also be designed for people with limited physical ability, and online delivery can increase accessibility. Aim To understand the perceptions and experiences of yoga for long-COVID, in order to establish the potential of yoga for helping people with long-COVID (PWLC). Methods An online survey of PWLC, comprised closed and open response questions on: long-COVID symptoms, support needs, perceptions of a yoga intervention and its components, and yoga use. Participants (n = 170) were recruited via Prolific. Inclusion criteria were long-COVID (formal diagnosis or self-reported) and living in the UK. Inductive thematic analysis was used for open ended responses. Results PWLC reported feeling despondent about their condition and abandoned by health professionals. We identified several unmet needs among PWLC that align with the potential benefits of a yoga intervention, particularly in supporting symptom management, self-management and psychological symptoms. Additionally, there was a high level of interest in a yoga intervention. Barriers included anxiety regarding the group setting, fitting sessions into schedules, lack of energy and concerns about suitability for long-COVID. Those already practising yoga with long-COVID reported that yoga helped to manage symptoms and associated psychological challenges, as well as increasing flexibility and providing a safer alternative to exercise. Conclusions Yoga appears to be an acceptable intervention for PWLC, but needs to be tailored to fit their ability and address their concerns. It should be offered in the context of health professional validation of symptoms. Yoga Long-COVID COVID-19 survey qualitative mixed-methods long-term health condition Figures Figure 1 Introduction Long-COVID is the commonly used name to describe symptoms of COVID-19 that remain after infection - also termed post-COVID condition by the World Health Organisation and post-COVID-19 syndrome by the UK National Institute of Health and Care Excellence (NICE). Long-COVID symptoms can last months and sometimes years [ 1 ]; they are wide-ranging, heterogeneous, change over time and multisystemic (affecting any and all organ systems) [ 2 ]. Key symptoms include chronic fatigue, breathlessness, “brain fog”, pain and post-exertional malaise (PEM) [ 3 ]. Factors such as uncertainty of illness trajectory, traumatic intensive care stays and loss of identity can impact mental health [ 4 ]. In April 2024 in England and Scotland, 3.3% of the population (two million) were experiencing self-reported long-COVID, with around three-quarters reporting the condition adversely effected day-to-day activities [ 5 ]. Whilst risk of experiencing long-COVID after COVID-19 infection is lower now compared to early in the pandemic, the estimated risk is still stands at 3.5% [ 6 ]. The impact of long-COVID can be substantial for individuals, health systems and the economy, nevertheless, treatment options are limited, with care focusing on support and managing symptoms [ 2 ]. In the UK, support for people with long-COVID (PWLC) varies from self-management advice for the more mildly affected, management in general practice for the moderately affected, and referral to specialist services where appropriate and if available for those who are more severely affected [ 7 ]. However, experiences of healthcare are mixed, with reports of inadequate support and medical gaslighting commonplace [ 8 ]. Research into the condition is hampered by a lack of a single definition of long-COVID and the multisystemic nature of the illness [ 9 ], as well as limited funding and investment into services and treatments [ 10 , 11 ]. Yoga offers a potential solution to reducing long-COVID burden by supporting PWLC with symptom reduction, self-management and quality of life. Yoga is a holistic mind-body practice originating from India that has become increasingly popular in the West as an accessible approach to manage health conditions [ 12 ], and support health and wellbeing [ 13 , 14 ]. Yoga is a multi-component intervention that typically incorporates physical postures, breathing techniques, and relaxation. Both cross-sectional population surveys and clinical trials suggest that yoga has physiological and psychological effects on health (particularly pain conditions and mental health), as well as being associated with positive health behaviours [ 13 , 15 – 20 ]. Research on yoga for long-COVID is in its infancy. A UK Iyengar Yoga intervention for PWLC (n = 55) that provided 10 individual sessions with three teachers, reported statistically significant improvements for physical and mental health for participants after the intervention [ 21 ]. Trials have also shown yoga to be safe and to improve outcomes for patients with COVID-19 [ 22 – 24 ]. Both a feasibility intervention [ 25 ] and RCT [ 26 ] that focused specifically on breathing techniques (a component of yoga) have shown positive effects for long-COVID. More robust evidence for the potential of yoga to improve long-COVID comes from research demonstrating the effects of yoga on the biological mechanisms implicated in long-COVID (e.g. dysautonomia and chronic inflammation [ 27 , 28 ]), related health conditions (e.g. chronic fatigue syndrome [ 29 ]), key long-COVID symptoms (e.g. fatigue [ 30 – 34 ], pulmonary issues [ 35 – 38 ]), and quality of life [ 39 – 41 ] and mental health [ 27 , 42 – 45 ]. Yoga interventions can be designed for people with very limited physical ability. Additionally, it can be delivered online compared to other services[ 46 ], increasing accessibility for PWLC. It is low cost [ 47 , 48 ] and popular among patients with long-term conditions including post-viral fatigue [ 29 , 32 , 49 , 50 ]. Yoga is already being provided on the NHS (e.g. acute mental health services) and via social prescribing for people with long-term conditions [ 50 ]; our research has previously found that a 10 week yoga intervention was acceptable to ethnically diverse NHS patients and supported self-management[ 50 ]. Home-based interventions are recommended for PWLC [ 51 ] and online live-streamed delivery of yoga is acceptable in both patient and community populations [ 46 ]. However, acceptability is often established through those already attending yoga interventions, less is known about acceptability among the wider population. This is important because yoga for PWLC is not without its challenges, given the low functionality of many PWLC and prevalence of post-exertional malaise (PEM) symptoms. Such issues have led to a backlash against planned exercise interventions in the United States [ 52 ], and are reflected in findings from a Spanish study which found both positive experiences of yoga and barriers due to long-COVID fatigue symptoms [ 53 ]. A safe and tailored approach to yoga in this population therefore needs to be established. Additionally, long-COVID and related communities may prioritise biomedical approaches [ 54 ]. Thus, more work is needed to understand the perspectives and experiences of PWLC on yoga. In summary, the treatment gap for long-COVID, combined with emerging evidence to support the use and suitability of yoga for PWLC, suggests its potential value as an intervention for this population. However, existing research is limited and the perspectives of PWLC remain underrepresented in the literature. This research therefore aimed to explore the perceptions and experiences of yoga for long-COVID among PWLC - regardless of prior yoga experience- in order to establish its potential role in supporting this population. Methods Design The study was a cross-sectional anonymous survey design, collecting both quantitative (closed choice questions) and qualitative (free text questions) data, during September and October 2024. The survey was developed for this study (see Supplementary file). Participants and recruitment Participants were recruited via the online research platform Prolific. Using Prolific allowed sampling of a broader range of participants, compared to recruitment through channels such as support groups and charities, who may be more motivated to seek support. To identify participants, firstly Prolific’s pre-screening questions were used (UK; long-term health condition/disability; formally diagnosed or self-reporting as having experienced Covid-19; and 90%+ approval rate) and these identified a possible 4296 possible participants. In order to identify those with long-COVID, we invited 3000 to answer a 10-option multiple choice question (‘which long-term health conditions have you experienced in the last five years?’). One-hundred and ninety-eight participants reported they had long-COVID and were invited to participate in the main survey; participants who reported they had long-COVID but also ticked a high number of the other response options were excluded as potential imposter participants (n = 5). One-hundred and seventy-one (90%) of those invited completed the main survey. We did not request a formal diagnosis of long-COVID from participants, as some report challenges getting a diagnosis due to issues such as lack of COVID-19 testing early in the pandemic, health professional scepticism and limited medical understanding of the illness [ 55 ]. This is particularly prevalent in ethnic minority populations who may experience mistrust in the healthcare system and barriers to service access [ 56 ]. Procedure Surveys were designed using Qualtrics software. A mixture of closed-response and open text questions collected demographic and other data including: Long-COVID details length of time with long-COVID, symptoms and severity. Key long-COVID symptoms were measured using PROMIS (Patient-Reported Outcomes Measurement Information System) [ 57 ] short form fatigue and physical function scales. PROMIS has previously been used with long-COVID populations [ 58 ] and it has established reliability and validity among patients with CFS/ME and fibromyalgia [ 59 , 60 ]. Cronbach’s alphas for this study were 0.91 (fatigue) and 0.86 (physical function). Additional long-COVID symptoms/associated issues were measured using VAS scales (anchored 0 -none to 100 -as bad as could be imagined), including breathlessness, pain, light-headedness or unsteadiness, cognitive difficulties (“difficulty thinking clearly”), feeling anxious or worried, and feeling low or depressed. Support needs participants were asked ‘Please tell us what kinds of support you would like to help manage your long-COVID symptoms?’, as well as support received from long-COVID NHS services and non-NHS interventions attended. Intervention perceptions Participants were provided with a description of an online course (Fig. 1), and were asked to rate how interested they might be in attending on a scale of 1 (very interested) – 5 (definitely not interested), as well their interest in each individual element of the course. Open text space allowed participants to explain their responses. Additionally, participants were asked ‘Some yoga therapists are already running these types of programmes, how would you feel about attending if it was labelled as 'yoga' for long-COVID and why? (from our past conversations with people with long-COVID some have said they had concerns about yoga, whereas others liked the idea)’ . Yoga use Participants were asked about previous yoga practice, and those reporting yoga with long-COVID were asked to provide further details of their practice and experiences. Analysis Descriptive analysis was conducted for quantitative variables, including frequencies, percentages, means and standard deviations. For the PROMIS measures (fatigue and physical function), t-scores were calculated which were then split by recommended cut-off scores to provide an indication of symptom severity (mild, moderate, severe). In order to understand if interest in a mind-body intervention was related to symptom severity, one-way ANOVAs were conducted for all the symptom variables and rated interest in the programme. Qualitative data was typically subject to content analysis [ 61 ], but where data were richer (i.e. what are your support needs? Explanation of interest in the course), inductive, thematic analysis was used [ 62 , 63 ]. Both authors read through all open-ended responses, which was initially coded by AC and then reviewed by TC and discussed to reach agreement. Both authors are experienced mixed methods researchers, with research expertise and personal experience of living with long-term health conditions. Results Demographics and NHS support Participants were predominately female (61%), White (90%) and aged 31–50 (55%). There was a spread of illness duration, but 2–3 years was most common (36%) (Table 1 ). The majority of participants had moderate to severe fatigue (80%) and challenges with physical function (59%) (Table 2 ). Cognitive difficulties were another key symptom for participants (52%), and around half were also experiencing mental health challenges (Table 3 ). Many participants had received some kind of support from the NHS for long-COVID, but a significant minority had not received any support. Most common forms of NHS support were self-management or stress management/psychological, in a one-to-one as opposed to group format (Table 4 ). Participants provided limited responses on how helpful they had found the support they had been offered, but support was more likely to be considered helpful than not, and pulmonary/breathing support, along with gentle exercise/activity, received more positive ratings. Several participants described waiting for extended periods of time to receive support. Table 1 – Participant demographics Number (%) Age (years) 18–30 34 20 31–40 52 30 41–50 43 25 51–60 23 13 61–70 15 9 70+ 3 2 Missing 1 1 Ethnicity Asian or Asian British 9 5 Black, African, Caribbean or Black British 3 2 Mixed or Multiple Ethnic Groups 3 2 White 154 90 Other 1 1 Missing 1 1 Gender Female 105 61 Male 61 36 Non-binary 3 2 I use a different term 1 1 Missing 1 1 Is this the same gender you were assigned at birth? Yes 164 96 No 5 3 Missing 2 1 Length of time with long-COVID Less than 6 months 14 8 6 months – 1 year 21 12 1–2 years 33 19 2–3 years 62 36 3–4 years 25 15 4 + years 16 9 Table 2 PROMIS scales, rating of severity by recommended cut-offs (percentage of participants) Normal Mild Moderate Severe Fatigue 9 11 53 27 Physical function 15 26 56 3 Table 3 – Ratings of long-COVID symptoms Symptom (0-100, ↑=worse) Mean Std dev Cognitive difficulties 52.0 29.8 Feeling anxious or worried 52.8 32.1 Feeling low or depressed 51.7 31.2 Light-headedness or unsteadiness 44.8 29.3 Breathlessness 41.7 26.0 Pain 34.8 28.5 Table 4 – What kind of support, if any, have you had from NHS Long-COVID services? Group One-to-one N (%) N (%) Self-management 21 (12.3) 40 (23.4) Stress management/ psychological support 10 (5.8) 34 (19.9) Breathing support 7 (4.1) 23 (13.5) Gentle exercise/activity 11 (6.4) 16 (9.4) Pulmonary rehabilitation 5 (3.0) 13 (7.6) Other* 6 (3.5) 8 (4.7) Nothing 58 (33.9) 45 (26.3) * n = 2: Cardiology clinic, CFS/ME clinic; n = 1: Sick notes, occupational therapy, pain management, practice nurse, Long-COVID clinic, Memory improvement techniques Support needs Whilst participants highlighted the importance of an effective biomedical treatment, here we focus on support needs in relation to symptom management. Participants’ need for their condition (and/or the extent of the impact it had on their lives) to be acknowledged by the medical community was a dominant theme, with many reporting struggling to get the recognition that they needed, requesting “ a doctor who listens to me and cares ”. “It would just be nice if all medics believed the diagnosis and didn't try and pretend that long-covid was not a real thing.” P10 A sense of despondency emerged from narratives with participants feeling like they had been left with little treatment, care, information or support. This sense of abandonment “ I'm being left to rot ”, meant some had been left with “ little hope for any useful help ” and a sense of desperation to access help - “ I would love to hear any solutions ”. Others were simply unclear if there was anything available that could help: “ unsure what support would manage extreme fatigue and brain fog. ” Consequently, many participants wanted better and more regular access to their GP as well as access to specialist services, like physiotherapy, rehabilitation or pulmonary support. They wanted help to manage their symptoms, particularly fatigue, changes in smell/taste, cognitive issues, breathlessness/lung function and pain, including prescriptions of effective medication. Psychological support was also prioritised by participants, with some suggesting talking therapy, counselling or “ support with psychosomatic symptoms, anxiety, depression ”. A number of participants said they would like local support groups. Self-management support was also mentioned, including how to manage and monitor symptoms, undertake gentle exercise, pacing, diet, communication with medical staff or knowing what services they could request. “ Coping strategies that can minimise long-term effects impact on daily life. How best to get through the working day etc when symptoms are bad. ” P68 Some sought access to knowledge and information about their condition – particularly around prognosis and treatment that might be available, including complementary medicine and research trials: “ information on how it affects people and how things are moving forward with treatments ” (P14). Whilst others needed practical support to help with day-to-day living and understanding/flexible working arrangements from employers. Interest in a multi-component course to support symptom management A description of an intervention including the components often found in yoga practice was presented to participants (Fig. 1). This was not described as a yoga intervention to avoid potential bias associated with common preconceptions about yoga. Interest in the intervention was generally positive, with 64% stating they were definitely/might be interested, 16% unsure and 20% probably/definitely not interested. Overwhelmingly, participants who were ‘definitely interested’ expressed a willingness to “try anything” (“I welcome any support for managing symptoms”) and felt the course sounded potentially helpful. Others liked the convenience of the online format or the course content– either specific activities (e.g. nervous system regulation) or the range of components included. Some participants valued the group setting, believing that connecting with others with long-COVID could help reduce feelings of isolation. “I would welcome this - being in an online environment is manageable as it wouldn't contribute to fatigue through travelling and having contact with other people who live with this would help me feel less alone. I want this very much. Gentle movement and stretching is something I don't know how much to try or do so this is important. Peer support is essential and I just don't have this at present. P47 However, many expressed concerns about interacting in a group setting, primarily due to anxiety, and some reported disliking online courses: “I'm a little nervous about interacting with people over livestream as it gives me anxiety” (P153). A more individualised approach was preferred by some to acknowledge the variability in symptom experience. These concerns led to a range of reactions from lack of interest in the course, to apprehension without deterring participation entirely. Many participants also expressed concerns about managing the sessions alongside fluctuating energy levels or busy schedules . “If it was something I could log into and just do when I feel like I have the energy, it would be perfect. But if it requires me to put X amount of minutes in a day - I can't know if I'll have the energy to do that.” P155 Of those with limited interest in the course, a number felt mostly recovered or were self-managing effectively. Others indicated they had already tried similar techniques, either self-guided (e.g. from online research) or attending a course, but with limited success. A smaller number reported feeling generally despondent or doubtful that such a course would be helpful. A few expressed scepticism, viewing such of courses as tokenistic: “ I’ve seen a lot of LC support that just feels bare minimum to “shut us up” but doesn’t really help. I’m sceptical I guess. ” (P157) A one-way between-groups analysis of variance was conducted to explore the impact of symptom severity on interest in participating in the course. There was a statistically significance difference for cognitive difficulties (F (4,163) = 2.7, p = 0.031; η² = 0.024), with a small effect size. Those with more severe symptoms were more likely to express interest in attending the course. No statistically significant differences were found for the other symptom or mental health variables. Chi-squared tests revealed no statistically significant effects of age or gender on interest in attendance. A Fisher’s exact test revealed a statistically significant difference (p = 0.015) toward those from an ethnic minority background being less interested in the intervention, but this is difficult to interpret given the low numbers of ethnic minority groups participating. In relation to interest in the different components of the course, symptom management (80%) was most highly rated (definitely or might be interested), followed by relaxation (74%), breathing exercises (70%) and gentle movement (60%). Connection with others with long-COVID (47%) was of least interest, which was reflected in the qualitative data where both social anxiety about connecting with others online and a need to connect with others having similar experiences to combat feelings of isolation were expressed. When asked if there was anything else they would like to see included, responses echoed quantitative findings around unmet needs, highlighting the importance of self-management support and relaxation. This included support to manage specific symptoms as well as broader self-management strategies such as pacing and brain retraining. Psychological support included positive thinking, building confidence, managing unhelpful thoughts and relaxation, whilst noting that some types of relaxation could exacerbate anxiety. Some participants wanted more information about long-COVID itself or diet and nutrition, with particular reference to loss of taste/smell. Finally, the tone of the course was highlighted as important, with some noting that being around others with more severe symptoms could be emotionally draining. Perceptions of Yoga of long-COVID All participants were asked about their perceptions of describing the intervention as 'yoga' for long-COVID. Over half (54%) reported positive attitudes towards a yoga course, often mentioning previous positive experiences with yoga, or simply an openness to try a gentle form of exercise, with others reporting they “would find this [yoga] reassuring”. Several were attracted by the holistic approach and positive focus on health: “I like the sound of yoga as it sounds healthy, proactive activity rather than something for sick people” (P54). A further 19% of participants reported uncertainties about ‘yoga’ because of concerns about how strenuous it might be (“post exertional malaise is a massive concern”), if it would be suitable for their comorbid conditions, or with limited mobility (“Yoga implies floor level and I can’t get that low”). “I am hesitant because yoga feels like something quite advanced - I would be worried about pushing myself too much, and having some days where I felt too unwell to participate physically - I think if I knew I was able to do less or minimal on some sessions depending on fatigue and pain levels, I would feel more confident. ” P47 A significant minority (25%) indicated they would find the term yoga off-putting. Whilst many did not specify their reasons, several responded by indicating they were not interested in yoga (“I do not enjoy yoga”), disliked groups or felt they were not fit enough. Additionally, two participants said they would feel offended by being offered yoga, as it implied their condition was not physical in nature. Another described it as a poor use of NHS resources. “This is just minimising the severity and reality of the disease. Wellness techniques are not cures or help for medical conditions.” P151 Experiences of yoga for long-COVID Fifty percent of participants had practised yoga before they had long-COVID. However, only 14% (n = 24) had practised yoga with long-COVID, the majority of whom (n = 20) had previously practised. The most common styles practised were restorative (n = 6), hatha (n = 5) and yin yoga (n = 4). The majority of those practising said that it helped their long-COVID symptoms ‘a little’ (n = 12), Table 5 . Table 5 Overall, how much does practising yoga help with your long-COVID symptoms? n (%) It makes them worse 1 (4.2) No difference 5 (20.1) Helps a little 12 (50.0) Helps a moderate amount 5 (20.1) Helps a lot 1 (4.2) Total 24 Participants reported a range of benefits from practising yoga with long-COVID, with relaxation the most common. Several participants described it as a safe alternative to exercise, allowing them to build strength, flexibility and fitness. Others noted benefits such as breath management (“helped with dysregulated breathing”), relief through distraction from symptoms, nervous system regulation, and overall symptom management. In terms of challenges to practising yoga with long-COVID, by far the most common issue reported was fatigue, which could impact ability or motivation: “might be too fatigued to even get started” (P3). Additionally, flexibility, breathing problems, pain and stamina also affected ability to practise. Less commonly reported challenges were aggravation of symptoms, boredom, time, space, difficulty level and certain poses: “stretching can aggravate, especially bending over if it’s a bad day” P48. Discussion This study explored the perceptions and experiences of yoga for long-COVID among PWLC, in order to establish the potential role of tailored yoga-based interventions in supporting symptom management in this population. Our findings highlight the many unmet support needs of PWLC, particularly the need for validation and recognition of their condition and its impact from healthcare professionals -the absence of which left many feeling despondent, abandoned and desperate. Importantly, we found alignment between several unmet needs and evidence-based potential benefits of a yoga intervention, namely support with symptom management, self-management and psychological impacts. This compatibility was also reflected in the high level of potential interest in a yoga-based intervention. Additionally, reports from those already practising yoga with long-COVID support the idea that it can help manage symptoms and associated psychological challenges, as well as providing a safer alternative to exercise. A significant minority did express concerns, with key barriers including anxiety regarding the group setting, fitting sessions into schedules or lack of energy. Importantly, our findings highlight that yoga for PWLC requires tailoring for long-COVID to reassure individuals, avoid exacerbation of symptoms and PEM, and be sensitive to the physical and cognitive limitations experienced by those with long-COVID. A key unmet need was the lack of acknowledgement of the condition and its impact by health professionals, a finding supported by others [ 8 , 64 , 65 ]. Lessons from treatment of individuals with ME/CFS have highlighted the importance of this basic level of care in the face of lack of treatment options[ 66 ] and guidelines on the management of long-COVID for health professionals have reflected this [ 2 ]. Nevertheless, this research suggests that practice is not always achieving these standards, and these experiences may worsen further given the current uncertainty around the future of long-COVID-specific services in the UK and elsewhere (i.e. long-COVID clinics). Additionally, doctors may find it challenging to deal with the clinical uncertainty surrounding long-COVID, resulting in unhelpful or dismissive interactions with patients [ 67 , 68 ] or lack of empathy [ 69 ]. This highlights the importance of training for healthcare professionals to work sensitively with patients [ 64 , 68 ]. A yoga intervention may help to provide some of the validation by a professional needed by PWLC but may also address other unmet needs, namely support with symptom management, self-management and psychological symptoms. Yoga interventions have been shown to improve key long-COVID symptoms such as fatigue [ 30 – 34 ], pulmonary function [ 35 – 38 ], pain [ 70 – 72 ], sleep [ 73 – 75 ], as well as support mental health and well-being [ 27 , 42 – 45 ]. They may also address the biological mechanisms implicated in long-COVID (e.g. Dysautonomia and chronic inflammation [ 27 , 28 ]), or provide a ‘safe’ way to move which can be challenging with long-COVID PEM symptoms. It is also possible to integrate specific self-management techniques for long-COVID (e.g. pacing) into yoga interventions [ 76 ]. The value of yoga to address some of these issues was supported by participants practising yoga in our study, however tailored programmes are likely to maximise potential benefits whilst minimising the risk of symptom exacerbation. Our findings suggest that a tailored yoga intervention, such as the one described in this paper, is likely to be acceptable to many PWLC, including men who are typically less likely to practise yoga [ 13 ]. Other research has found that yoga interventions (including online) are generally acceptable to patients including those with ME/CFS [ 29 , 46 , 49 , 76 ] and PWLC [ 77 , 78 ]. However, acceptability is typically established in existing studies among those already enrolled on a yoga programme, this research highlights there may be issues prohibiting wider uptake. For example, whilst a group format to connect PWLC to others with the condition was very appealing to some, more participants expressed discomfort at the group setting, particularly in relation to interacting with the group or being on video. In addition, ‘connection with others with long-COVID’ gained the lowest ratings of interest among participants (47%). Thus, online interventions that do not involve group interaction or require participants to have their video on may be more popular than previously thought, options of face-to-face interventions or those that include group interaction also have a role [ 49 ]. The lack of correlation between interest in yoga and LC symptoms or participant demographics does, however, indicate a broad appeal. Further barriers included fitting sessions into schedules alongside lack of energy on the day, suggesting the value of flexible on-line sessions. Interestingly, concerns around low energy primarily reflected worries about ability to participate, rather than concern that yoga would exacerbate symptoms. Additionally, the lack of correlation between interest in the intervention and symptom severity, suggests that many people with long-COVID are aware of and able to work within their energy limitations. Nevertheless, careful consideration should be given to how the intervention is described, with an emphasis on safety and appropriate modifications for PEM. The use of ‘yoga’ [ 79 , 80 ] is also important. The majority of participants in this study responded positively (or neutrally) to the term ‘yoga’, or it clarified for participants that this was not the right intervention for them. For others it raised concerns that would require addressing when promoting such programmes, for example clarity regarding the suitability for individuals with co-morbidities or limited mobility.. Importantly, yoga for long-COVID should be offered in the context of health professional validation of symptoms and research into biomedical treatments [ 64 ] to ensure individuals feel heard and their concerns are appropriately addressed. Strengths and limitations A key strength of this study was its inclusion of any individual with long-COVID, rather than those already accessing an intervention – as has been the case for previous research exploring yoga acceptability. Recruitment through Prolific enabled access to a broader sample than might be obtained through support groups who may be more motivated to seek help and be positively biased towards yoga. Nevertheless, this was not a random sample and participants using Prolific may have certain biases. The study relied on self-reported long-COVID status and we did not require a formal clinical diagnosis. While this may introduce some diagnostic uncertainty, we considered it important to include all individuals identifying as having long-COVID to avoid excluding key groups - such as those infected in the first wave and ethnic minority populations who find it hard to get a diagnosis. Indeed, this has also been the approach of other studies in the area [ 56 ]. Nevertheless minority ethnic groups are still underrepresented in our sample, comprising 9% of participants compared with 16% in the general UK population [ 81 ]. Conclusions Yoga appears to be an acceptable intervention for a significant proportion of those with long-COVID, but needs to be appropriately tailored to fit the ability and address the concerns of PWLC. Given the narratives of struggle for recognition and treatment of long-COVID within the medical domain, any intervention should be offered alongside health professional validation of symptoms and situated within the broader context of research into biomedical treatments for the condition. Abbreviations NICE National Institute of Health and Care Excellence NHS National Health Service PEM post-exertional malaise PROMIS patient-reported outcomes measurement information system PWLC people with long-COVID UK United Kingdom Declarations Ethics approval and consent to participate: Ethical approval for the study was gained from the University of Westminster, College of Liberal Arts and Sciences ethics committee (ETH2324-2236). All participants were provided with a participant information sheet and consent form, and gave consent prior to completing surveys. The study adhered to the Declaration of Helsinki. Consent for publication: Not applicable Funding: This work did not receive any funding Author Contribution AC conceptualised the study and led on study design, data collection, analysis and write up. TC contributed to study design, data collection, analysis and write up. Both authors reviewed and agreed upon the final manuscript. Acknowledgement We would like to thank all of our participants for sharing their personal insights and for participating in this study. Data Availability The datasets generated and/or analysed during the current study are not publicly available due ethical reasons. References Nehme M, Braillard O, Chappuis F, Courvoisier DS, Guessous I. Prevalence of symptoms more than seven months after diagnosis of symptomatic covid-19 in an outpatient setting. Ann Intern Med. 2021;174:1252–60. Greenhalgh T, Sivan M, Perlowski A, Nikolich J. Long COVID: a clinical update. Lancet. 2024;404:707–24. NHS England and NHS Improvement coronavirus. 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Sieczkowska SM, Casagrande P, de O, Coimbra DR, Vilarino GT, Andreato LV, Andrade A. Effect of yoga on the quality of life of patients with rheumatic diseases: Systematic review with meta-analysis. Complement Ther Med. 2019;46:9–18. Cramer H, Lauche R, Anheyer D, Pilkington K, de Manincor M, Dobos G, et al. Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2018;35:830–43. Brinsley J, Schuch F, Lederman O, Girard D, Smout M, Immink MA, et al. Effects of yoga on depressive symptoms in people with mental disorders: a systematic review and meta-analysis. Br J Sports Med. 2021;55:992–1000. Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for Depression: A systematic review and meta-analysis. Depress Anxiety. 2013;30:1068–83. Pascoe MC, Bauer IE. A systematic review of randomised control trials on the effects of yoga on stress measures and mood. J Psychiatr Res. 2015;68:270–82. Brosnan P, Nauphal M, Tompson MC. Acceptability and feasibility of the online delivery of hatha yoga: A systematic review of the literature. Complement Ther Med. 2021;60:102742. Chuang LH, Soares MO, Tilbrook H, Cox H, Hewitt CE, Aplin J, et al. A pragmatic multicentered randomized controlled trial of yoga for chronic low back pain: Economic evaluation. Spine (Phila Pa 1976). 2012;37:1593–601. Aboagye E, Karlsson M, Hagberg J, Jensen I. Cost-effectiveness of early interventions for non-specific low back pain: a randomized controlled study investigating medical yoga, exercise therapy and self-care advice. J Rehabil Med. 2015;47:167–73. Fowler-Davis S, Platts K, Thelwell M, Woodward A, Harrop D. A mixed-methods systematic review of post-viral fatigue interventions: Are there lessons for long Covid? Kardeş S. editor PLoS One. 2021;16:e0259533. Cheshire A, Richards R, Cartwright T. ‘Joining a group was inspiring’: a qualitative study of service users’ experiences of yoga on social prescription. BMC Complement Med Ther. 2022. Fowler-Davis S, Platts K, Thelwell M, Woodward A, Harrop D. A mixed-methods systematic review of post-viral fatigue interventions: Are there lessons for long Covid? PLoS ONE. 2021;16:e0259533. Fairbank R. Long COVID exercise trials proposed by NIH raise alarm. Nature. 2023;616:228–9. Samper-Pardo M, Formento-Marín N, Oliván-Blázquez B, León-Herrera S, Benedé-Azagra B. Use of community resources as health assets for rehabilitation of people with Long COVID in northeastern Spain two years after the outbreak of the COVID-19 pandemic: qualitative study. Arch Public Heal. 2023;81:1–10. GOV.UK. Improving the experiences of people with ME/CFS: consultation outcome - GOV.UK [Internet]. 2024 [cited 2025 Mar 11]. Available from: https://www.gov.uk/government/consultations/improving-the-experiences-of-people-with-mecfs-interim-delivery-plan/outcome/improving-the-experiences-of-people-with-mecfs-consultation-outcome Alwan NA. Lessons from Long COVID: working with patients to design better research. Nat Rev Immunol 2022 224. 2022;22:201–2. Smyth N, Ridge D, Kingstone T, Gopal DP, Alwan NA, Wright A, et al. People from ethnic minorities seeking help for long COVID: a qualitative study. Br J Gen Pract. 2024;74:e814–22. PROMIS. PROMIS® Instrument Development and Validation Scientific Standards, Version 2.0, (revised. May 2013). 2013. Ganesh R, Ghosh AK, Nyman MA, Croghan IT, Grach SL, Anstine CV et al. PROMIS Scales for Assessment of Persistent Post-COVID Symptoms: A Cross Sectional Study. J Prim Care Community Heal. 2021;12. Yang M, Keller S, Lin JMS. Psychometric properties of the PROMIS® Fatigue Short Form 7a among adults with myalgic encephalomyelitis/chronic fatigue syndrome. Qual Life Res. 2019;28:3375–84. Yost KJ, Waller NG, Lee MK, Vincent A. The PROMIS fatigue item bank has good measurement properties in patients with fibromyalgia and severe fatigue. Qual Life Res. 2017;26:1417–26. Krippendorff K. Content Analysis: An Introduction to Its Methodology. Content Anal An Introd to Its Methodol. 2019. Bowling A. Research Methods in Health: investigating health and health services. London: McGraw-Hill Education; 2014. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. McNabb KC, Bergman AJ, Smith-Wright R, Seltzer J, Slone SE, Tomiwa T, et al. It was almost like it’s set up for people to fail A qualitative analysis of experiences and unmet supportive needs of people with Long COVID. BMC Public Health. 2023;23:1–12. Kingstone T, Taylor AK, O’Donnell C, Atherton H, Blane D, Chew-Graham CA. Finding the right GP: a qualitative study of the experiences of people with long-COVID. Br J Gen Pract. Pilkington K, Ridge D, Igwesi-Chidobe CN, Chew-Graham C, Little P, Babatunde O et al. A relational analysis of an invisible illness: A meta-ethnography of people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and their support needs. Soc Sci Med. 2020;113369. Yon K, Nettleton S, Walters K, Lamahewa K, Buszewicz M. Junior doctors’ experiences of managing patients with medically unexplained symptoms: a qualitative study. BMJ Open. 2015;5:e009593. Howman M, Walters K, Rosenthal J, Ajjawi R, Buszewicz M. You kind of want to fix it don’t you? Exploring general practice trainees’ experiences of managing patients with medically unexplained symptoms. BMC Med Educ. 2016;16:1–10. Taylor AK, Kingstone T, Briggs TA, O’Donnell CA, Atherton H, Blane DN, et al. Reluctant pioneer: A qualitative study of doctors’ experiences as patients with long COVID. Heal Expect. 2021;24:833–42. Rivest-Gadbois E, Boudrias M-H. What are the known effects of yoga on the brain in relation to motor performances, body awareness and pain? A narrative review. Complement Ther Med. 2019;44:129–42. Rivest-Gadbois E, Boudrias MH. What are the known effects of yoga on the brain in relation to motor performances, body awareness and pain? A narrative review. Complement Ther Med. 2019;44:129–42. Zhu F, Zhang M, Wang D, Hong Q, Zeng C, Chen W. Yoga compared to non-exercise or physical therapy exercise on pain, disability, and quality of life for patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE. 2020;15:e0238544. Zhu J, Chen X, Zhen X, Zheng H, Chen H, Chen H, et al. Meta-analysis of effects of yoga exercise intervention on sleep quality in breast cancer patients. Front Oncol. 2023;13:1146433. Wang WL, Chen KH, Pan YC, Yang SN, Chan YY. The effect of yoga on sleep quality and insomnia in women with sleep problems: A systematic review and meta-analysis. BMC Psychiatry. 2020;20:1–19. de Orleans Casagrande P, Coimbra DR, de Souza LC, Andrade A. Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis. PM&R. 2023;15:899–915. Cheshire A, Richards R, Cartwright T. Joining a group was inspiring’: a qualitative study of service users’ experiences of yoga on social prescription. BMC Complement Med Ther. 2022;22:1–15. Wright H, Turner A, Ennis S, Percy C, Loftus G, Clyne W, et al. Digital Peer-Supported Self-Management Intervention Codesigned by People With Long COVID: Mixed Methods Proof-of-Concept Study. JMIR Form Res. 2022;6:e41410. Rinn R, Gao L, Schoeneich S, Dahmen A, Anand Kumar V, Becker P, et al. Digital Interventions for Treating Post-COVID or Long-COVID Symptoms: Scoping Review. J Med Internet Res. 2023;25:e45711. Bilc M-I, Pollmann N, Eisenmann C, Buchholz A, Pokhrel B, Lauche R, et al. Yoga intervention for colorectal cancer survivors: a qualitative study exploring participants’ expectations and experiences. Ann Med. 2024;56:2397571. Evans S, Moieni M, Subramanian S, Tsao JCI, Sternlieb B, Zeltzer LK, et al. Now I see a brighter day: expectations and perceived benefits of an Iyengar yoga intervention for young patients with rheumatoid arthritis. J Yoga Phys Ther. 2011;1:101. Uberoi E, Sturge G, Allen G, Danechi S, Kirk-Wade E, Barton C et al. Ethnic diversity in politics and public life. 2023. Additional Declarations No competing interests reported. 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Long-COVID symptoms can last months and sometimes years [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]; they are wide-ranging, heterogeneous, change over time and multisystemic (affecting any and all organ systems) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Key symptoms include chronic fatigue, breathlessness, \u0026ldquo;brain fog\u0026rdquo;, pain and post-exertional malaise (PEM) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Factors such as uncertainty of illness trajectory, traumatic intensive care stays and loss of identity can impact mental health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In April 2024 in England and Scotland, 3.3% of the population (two million) were experiencing self-reported long-COVID, with around three-quarters reporting the condition adversely effected day-to-day activities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Whilst risk of experiencing long-COVID after COVID-19 infection is lower now compared to early in the pandemic, the estimated risk is still stands at 3.5% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe impact of long-COVID can be substantial for individuals, health systems and the economy, nevertheless, treatment options are limited, with care focusing on support and managing symptoms [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the UK, support for people with long-COVID (PWLC) varies from self-management advice for the more mildly affected, management in general practice for the moderately affected, and referral to specialist services where appropriate and if available for those who are more severely affected [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, experiences of healthcare are mixed, with reports of inadequate support and medical gaslighting commonplace [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Research into the condition is hampered by a lack of a single definition of long-COVID and the multisystemic nature of the illness [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], as well as limited funding and investment into services and treatments [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eYoga offers a potential solution to reducing long-COVID burden by supporting PWLC with symptom reduction, self-management and quality of life. Yoga is a holistic mind-body practice originating from India that has become increasingly popular in the West as an accessible approach to manage health conditions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and support health and wellbeing [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Yoga is a multi-component intervention that typically incorporates physical postures, breathing techniques, and relaxation. Both cross-sectional population surveys and clinical trials suggest that yoga has physiological and psychological effects on health (particularly pain conditions and mental health), as well as being associated with positive health behaviours [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Research on yoga for long-COVID is in its infancy. A UK Iyengar Yoga intervention for PWLC (n\u0026thinsp;=\u0026thinsp;55) that provided 10 individual sessions with three teachers, reported statistically significant improvements for physical and mental health for participants after the intervention [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Trials have also shown yoga to be safe and to improve outcomes for patients with COVID-19 [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Both a feasibility intervention [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and RCT [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] that focused specifically on breathing techniques (a component of yoga) have shown positive effects for long-COVID. More robust evidence for the potential of yoga to improve long-COVID comes from research demonstrating the effects of yoga on the biological mechanisms implicated in long-COVID (e.g. dysautonomia and chronic inflammation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]), related health conditions (e.g. chronic fatigue syndrome [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]), key long-COVID symptoms (e.g. fatigue [\u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], pulmonary issues [\u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]), and quality of life [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and mental health [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eYoga interventions can be designed for people with very limited physical ability. Additionally, it can be delivered online compared to other services[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], increasing accessibility for PWLC. It is low cost [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] and popular among patients with long-term conditions including post-viral fatigue [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Yoga is already being provided on the NHS (e.g. acute mental health services) and via social prescribing for people with long-term conditions [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]; our research has previously found that a 10 week yoga intervention was acceptable to ethnically diverse NHS patients and supported self-management[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Home-based interventions are recommended for PWLC [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] and online live-streamed delivery of yoga is acceptable in both patient and community populations [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. However, acceptability is often established through those already attending yoga interventions, less is known about acceptability among the wider population. This is important because yoga for PWLC is not without its challenges, given the low functionality of many PWLC and prevalence of post-exertional malaise (PEM) symptoms. Such issues have led to a backlash against planned exercise interventions in the United States [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], and are reflected in findings from a Spanish study which found both positive experiences of yoga and barriers due to long-COVID fatigue symptoms [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. A safe and tailored approach to yoga in this population therefore needs to be established. Additionally, long-COVID and related communities may prioritise biomedical approaches [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Thus, more work is needed to understand the perspectives and experiences of PWLC on yoga.\u003c/p\u003e \u003cp\u003eIn summary, the treatment gap for long-COVID, combined with emerging evidence to support the use and suitability of yoga for PWLC, suggests its potential value as an intervention for this population. However, existing research is limited and the perspectives of PWLC remain underrepresented in the literature. This research therefore aimed to explore the perceptions and experiences of yoga for long-COVID among PWLC - regardless of prior yoga experience- in order to establish its potential role in supporting this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThe study was a cross-sectional anonymous survey design, collecting both quantitative (closed choice questions) and qualitative (free text questions) data, during September and October 2024. The survey was developed for this study (see Supplementary file).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and recruitment\u003c/h3\u003e\n\u003cp\u003eParticipants were recruited via the online research platform Prolific. Using Prolific allowed sampling of a broader range of participants, compared to recruitment through channels such as support groups and charities, who may be more motivated to seek support. To identify participants, firstly Prolific\u0026rsquo;s pre-screening questions were used (UK; long-term health condition/disability; formally diagnosed or self-reporting as having experienced Covid-19; and 90%+ approval rate) and these identified a possible 4296 possible participants. In order to identify those with long-COVID, we invited 3000 to answer a 10-option multiple choice question (\u0026lsquo;which long-term health conditions have you experienced in the last five years?\u0026rsquo;). One-hundred and ninety-eight participants reported they had long-COVID and were invited to participate in the main survey; participants who reported they had long-COVID but also ticked a high number of the other response options were excluded as potential imposter participants (n\u0026thinsp;=\u0026thinsp;5). One-hundred and seventy-one (90%) of those invited completed the main survey. We did not request a formal diagnosis of long-COVID from participants, as some report challenges getting a diagnosis due to issues such as lack of COVID-19 testing early in the pandemic, health professional scepticism and limited medical understanding of the illness [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. This is particularly prevalent in ethnic minority populations who may experience mistrust in the healthcare system and barriers to service access [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eSurveys were designed using Qualtrics software. A mixture of closed-response and open text questions collected demographic and other data including:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLong-COVID details\u003c/strong\u003e \u003cp\u003elength of time with long-COVID, symptoms and severity. Key long-COVID symptoms were measured using PROMIS (Patient-Reported Outcomes Measurement Information System) [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e] short form fatigue and physical function scales. PROMIS has previously been used with long-COVID populations [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e] and it has established reliability and validity among patients with CFS/ME and fibromyalgia [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Cronbach\u0026rsquo;s alphas for this study were 0.91 (fatigue) and 0.86 (physical function). Additional long-COVID symptoms/associated issues were measured using VAS scales (anchored 0 -none to 100 -as bad as could be imagined), including breathlessness, pain, light-headedness or unsteadiness, cognitive difficulties (\u0026ldquo;difficulty thinking clearly\u0026rdquo;), feeling anxious or worried, and feeling low or depressed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSupport needs\u003c/strong\u003e \u003cp\u003eparticipants were asked \u0026lsquo;Please tell us what kinds of support you would like to help manage your long-COVID symptoms?\u0026rsquo;, as well as support received from long-COVID NHS services and non-NHS interventions attended.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIntervention perceptions\u003c/strong\u003e \u003cp\u003eParticipants were provided with a description of an online course (Fig.\u0026nbsp;1), and were asked to rate how interested they might be in attending on a scale of 1 (very interested) \u0026ndash; 5 (definitely not interested), as well their interest in each individual element of the course. Open text space allowed participants to explain their responses. Additionally, participants were asked \u003cem\u003e\u0026lsquo;Some yoga therapists are already running these types of programmes, how would you feel about attending if it was labelled as 'yoga' for long-COVID and why? (from our past conversations with people with long-COVID some have said they had concerns about yoga, whereas others liked the idea)\u0026rsquo;\u003c/em\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eYoga use\u003c/strong\u003e \u003cp\u003eParticipants were asked about previous yoga practice, and those reporting yoga with long-COVID were asked to provide further details of their practice and experiences.\u003c/p\u003e \u003c/p\u003e \n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eDescriptive analysis was conducted for quantitative variables, including frequencies, percentages, means and standard deviations. For the PROMIS measures (fatigue and physical function), t-scores were calculated which were then split by recommended cut-off scores to provide an indication of symptom severity (mild, moderate, severe). In order to understand if interest in a mind-body intervention was related to symptom severity, one-way ANOVAs were conducted for all the symptom variables and rated interest in the programme. Qualitative data was typically subject to content analysis [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e], but where data were richer (i.e. what are your support needs? Explanation of interest in the course), inductive, thematic analysis was used [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Both authors read through all open-ended responses, which was initially coded by AC and then reviewed by TC and discussed to reach agreement. Both authors are experienced mixed methods researchers, with research expertise and personal experience of living with long-term health conditions.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eDemographics and NHS support\u003c/h2\u003e \u003cp\u003eParticipants were predominately female (61%), White (90%) and aged 31\u0026ndash;50 (55%). There was a spread of illness duration, but 2\u0026ndash;3 years was most common (36%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of participants had moderate to severe fatigue (80%) and challenges with physical function (59%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Cognitive difficulties were another key symptom for participants (52%), and around half were also experiencing mental health challenges (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMany participants had received some kind of support from the NHS for long-COVID, but a significant minority had not received any support. Most common forms of NHS support were self-management or stress management/psychological, in a one-to-one as opposed to group format (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Participants provided limited responses on how helpful they had found the support they had been offered, but support was more likely to be considered helpful than not, and pulmonary/breathing support, along with gentle exercise/activity, received more positive ratings. Several participants described waiting for extended periods of time to receive support.\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\u003e\u0026ndash; Participant demographics\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian or Asian British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack, African, Caribbean or Black British\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed or Multiple Ethnic Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-binary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI use a different term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIs this the same gender you were assigned at birth?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of time with long-COVID\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months \u0026ndash; 1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \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\u003ePROMIS scales, rating of severity by recommended cut-offs (percentage of participants)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \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\u003e\u0026ndash; Ratings of long-COVID symptoms\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptom (0-100, \u0026uarr;=worse)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd dev\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive difficulties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeling anxious or worried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeling low or depressed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLight-headedness or unsteadiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathlessness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \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\u003e\u0026ndash; What kind of support, if any, have you had from NHS Long-COVID services?\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eOne-to-one\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(23.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress management/\u003c/p\u003e \u003cp\u003epsychological support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(19.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreathing support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGentle exercise/activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary rehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(7.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e(26.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* n\u0026thinsp;=\u0026thinsp;2: Cardiology clinic, CFS/ME clinic; n\u0026thinsp;=\u0026thinsp;1: Sick notes, occupational therapy, pain management, practice nurse, Long-COVID clinic, Memory improvement techniques\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSupport needs\u003c/h3\u003e\n\u003cp\u003eWhilst participants highlighted the importance of an effective biomedical treatment, here we focus on support needs in relation to symptom management. Participants\u0026rsquo; need for their condition (and/or the extent of the impact it had on their lives) to be acknowledged by the medical community was a dominant theme, with many reporting struggling to get the recognition that they needed, requesting \u0026ldquo;\u003cem\u003ea doctor who listens to me and cares\u003c/em\u003e\u0026rdquo;.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It would just be nice if all medics believed the diagnosis and didn't try and pretend that long-covid was not a real thing.\u0026rdquo; P10\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA sense of despondency emerged from narratives with participants feeling like they had been left with little treatment, care, information or support. This sense of abandonment \u0026ldquo;\u003cem\u003eI'm being left to rot\u003c/em\u003e\u0026rdquo;, meant some had been left with \u0026ldquo;\u003cem\u003elittle hope for any useful help\u003c/em\u003e\u0026rdquo; and a sense of desperation to access help - \u0026ldquo;\u003cem\u003eI would love to hear any solutions\u003c/em\u003e\u0026rdquo;. Others were simply unclear if there was anything available that could help: \u0026ldquo;\u003cem\u003eunsure what support would manage extreme fatigue and brain fog.\u003c/em\u003e\u0026rdquo;\u003c/p\u003e \u003cp\u003eConsequently, many participants wanted better and more regular access to their GP as well as access to specialist services, like physiotherapy, rehabilitation or pulmonary support. They wanted help to manage their symptoms, particularly fatigue, changes in smell/taste, cognitive issues, breathlessness/lung function and pain, including prescriptions of effective medication. Psychological support was also prioritised by participants, with some suggesting talking therapy, counselling or \u0026ldquo;\u003cem\u003esupport with psychosomatic symptoms, anxiety, depression\u003c/em\u003e\u0026rdquo;. A number of participants said they would like local support groups. Self-management support was also mentioned, including how to manage and monitor symptoms, undertake gentle exercise, pacing, diet, communication with medical staff or knowing what services they could request.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;\u003cem\u003eCoping strategies that can minimise long-term effects impact on daily life. How best to get through the working day etc when symptoms are bad.\u003c/em\u003e\u0026rdquo; P68\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome sought access to knowledge and information about their condition \u0026ndash; particularly around prognosis and treatment that might be available, including complementary medicine and research trials: \u0026ldquo;\u003cem\u003einformation on how it affects people and how things are moving forward with treatments\u003c/em\u003e\u0026rdquo; (P14). Whilst others needed practical support to help with day-to-day living and understanding/flexible working arrangements from employers.\u003c/p\u003e\n\u003ch3\u003eInterest in a multi-component course to support symptom management\u003c/h3\u003e\n\u003cp\u003eA description of an intervention including the components often found in yoga practice was presented to participants (Fig.\u0026nbsp;1). This was not described as a yoga intervention to avoid potential bias associated with common preconceptions about yoga. Interest in the intervention was generally positive, with 64% stating they were definitely/might be interested, 16% unsure and 20% probably/definitely not interested.\u003c/p\u003e \u003cp\u003eOverwhelmingly, participants who were \u0026lsquo;definitely interested\u0026rsquo; expressed a willingness to \u0026ldquo;try anything\u0026rdquo; (\u0026ldquo;I welcome any support for managing symptoms\u0026rdquo;) and felt the course sounded potentially helpful. Others liked the convenience of the online format or the course content\u0026ndash; either specific activities (e.g. nervous system regulation) or the range of components included. Some participants valued the group setting, believing that connecting with others with long-COVID could help reduce feelings of isolation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I would welcome this - being in an online environment is manageable as it wouldn't contribute to fatigue through travelling and having contact with other people who live with this would help me feel less alone. I want this very much. Gentle movement and stretching is something I don't know how much to try or do so this is important. Peer support is essential and I just don't have this at present. P47\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, many expressed concerns about interacting in a group setting, primarily due to anxiety, and some reported disliking online courses: \u0026ldquo;I'm a little nervous about interacting with people over livestream as it gives me anxiety\u0026rdquo; (P153). A more individualised approach was preferred by some to acknowledge the variability in symptom experience. These concerns led to a range of reactions from lack of interest in the course, to apprehension without deterring participation entirely. Many participants also expressed concerns about managing the sessions alongside fluctuating energy levels or busy schedules .\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;If it was something I could log into and just do when I feel like I have the energy, it would be perfect. But if it requires me to put X amount of minutes in a day - I can't know if I'll have the energy to do that.\u0026rdquo; P155\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOf those with limited interest in the course, a number felt mostly recovered or were self-managing effectively. Others indicated they had already tried similar techniques, either self-guided (e.g. from online research) or attending a course, but with limited success. A smaller number reported feeling generally despondent or doubtful that such a course would be helpful. A few expressed scepticism, viewing such of courses as tokenistic: \u0026ldquo;\u003cem\u003eI\u0026rsquo;ve seen a lot of LC support that just feels bare minimum to \u0026ldquo;shut us up\u0026rdquo; but doesn\u0026rsquo;t really help. I\u0026rsquo;m sceptical I guess.\u003c/em\u003e\u0026rdquo; (P157)\u003c/p\u003e \u003cp\u003eA one-way between-groups analysis of variance was conducted to explore the impact of symptom severity on interest in participating in the course. There was a statistically significance difference for cognitive difficulties (F (4,163)\u0026thinsp;=\u0026thinsp;2.7, p\u0026thinsp;=\u0026thinsp;0.031; η\u0026sup2; = 0.024), with a small effect size. Those with more severe symptoms were more likely to express interest in attending the course. No statistically significant differences were found for the other symptom or mental health variables. Chi-squared tests revealed no statistically significant effects of age or gender on interest in attendance. A Fisher\u0026rsquo;s exact test revealed a statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.015) toward those from an ethnic minority background being less interested in the intervention, but this is difficult to interpret given the low numbers of ethnic minority groups participating.\u003c/p\u003e \u003cp\u003eIn relation to interest in the different components of the course, symptom management (80%) was most highly rated (definitely or might be interested), followed by relaxation (74%), breathing exercises (70%) and gentle movement (60%). Connection with others with long-COVID (47%) was of least interest, which was reflected in the qualitative data where both social anxiety about connecting with others online and a need to connect with others having similar experiences to combat feelings of isolation were expressed.\u003c/p\u003e \u003cp\u003eWhen asked if there was anything else they would like to see included, responses echoed quantitative findings around unmet needs, highlighting the importance of self-management support and relaxation. This included support to manage specific symptoms as well as broader self-management strategies such as pacing and brain retraining. Psychological support included positive thinking, building confidence, managing unhelpful thoughts and relaxation, whilst noting that some types of relaxation could exacerbate anxiety. Some participants wanted more information about long-COVID itself or diet and nutrition, with particular reference to loss of taste/smell. Finally, the tone of the course was highlighted as important, with some noting that being around others with more severe symptoms could be emotionally draining.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePerceptions of Yoga of long-COVID\u003c/h2\u003e \u003cp\u003eAll participants were asked about their perceptions of describing the intervention as 'yoga' for long-COVID. Over half (54%) reported positive attitudes towards a yoga course, often mentioning previous positive experiences with yoga, or simply an openness to try a gentle form of exercise, with others reporting they \u0026ldquo;would find this [yoga] reassuring\u0026rdquo;. Several were attracted by the holistic approach and positive focus on health: \u0026ldquo;I like the sound of yoga as it sounds healthy, proactive activity rather than something for sick people\u0026rdquo; (P54). A further 19% of participants reported uncertainties about \u0026lsquo;yoga\u0026rsquo; because of concerns about how strenuous it might be (\u0026ldquo;post exertional malaise is a massive concern\u0026rdquo;), if it would be suitable for their comorbid conditions, or with limited mobility (\u0026ldquo;Yoga implies floor level and I can\u0026rsquo;t get that low\u0026rdquo;).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I am hesitant because yoga feels like something quite advanced - I would be worried about pushing myself too much, and having some days where I felt too unwell to participate physically - I think if I knew I was able to do less or minimal on some sessions depending on fatigue and pain levels, I would feel more confident.\u003c/em\u003e\u0026rdquo; P47\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA significant minority (25%) indicated they would find the term yoga off-putting. Whilst many did not specify their reasons, several responded by indicating they were not interested in yoga (\u0026ldquo;I do not enjoy yoga\u0026rdquo;), disliked groups or felt they were not fit enough. Additionally, two participants said they would feel offended by being offered yoga, as it implied their condition was not physical in nature. Another described it as a poor use of NHS resources.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;This is just minimising the severity and reality of the disease. Wellness techniques are not cures or help for medical conditions.\u0026rdquo; P151\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eExperiences of yoga for long-COVID\u003c/h2\u003e \u003cp\u003eFifty percent of participants had practised yoga before they had long-COVID. However, only 14% (n\u0026thinsp;=\u0026thinsp;24) had practised yoga with long-COVID, the majority of whom (n\u0026thinsp;=\u0026thinsp;20) had previously practised. The most common styles practised were restorative (n\u0026thinsp;=\u0026thinsp;6), hatha (n\u0026thinsp;=\u0026thinsp;5) and yin yoga (n\u0026thinsp;=\u0026thinsp;4). The majority of those practising said that it helped their long-COVID symptoms \u0026lsquo;a little\u0026rsquo; (n\u0026thinsp;=\u0026thinsp;12), Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverall, how much does practising yoga help with your long-COVID symptoms?\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=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIt makes them worse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(20.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHelps a little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHelps a moderate amount\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(20.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHelps a lot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e(4.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants reported a range of benefits from practising yoga with long-COVID, with relaxation the most common. Several participants described it as a safe alternative to exercise, allowing them to build strength, flexibility and fitness. Others noted benefits such as breath management (\u0026ldquo;helped with dysregulated breathing\u0026rdquo;), relief through distraction from symptoms, nervous system regulation, and overall symptom management.\u003c/p\u003e \u003cp\u003eIn terms of challenges to practising yoga with long-COVID, by far the most common issue reported was fatigue, which could impact ability or motivation: \u0026ldquo;might be too fatigued to even get started\u0026rdquo; (P3). Additionally, flexibility, breathing problems, pain and stamina also affected ability to practise. Less commonly reported challenges were aggravation of symptoms, boredom, time, space, difficulty level and certain poses: \u0026ldquo;stretching can aggravate, especially bending over if it\u0026rsquo;s a bad day\u0026rdquo; P48.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the perceptions and experiences of yoga for long-COVID among PWLC, in order to establish the potential role of tailored yoga-based interventions in supporting symptom management in this population. Our findings highlight the many unmet support needs of PWLC, particularly the need for validation and recognition of their condition and its impact from healthcare professionals -the absence of which left many feeling despondent, abandoned and desperate. Importantly, we found alignment between several unmet needs and evidence-based potential benefits of a yoga intervention, namely support with symptom management, self-management and psychological impacts. This compatibility was also reflected in the high level of potential interest in a yoga-based intervention. Additionally, reports from those already practising yoga with long-COVID support the idea that it can help manage symptoms and associated psychological challenges, as well as providing a safer alternative to exercise. A significant minority did express concerns, with key barriers including anxiety regarding the group setting, fitting sessions into schedules or lack of energy. Importantly, our findings highlight that yoga for PWLC requires tailoring for long-COVID to reassure individuals, avoid exacerbation of symptoms and PEM, and be sensitive to the physical and cognitive limitations experienced by those with long-COVID.\u003c/p\u003e \u003cp\u003eA key unmet need was the lack of acknowledgement of the condition and its impact by health professionals, a finding supported by others [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Lessons from treatment of individuals with ME/CFS have highlighted the importance of this basic level of care in the face of lack of treatment options[\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e] and guidelines on the management of long-COVID for health professionals have reflected this [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nevertheless, this research suggests that practice is not always achieving these standards, and these experiences may worsen further given the current uncertainty around the future of long-COVID-specific services in the UK and elsewhere (i.e. long-COVID clinics). Additionally, doctors may find it challenging to deal with the clinical uncertainty surrounding long-COVID, resulting in unhelpful or dismissive interactions with patients [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e] or lack of empathy [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. This highlights the importance of training for healthcare professionals to work sensitively with patients [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA yoga intervention may help to provide some of the validation by a professional needed by PWLC but may also address other unmet needs, namely support with symptom management, self-management and psychological symptoms. Yoga interventions have been shown to improve key long-COVID symptoms such as fatigue [\u003cspan additionalcitationids=\"CR31 CR32 CR33\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], pulmonary function [\u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], pain [\u003cspan additionalcitationids=\"CR71\" citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e], sleep [\u003cspan additionalcitationids=\"CR74\" citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], as well as support mental health and well-being [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. They may also address the biological mechanisms implicated in long-COVID (e.g. Dysautonomia and chronic inflammation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]), or provide a \u0026lsquo;safe\u0026rsquo; way to move which can be challenging with long-COVID PEM symptoms. It is also possible to integrate specific self-management techniques for long-COVID (e.g. pacing) into yoga interventions [\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. The value of yoga to address some of these issues was supported by participants practising yoga in our study, however tailored programmes are likely to maximise potential benefits whilst minimising the risk of symptom exacerbation.\u003c/p\u003e \u003cp\u003eOur findings suggest that a tailored yoga intervention, such as the one described in this paper, is likely to be acceptable to many PWLC, including men who are typically less likely to practise yoga [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Other research has found that yoga interventions (including online) are generally acceptable to patients including those with ME/CFS [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e] and PWLC [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. However, acceptability is typically established in existing studies among those already enrolled on a yoga programme, this research highlights there may be issues prohibiting wider uptake. For example, whilst a group format to connect PWLC to others with the condition was very appealing to some, more participants expressed discomfort at the group setting, particularly in relation to interacting with the group or being on video. In addition, \u0026lsquo;connection with others with long-COVID\u0026rsquo; gained the lowest ratings of interest among participants (47%). Thus, online interventions that do not involve group interaction or require participants to have their video on may be more popular than previously thought, options of face-to-face interventions or those that include group interaction also have a role [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. The lack of correlation between interest in yoga and LC symptoms or participant demographics does, however, indicate a broad appeal.\u003c/p\u003e \u003cp\u003eFurther barriers included fitting sessions into schedules alongside lack of energy on the day, suggesting the value of flexible on-line sessions. Interestingly, concerns around low energy primarily reflected worries about ability to participate, rather than concern that yoga would exacerbate symptoms. Additionally, the lack of correlation between interest in the intervention and symptom severity, suggests that many people with long-COVID are aware of and able to work within their energy limitations. Nevertheless, careful consideration should be given to how the intervention is described, with an emphasis on safety and appropriate modifications for PEM. The use of \u0026lsquo;yoga\u0026rsquo; [\u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e] is also important. The majority of participants in this study responded positively (or neutrally) to the term \u0026lsquo;yoga\u0026rsquo;, or it clarified for participants that this was not the right intervention for them. For others it raised concerns that would require addressing when promoting such programmes, for example clarity regarding the suitability for individuals with co-morbidities or limited mobility.. Importantly, yoga for long-COVID should be offered in the context of health professional validation of symptoms and research into biomedical treatments [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e] to ensure individuals feel heard and their concerns are appropriately addressed.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA key strength of this study was its inclusion of any individual with long-COVID, rather than those already accessing an intervention \u0026ndash; as has been the case for previous research exploring yoga acceptability. Recruitment through Prolific enabled access to a broader sample than might be obtained through support groups who may be more motivated to seek help and be positively biased towards yoga. Nevertheless, this was not a random sample and participants using Prolific may have certain biases. The study relied on self-reported long-COVID status and we did not require a formal clinical diagnosis. While this may introduce some diagnostic uncertainty, we considered it important to include all individuals identifying as having long-COVID to avoid excluding key groups - such as those infected in the first wave and ethnic minority populations who find it hard to get a diagnosis. Indeed, this has also been the approach of other studies in the area [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Nevertheless minority ethnic groups are still underrepresented in our sample, comprising 9% of participants compared with 16% in the general UK population [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eYoga appears to be an acceptable intervention for a significant proportion of those with long-COVID, but needs to be appropriately tailored to fit the ability and address the concerns of PWLC. Given the narratives of struggle for recognition and treatment of long-COVID within the medical domain, any intervention should be offered alongside health professional validation of symptoms and situated within the broader context of research into biomedical treatments for the condition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNICE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute of Health and Care Excellence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePEM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epost-exertional malaise\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePROMIS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epatient-reported outcomes measurement information system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePWLC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003epeople with long-COVID\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate:\u003c/h2\u003e \u003cp\u003e Ethical approval for the study was gained from the University of Westminster, College of Liberal Arts and Sciences ethics committee (ETH2324-2236). All participants were provided with a participant information sheet and consent form, and gave consent prior to completing surveys. The study adhered to the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication:\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis work did not receive any funding\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAC conceptualised the study and led on study design, data collection, analysis and write up. TC contributed to study design, data collection, analysis and write up. Both authors reviewed and agreed upon the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank all of our participants for sharing their personal insights and for participating in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due ethical reasons.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNehme M, Braillard O, Chappuis F, Courvoisier DS, Guessous I. Prevalence of symptoms more than seven months after diagnosis of symptomatic covid-19 in an outpatient setting. Ann Intern Med. 2021;174:1252\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreenhalgh T, Sivan M, Perlowski A, Nikolich J. Long COVID: a clinical update. 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BMC Complement Med Ther. 2022;22:1\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright H, Turner A, Ennis S, Percy C, Loftus G, Clyne W, et al. Digital Peer-Supported Self-Management Intervention Codesigned by People With Long COVID: Mixed Methods Proof-of-Concept Study. JMIR Form Res. 2022;6:e41410.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRinn R, Gao L, Schoeneich S, Dahmen A, Anand Kumar V, Becker P, et al. Digital Interventions for Treating Post-COVID or Long-COVID Symptoms: Scoping Review. J Med Internet Res. 2023;25:e45711.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBilc M-I, Pollmann N, Eisenmann C, Buchholz A, Pokhrel B, Lauche R, et al. Yoga intervention for colorectal cancer survivors: a qualitative study exploring participants\u0026rsquo; expectations and experiences. Ann Med. 2024;56:2397571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvans S, Moieni M, Subramanian S, Tsao JCI, Sternlieb B, Zeltzer LK, et al. Now I see a brighter day: expectations and perceived benefits of an Iyengar yoga intervention for young patients with rheumatoid arthritis. J Yoga Phys Ther. 2011;1:101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUberoi E, Sturge G, Allen G, Danechi S, Kirk-Wade E, Barton C et al. Ethnic diversity in politics and public life. 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Yoga, Long-COVID, COVID-19, survey, qualitative, mixed-methods, long-term health condition","lastPublishedDoi":"10.21203/rs.3.rs-6723479/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6723479/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe impact of long-COVID can be substantial for individuals, health systems and the economy, nevertheless, treatment and support options are limited. Yoga offers a potential solution to reduce the burden of long-COVID, demonstrating positive impacts on the biological mechanisms implicated in long-COVID, key long-COVID symptoms and associated mental health challenges. Yoga interventions can also be designed for people with limited physical ability, and online delivery can increase accessibility.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eTo understand the perceptions and experiences of yoga for long-COVID, in order to establish the potential of yoga for helping people with long-COVID (PWLC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn online survey of PWLC, comprised closed and open response questions on: long-COVID symptoms, support needs, perceptions of a yoga intervention and its components, and yoga use. Participants (n\u0026thinsp;=\u0026thinsp;170) were recruited via Prolific. Inclusion criteria were long-COVID (formal diagnosis or self-reported) and living in the UK. Inductive thematic analysis was used for open ended responses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePWLC reported feeling despondent about their condition and abandoned by health professionals. We identified several unmet needs among PWLC that align with the potential benefits of a yoga intervention, particularly in supporting symptom management, self-management and psychological symptoms. Additionally, there was a high level of interest in a yoga intervention. Barriers included anxiety regarding the group setting, fitting sessions into schedules, lack of energy and concerns about suitability for long-COVID. Those already practising yoga with long-COVID reported that yoga helped to manage symptoms and associated psychological challenges, as well as increasing flexibility and providing a safer alternative to exercise.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eYoga appears to be an acceptable intervention for PWLC, but needs to be tailored to fit their ability and address their concerns. It should be offered in the context of health professional validation of symptoms.\u003c/p\u003e","manuscriptTitle":"Perceptions, acceptability and experiences of yoga to support long-COVID: A survey of people living with long-COVID","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 06:19:47","doi":"10.21203/rs.3.rs-6723479/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-11T13:56:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-19T07:49:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153702258716672719942312921832455452782","date":"2025-07-19T06:48:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T10:43:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256445745470117970831481839630249207575","date":"2025-06-22T06:00:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208453049640735346888454984830169026490","date":"2025-06-19T03:06:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-17T05:06:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-11T05:40:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-05T10:53:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2025-06-05T10:14:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2475dbcb-8431-4c19-b7ee-8181a7027eed","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-21T09:24:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-25 06:19:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6723479","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6723479","identity":"rs-6723479","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}