Long COVID Drains Time and Energy From Everyday Tasks, Study Finds

For most people, taking a shower, preparing a meal, or driving to the grocery store are routines that unfold almost without thought. But for a growing number of people living with Long COVID, these ordinary activities have become slow, effortful, and sometimes impossible to complete alone. A new Danish study published in the Scandinavian Journal of Occupational Therapy offers one of the most detailed pictures yet of exactly which daily tasks falter after the condition takes hold, and how the quality of everyday performance quietly erodes even when independence appears intact.

The research, led by occupational therapist Rina Juel Kaptain of University College of Northern Denmark and colleagues at the Parker Institute in Copenhagen and the University of Southern Denmark, took an exploratory cross-sectional approach. The team recruited 30 adults diagnosed with Long COVID who were enrolled in an interdisciplinary, municipality-based rehabilitation program between April and December 2022. All had been referred from a clinic for long-term sequelae of COVID-19 at a county university hospital after their symptoms had persisted for at least six weeks. Of 53 people invited to take part, 57 percent agreed to share clinical data collected as part of their routine care.

The study’s central innovation lies in the assessment tool it deployed. Rather than relying on coarse questionnaires that simply ask whether a person can or cannot perform a task, the researchers used the ADL Interview, or ADL-I, a validated occupational therapy instrument that probes the quality of task performance across 47 activities: 31 personal ADL tasks such as eating, grooming, and dressing, and 16 instrumental ADL tasks such as cooking, shopping, and cleaning. For each task, respondents describe whether they perform it without extra time or effort, with added time, with added effort or fatigue, with risk of injury, with partial assistance, or not at all. These ratings are then converted, through a Rasch rating scale model, into an overall interval-level measure of self-reported ADL ability, adjusted for the difficulty of each task.

The results reveal a striking and consistent pattern. Nearly every participant reported degraded performance quality in both personal and instrumental domains, but the dominant problems were not outright dependence. Instead, they were subtler: extra time consumed and extra effort expended. Within the personal ADL domain, between 60 and 97 percent of participants reported communication difficulties, including taking part in conversation, using the phone, reading, and writing by hand or word processor. Roughly half reported similar time-and-effort burdens when walking between floors or moving about the neighborhood, and nearly half reported the same when washing or bathing. Almost a third reported added effort simply to wash their hair.

The instrumental domain showed even broader disruption. More than half of the participants reported decreased quality of performance across transportation, cooking, shopping, and cleaning tasks. Sixteen participants had trouble riding a bicycle or moped, and 21 reported problems driving a car, again mostly because of increased time or effort, though a smaller group described safety risks, a need for help, or inability to complete the task. Cooking a hot meal, making shopping plans, and both small- and large-quantity shopping were each affected in more than half the sample. By contrast, nearly all participants remained competent at heating up liquid or prepared food and preparing a cold meal, suggesting that simpler, shorter tasks remained within reach while complex, multi-step activities did not.

Statistically, the picture sharpened further. Using Spearman’s rho and point biserial correlations, the researchers examined whether ADL ability was linked to a range of health-related, social, and personal factors: age, sex, cohabitation, comorbidity, symptom presence, and work status. Only one factor rose above weak association. Fatigue, measured with the Modified Fatigue Impact Scale, showed a moderate negative correlation with ADL ability (r = −0.50, p = 0.01), meaning that the more severely participants were affected by fatigue, the poorer their rated quality of everyday task performance. None of the remaining variables, including age, showed meaningful relationships, a finding the authors describe as surprising given that ADL ability typically declines with age in the general population. Long COVID, they suggest, may disrupt typical age-related patterns of function.

The centrality of fatigue is consistent with a broader literature. Previous research has found that more than 70 percent of people with Long COVID report fatigue as their worst symptom, and that physical activity, stress, and disturbed sleep can all exacerbate it. Fatigue is also a well-documented driver of functional limitation in other chronic conditions, including heart failure, fibromyalgia, chronic pain, hypertension, and stroke, and self-reported fatigue in older adulthood has been shown to predict the need for ADL assistance years later. The Danish findings extend this pattern to Long COVID, reinforcing the idea that energy dysregulation lies at the heart of the condition’s functional toll.

The study also documented a heavy occupational cost. Only 10 percent of participants were able to maintain their regular working hours; more than half worked reduced hours, and one third were on full-time sick leave. This aligns with earlier research showing that only a minority of previously employed people with Long COVID return to their pre-illness working hours. Notably, the tasks that most often deteriorated, communication, planning, transportation, and household management, are precisely the capacities that underpin employment and social participation. The authors point out that difficulty with conversation, reading, and writing is particularly consequential, and cite prior work showing that 73 percent of Long COVID patients report difficulties socializing.

For rehabilitation practice, the findings carry concrete implications. Because most participants retained independence but lost efficiency, the authors argue that rehabilitation planning should assess not just whether patients can perform a task, but how much time, effort, and risk the performance involves. They highlight the role of occupational therapy in energy management interventions, teaching patients to understand the factors that influence their energy levels and to apply strategies such as pacing, prioritizing activities, planning ahead, and modifying their environment. Evidence suggests such interventions can be delivered effectively both in person and remotely, and recent data show meaningful improvements in fatigue, energy-management competence, and ADL performance, a flexibility that matters given the fluctuating nature of Long COVID symptoms.

The authors are careful to note the study’s limits. The sample of 30 participants was small and drawn retrospectively from people who had completed municipal rehabilitation, so the findings may not generalize to those with milder symptoms or limited healthcare access. Still, the heterogeneity of the sample, spanning ages 28 to 73, both sexes, varied symptom profiles, and different times since diagnosis, strengthens the correlational analyses. And the use of a standardized, task-specific instrument administered by a certified occupational therapist gives the study a granularity that binary assessments cannot match. The conclusion is sobering but actionable: Long COVID does not merely make people unable to do things; it makes the doing of ordinary life slower, costlier, and more fragile, and rehabilitation that targets energy and efficiency, not just independence, may be key to restoring it.

Subject of Research: Quality of activities of daily living task performance and fatigue in adults with Long COVID

Article Title: Activities of daily living following Long COVID: An exploratory cross-sectional study

Article References: Kaptain, R. J., Jensen, K. E. B., Nielsen, K. T., & Wæhrens, E. E. (2025). Activities of daily living following Long COVID: An exploratory cross-sectional study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2597212. https://doi.org/10.1080/11038128.2025.2597212

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2597212

Keywords: Long COVID, activities of daily living, ADL-I, fatigue, occupational therapy, rehabilitation, functional disability, post-acute sequelae of COVID-19, energy management, cross-sectional study, personal ADL, instrumental ADL