Sleeping Better

Sleeping Better

Why do we sleep?
Sleep is a vital bodily function which allows the body and brain to recharge. Sleeping is important for memory retention and to maintain good cognitive function. When we fail to get enough sleep, it can have a detrimental effect on our bodies.

Lack of sleep can:


How does my body know when it’s time to fall asleep?
Your body has an “internal clock” known as your Circadian Rhythm. One of the processes controlled by this “clock” is your sleep-wake cycle. This cycle is closely tied to light. In the day, the light stimulates signals that keep us alert and active and at night the reduced light exposure promotes the production of Melatonin, a hormone which helps us get to sleep and keep us asleep.
Not everyone has the same sleep-wake cycle , 30% of the adult population are known as “owls”, in that they will feel more tired later at night and tend to wake up later in the morning when given the choice, this is even more common in your teenage years. Other people will find the opposite and are known as “larks”. They feel more tired earlier at night and prefer to get up earlier in the morning, which is more common as we get older. This is thought to be caused by genes we inherit.


How much sleep do we need?
The amount of sleep we need changes depending on our age, this typically starts out longer when we’re younger and gets shorter as we age but stays between 7-9 hours for most of our life. The table below is taken from the recommendations.


Age Group Age Range Recommended Amount of Sleep per Day:

Newborn 0-3 months              14-17 hours
Infant 4-11 months                  12-15 hours
Toddler 1-2 years                     11-14 hours
Preschool 3-5 years                 10-13 hours
School-age 6-13 years             9-11 hours
Teen 14-17 years                      8-10 hours
Young Adult 18-25 years       7-9 hours
Adult 26-64 years                   7-9 hours
Older Adult 65 years +          7-8 hours


How do I know if I am getting enough sleep?

Activity trackers and smart watches have been shown to be good at measuring time
in bed but poor at measuring the quality of sleep.

A simpler way is to ask yourself:
● Could you fall back asleep at 10am or 11am?
● If you did not set an alarm in the morning would you sleep past it?
● Could you function well without caffeine before noon?

If the answer to the first 2 questions are yes, then you are likely not getting enough sleep.
If the answer to the third question is no, you are likely using caffeine to self-medicate your lack of sleep.

What can I do to improve my sleep?

1. Try going to bed and getting up at the same time every day. It takes more than one or two nights to catch up on reduced sleep. So a lie in on the weekends might not be enough to catch up on sleeping poorly throughout the rest of the week.
2. Exercise can be great for increasing your sleep pressure (the desire to go to sleep).
3. Avoid caffeine after noon. Caffeine has a half-life of 6 hours, meaning a cup of coffee at 4pm is the same as having half a cup of coffee at 10pm.
4. Do not smoke. The nicotine in cigarettes act as a stimulant making it harder to get to sleep. Smokers can also be woken up earlier by nicotine cravings.
5. Avoid large meals and drinks just before bed. This can lead to indigestion which can interfere with sleep. Drinking too much before bed can lead to frequent awakenings to urinate.
6. Naps can be very useful in the early afternoon, but naps after 3pm can make it harder to sleep at night.
7. Relax before bed. Reading, listening to music or meditation can be a good way to relax before going to bed.
8. Thermal dump – Taking a hot shower or bath before bed can be a useful way to reduce your core body temperature which helps your body prepare for sleep. This is because our bodies will naturally drop about 1°C during sleep, when you get out of the hot water more of the blood will rise to the skin’s surface (this is why your face gets red when its warm) which means heat is lost more quickly, leading to a drop in core body temperature.
9. Make your bedroom a hibernation station, create an environment which is cool, dark, and quiet.
10. Reduce your screen time before bed, because the production of melatonin (the hormone which makes you tired) is tied with darkness. Blue light especially has been shown to delay the production of melatonin so downloading blue light filter apps such as “Twilight” can be helpful. Also using lamps and smaller lights in the evening can be a good way of reducing light exposure.
11. Getting exposure to light when you wake up can be useful in making you feel more awake, ideally outdoors with sunlight.
12. Do not lie in bed if you’re feeling awake, get up and do some relaxing activity such as reading and return when you feel tired. Clock watching can cause sleep anxiety by making us feel more stressed and less able to relax, to prevent this turn clocks around so they are not easily seen.


Further resources:

Cutting back on lawnmower injuries

Published on  22 September 2023


The smell of freshly-cut grass is one of the classic senses of spring, but ACC is challenging all New Zealanders to be safe when they pull their lawnmower out of the shed.

ACC accepted 6,922 lawnmowing-related injuries in 2022 – the highest number of claims since 2019.  These injuries came at a cost of $12.6 million to help people recover.

ACC injury prevention leader James Whitaker says it feels great to get the lawns done so you’re free to do other things, but he encourages people to slow down to consider the risks of injury.

“Our data shows injuries are more likely to happen at our homes than anywhere else,” James says.

“No one wants to start their weekend getting ready to mow the lawns or do a DIY job and then end up in accident and emergency with an injury.

“The good news is these injuries are preventable. You can stop them from happening if you take a moment to consider the risks before you get stuck in.”

Free Person Using Lawn Mower Stock Photo

Lawnmowing injuries by the numbers

In Aotearoa, the grass grows fastest during the spring months, and this is reflected in the injury data.

In August 2022, ACC accepted 423 lawnmowing-related injury claims and these increased throughout the months of spring – September (550), October (690) and November (839).

The leading regions for lawnmowing injuries in 2022 were Auckland (1,986), Waikato (932), Canterbury (693) and Northland (493).

Last year, males (4,540) were almost twice as likely to suffer a lawnmowing injury compared to females (2,382).

The most common types of injury were mostly soft tissue Injuries (5,334), ahead of laceration/puncture/sting (915) and fracture/dislocation (154).

Free A Person Cutting Grass With a Lawn Mower Stock Photo

‘Have a Hmmm’ before you get stuck into DIY

Alongside lawnmowing injuries, ACC accepted 19,300 DIY injury claims in 2022. These injuries came at a cost of $30 million to help people recover. This was the highest cost over the past five years.

“We know many people will use spring as an opportunity to do some odd jobs around the house and garden,” James says.

“Our top tip for a safe DIY project is to slow down.  Many accidents in the home happen simply because people are rushing and not thinking about what they’re doing.

“We want everyone to have that satisfaction of completing their DIY project and also be injury free so they can enjoy their time with their whānau.”

Free Blue and yellow ball on green grass Stock Photo

Five things before you mow your lawn

  1. Do you have the right gear on? Always wear safest shoes possible (preferably steel-capped boots), earmuffs and safety glasses.
  2. Are your kids and other people nearby and in danger?
  3. Have you cleared the area of any debris (such as rocks, stones, hard sticks and branches etc?
  4. Do you know how to use the mower you’re using? If not, read the safety manual, watch the manufacturers videos on YouTube or chat to a mate who has used it.
  5. Have you thought of ways to mow the lawn without putting strain on your back?

Strength and Balance Training for Runners

Running is excellent aerobic exercise, is an amazing outdoor sport, and is accessible to anyone with very little equipment. It’s important to remember that running places large forces and physical
demands on the body regardless of your chosen distance, pace, or terrain. Without proper conditioning of the leg muscles along the biomechanical chain it can be easy to pick up injuries.
Running injuries include bone and soft-tissue injuries caused by sudden events like sprains or strains, or can be caused by repetitive injury and overuse. ACC data shows that there were 153,014 running related injuries reported between 2010 and 2020 in New Zealand. The majority of those affected were aged 10-54, with similar numbers of males to females… basically, running injuries can affect anyone at any time!

Every runner’s regular training routine should include some form of strength and balance training. Adding these types of exercises into your training can improve your overall performance in addition to preventing injury. Remember to choose exercises suitable for your level – if they are too easy then you won’t see improvements, and if they are too hard then you won’t perform well enough and will likely forget about them after a few sessions. This principle applies to both strength and balance exercises.

For strength training you can start with body-weighted exercises and progress to using weights as you become stronger. To build muscle strength you should pick an exercise and weight that allows you to perform somewhere between 8-12 reps well while making any further reps difficult. Complete 2-3 sets of 8-12 reps on 3 or more days each week to see improvement over time. To improve balance, you need to ensure that your exercises are challenging enough to stimulate your nervous system. Balance exercises often involve standing on one leg and keeping your balance
for as long as possible. Create challenging drills by standing on an uneven surface like a Bosu ball and add movement or distraction like throwing and catching a ball at the same time! Aim to complete 5-10 minutes of balance exercises on 2 days each week. If you’re unsure which exercises to choose – have a look at the examples below.

If you are serious about building a personalised training routine and incorporating strength and balance exercises that target your weaker areas, book an appointment with one of our physiotherapists for assessment and guidance.

Single leg squat: Stand near a wall or table for support if you need it. Balance on your affected leg. Keeping the heel on the ground, bend your knee, ensuring the knee travels directly
forwards over your toes. Straighten back up fully, and repeat the movement.

Single leg bridging: Lie on your back. Bend one leg upwards, placing the foot on the floor. Draw your other leg up to the same position, maintaining a hips width between
your legs. Lift one foot slightly off the floor. Using the effort of your remaining foot, lift your hips up into a bridge until you have a straight line from your shoulders to your knees. Lower back down and repeat. Keep your pelvis level throughout this exercise.

Single leg heel raise with weight: Stand up straight holding a weight in each hand. Move your weight onto the leg to be exercised, lifting your other from the floor. Ensure you to not rest your elevated leg on your stance leg. Keeping your gaze directly ahead and your knee straight, rise up onto the ball of your foot. Ensure you keep your core, buttocks and thigh muscles activated to help control this movement. Slowly lower your heel back to the floor and repeat.

Nordic hamstring curl: This exercise requires a partner. – Start position is kneeling on the floor with the partner behind holding onto your heels to keep the legs in place. Lean forward from the waist slightly for three repetitions, returning to the starting position each time. Do not bend at the waist and keep the trunk and the thighs in line. After the first three repetitions, increase the forward lean a bit more for every movement until you reach an angle from which you are unable to return, then fall forward keeping the trunk rigid and use a push-up to return to the starting position

Resisted crab walks: Place a band around your ankles and gather some tension. Side-step keeping constant tension on the band. Make sure you do not bring your feet too close together and keep your toes and knees pointing forwards.

Side plank with dip: Lie on your side and lift yourself in to a plank on your elbow, with a straight line from your head to your feet. Drop your hips down until they are just off the floor, and then bring them back up.

Mountain climbers: Adopt a plank position insuring your hands are directly beneath your shoulders. Fully flex one hip and hold. Extend the bent leg to the rear and repeat the movement pattern on the opposite side.

Box jumps on/off: Start Position is standing in front of a box or step with your feet shoulder width apart. Perform a short squat in preparation for jumping at the same time swinging your
arms behind you. Rebound out of this position, extending through the hips, knees, and ankles to jump as high as possible. Swing your arms forward and up. Land on the box with your knees bent, absorbing the impact through the legs. Jump off the box landing on the balls of the feet and heels absorbing the impact through the knees and hips.

Plyometric alternating lateral hop: Stand up straight with a line marker on each of your sides. Transfer your weight onto one foot and lift your other off the floor. Using your arms to generate momentum, hop sideways over one line landing lightly on your foot, then immediately hop sideways over the other line landing on your other foot. Continue as instructed.

Single leg stand on BOSU throw/catch against wall (stand on round side): Place a BOSU onto its flat side on the floor in front of a wall. Stand on one leg on the rounded side of the BOSU and gain your balance. Throw the ball against the wall, keeping your balance as you catch it. Repeat this movement, trying to keep the BOSU as steady as possible.

Slippery Slopes? Queenstown Physio’s Guide to Recovery this Winter

Acute joint and muscle injuries can be very painful, cause swelling and heat in the area, and can also cause painful muscle spasm. If you are unlucky enough to injure yourself on the slopes this winter, here are some helpful tips to guide you through the first 24-48 hours following injury.

1. Remain Calm
Injuries that occur on the slopes are usually fast, and unexpected! It’s normal to feel shocked, and emotional on top of the pain experienced at the sit of injury. Try to remain calm, take some deep breaths to clear your head, then focus on getting help.

2. Get to Safety and/or Get Help!
If you are in the middle of a busy slope it’s important to get to safety. You don’t need anyone bumping into you after injury, and equally you can risk injuring others if you are stopped in the middle of a slope. Get to the side of the slope if possible. If you are unable to stand, ride, or walk to the edge – put your hands up and flag down a passer-by for some help. Attention the medic or ask someone to call one.

3. Get RICE (Rest, Ice, Compression, Elevation)
Most acute injuries benefit from using the RICE method to control pain and swelling in the first 48- 72 hours post-injury.

Take it easy, but don’t stop moving the affected area completely. Move as much as you can tolerate, but don’t force painful movements – this will help the injured tissue to repair. Enjoy a cup of hot chocolate and relax!

As soon as possible apply ice wrapped in a damp towel to the injured area. Leave it there for 15-20 minutes and repeat 4-8 times daily for at least 48 hours. You cannot do this too much!

Use elastic wrap or a bandage to apply compression to the injured area. If you experience throbbing, tingling, numbness, or blue looking skin in the area then the compression is too tight!! Remove it and re-wrap with less pressure. Do not use compression at night as you cannot monitor the area while asleep.

When it comes to swelling, gravity is not your friend! Keep the injured area elevated while resting, aiming to have it higher than your heart. This will limit and help to reduce swelling. Use pillows during the day or night to support the injured area.

4. Analgesia and Rest
Take some simple pain-relieving medication. Using pain-relief will allow you to move more freely, get some restful sleep, and can prevent secondary injury. If you are unsure which medication to take, or are unsure if a medication is safe for you – consult the medic or a doctor.

5. Slippery Slope
Don’t be tempted to resume skiing or snowboarding if you have not fully recovered! This is a slippery
slope and something many people do to avoid missing out on time enjoying the sport or their holiday – be warned that it usually ends in further injury or prolonged recovery!

6. Get it Checked
If your injury is not improving, is slow to recover, or you are concerned about it for any reason – get
professional advice from a physiotherapist or doctor. Queenstown Physio offers appointments Monday to Friday in
Queenstown and Frankton with a team of experienced physiotherapists – give us a call or book online.

The $1.8 Billion Problem ACC Wants to Solve

Published on 2nd April 2023.

ACC is launching a free app to help people combat the most common preventable injury in the country – falls.

In 2022, ACC accepted 749,610 claims relating to fall-related injuries, with a cost of $1.8 billion. Over the last six years, fall-related injuries have cost the taxpayer $8.6b. James Whitaker, ACC injury prevention leader, said falls are more often than not preventable, and they have a massive impact both financially and socially. “If somebody does fall and they get injured, it doesn’t just affect them it affects their family, friends, workmates and their teammates too,” he said. Falls account for 39% of all ACC claims, with one in three people over 65 injuring themselves in a fall every year, rising to one in two for people aged 80 or over. However, this did not have to be the case, Whitaker said. “We want people to realise that a fall and fall-related injuries don’t need to be a part of the ageing process … it’s been proven many times of over that if you improve your strength and your balance you can live a pretty active and fun lifestyle.” The Nymbl app launches on Monday April 3, which ACC hopes will help reduce the prevalence and social cost of falls. Colin McGregor, 64, took part in the app’s trial alongside 15,000 other New Zealanders. It boosted his confidence after he began to feel uneasy while riding his 1000cc Suzuki motorbike.

“I ride quite a big motorcycle and needed to make sure I was well-balanced … I noticed that my strength and my balance hadn’t been so good so when I saw it available I thought I’d give it a go.” McGregor said the exercises had helped him in everyday activities. “I felt a sense of improvement in how I was coping day-to-day … I’m much more confident in doing things that I might not otherwise have done, so I’m much more physically active than I used to be.” Recently completing a 3000km motorbike trip around the South Island, the physical toll of his motorbiking adventures were less of a worry now, he said. “I can see myself lasting on the bike a lot longer than I might’ve done otherwise.”

Using the app was a calming experience, and he appreciated being able to track his progress day-by-day, McGregor said. Although he found the app a bit difficult at first, he noticed it adapted the next session to reflect his feedback. Nymbl mixes physical activities with cognitive stimulation to keep users engaged as they strengthen their bodies and build up mental confidence. The cognitive activities include trivia and brain games to keep users engaged and keen to try again the next day.

What a Croc! ACC Reveals 51 Croc-Related Claims Over Last 12 Months

Published on 21st March 2023.

A footwear favourite of some, the humble croc has cost the taxpayer $36,351 in the year to March 2023 with people literally falling over them, according to data made available by ACC.

With 51 active croc-related claims paid out in the past 12 months, the shoe was to blame for injuries sustained to all parts of the body. Of new claims made during this period, 15 injuries were related to the foot, eight related to the ankle and the remainder of injuries were suffered across the body. Soft tissue injuries accounted for 25 of the new claims made, with those in the 65-plus age group appearing in the data the most frequently. New croc related claims were made on ten occasions in Auckland, seven times in Canterbury, six in Wellington, four in the Bay of Plenty, and the balance elsewhere across the regions.

The inclusion of the term “croc” on an ACC claim, is down to whether the patient declares the footwear in their injury themselves. While crocs are not necessarily worse for your feet overall than other footwear choices, lead podiatrist at Hamilton-based Waikato Podiatry Clinic, Andrew Jones says it’s a matter of “horses for courses”. Practicing for more than two decades, he says that the shoe should suit the occasion, and while a croc might be good for “around the house,” it’s certainly not made for tramping in. The material used to produce crocs is also of a less durable construction, says Jones. “Some of the things I’ve seen with crocs: the manufacturing of them is reasonably cheap, although you wouldn’t think that now because they cost $85. They don’t have an outsole and a midsole, they’re just one material in themselves. That in itself is quite soft. There’s an inverse relationship between softness and durability.” A slippery surface can really put the croc to the test, Jones says. “They are bloody dynamite. If you have a worn croc on a polished concrete floor that is wet … it’s like skating on ice. That’s something people really need to be aware of.” Supported by the data, Jones says older croc wearers ought to beware.

“In the elderly population footwear is certainly a fall risk. That’s a big problem, because fractured neck of femurs and those things can be life changing injuries … They need to be probably a little more proactive in selecting shoes; if they have a fastening, if they have a midsole with a resonable level of density, an outersole, a heel counter.” Jones’ personal recommendation for a croc-like alternative is the venerable birkenstock. A moulded foot bed and buckle fastening offer better support and durability, he says.

Six Minutes of Intense Exercise Boosts Key Brain Protein

Published by University of Otago on Friday 13 January 2023.

Six minutes of high intensity exercise may help maintain a healthy brain and delay the onset of neurodegenerative disorders, research led by the University of Otago has shown.

The research, led by former Otago researcher Dr Travis Gibbons, of the School of Physical Education, Sport and Exercise Sciences, was published in the Journal of Physiology today. It focuses on the protein called brain-derived neurotrophic factor (BDNF), that is essential in memory formation and storage and found that short bursts of high intensity exercise increased production of the neuro-protective protein.

Dr Gibbons says while research using animal models has shown that increased BDNF promotes growth and survival of neurons in the brain, and slows brain-specific ageing processes, there had been limited research exploring strategies of how to naturally increase the protein in humans.

Using 12 physically active participants – six males and six females, aged between 18 and 56 – researchers compared four conditions to examine which was most effective at increasing the protein in the blood.

“We compared fasting for 20 hours, light exercise (90 minutes of low-intensity cycling), high-intensity exercise (6 minutes of vigorous cycling), and combined fasting and exercise,” Dr Gibbons says.

“We found that the brief, intense exercise was the most efficient means to increase BDNF in the blood, and it did so by four to five-fold, compared with only a slight increase with low-intensity exercise, and no change with fasting.”

Why this happens is not yet clear, but researchers “suspect it is related to the brain switching from using glucose as its primary fuel, to using lactate, that is produced during high-intensity exercise”.

“This ‘substrate switch’ allows the brain to utilise alternative fuels and initiates the production of key neurotrophic factors such as BDNF. Another possibility is related to the 20 per cent increase in the concentration of circulating platelets that occurs with exercise, as platelets store a large amount of BDNF.”

The results propose a possible mechanism by which exercise might contribute to improved brain health, he says.

And further work is already underway.

“We are now studying how fasting for longer durations – up to three days – with and without intense exercise, influences BDNF. Fasting and exercise are rarely studied together, and we think the combination may optimise the production of BDNF,” Dr Gibbons says.

Senior author Dr Kate Thomas, of Otago’s Department of Surgical Sciences, says although these protocols may sound demanding, this work will help researchers better understand the natural production of BDNF.

“It is becoming more and more clear that exercise benefits brain health at all stages of life. These data show one avenue by which intense exercise may play a role. Fortunately, exercise is widely accessible, equitable, and affordable.”

Windsor Woman Helping Cancer Patients Take Next Steps

Published on on 25th of October 2022. Our physio Anna is also a certified Pinc & Steel Cancer Rehab physiotherapist.

When cancer survivor Sarah Hutton walks into her physiotherapist’s clinic once a week she’s doing far more than rebuilding her physical strength, she says. With the help of Olivia van Schaik, she’s regaining her emotional strength and confidence and getting back to who she was before her diagnosis. Working from Windsor Physio, Van Schaik has personally raised funds through the Dry July campaign to be able to offer the Pinc Cancer Rehabilitation Program and Next Steps group classes to Southland women.

“The aim is to shift participants’ focus from illness to wellness,” she said. Van Schaik had been certified to offer the program in Tauranga in the past, so when she moved home to Southland and heard it wasn’t being offered in the region any more, she wanted to get it up and running again. The Pinc and Steel Cancer Rehabilitation Foundation funds programs for Kiwis with all cancers throughout New Zealand.

Like many Southlanders, Van Schaik has watched friends and families go through cancer and wanted to do something to help. Rehabilitation and exercise helps reduce the side effects of cancer and treatments, and can improve functional ability, quality of life and ultimately, survival for patients. The majority of the women Van Schaik works with have fought breast cancer and by the time they join the program “they’ve been blasted with ominous words, but most have finished the crux of their treatment journey”. Through the Pinc program, she helped women work towards their previous hobbies and goals and take back control of their bodies, she said.

Next Steps – the physio-led group exercise classes which she’s been hosting for about two months – offered a social aspect where women could find motivation and emotional support from each other, Van Schaik said. “It’s a super positive and inspiring place for them to come. It’s pretty cool to be able to offer that service.” Hutton recently arranged a morning tea to thank Van Schaik and the clinic for their work. “She has such a giving heart. I wanted to honour her and express how thankful I am,” Hutton said.

She started going to physiotherapy with Van Schaik after her mastectomy in late 2021 and said as someone who had been quite active before, it was important for her to keep moving after the operation. Hutton said the class meant a lot to her, because she’d found a group of women cheering each other on. “Walking through this journey with other women, it’s encouraging to see each of us gaining strength, forming beautiful friendships and supporting each other in our journeys of healing and wellness,” she said.

Physiotherapists put their hands up to help relieve load on GPs

Published on on 11th of July 2022.

Physiotherapists say they could help relieve pressure on general practices by seeing more people with complaints such as soft tissue injuries and joint pain. Palmerston North physiotherapist Fiona O’Connor said they see and treat people without them having to see a GP first. She said part of the problem was that a lot of people were not aware they could go directly to a physiotherapist. If people had an injury such as a sprained ankle, ACC would partly cover the cost of their physiotherapy treatment. If a physiotherapist was concerned there could be a fracture or other serious injury, they could make a referral for an x-ray or scan. “People in the community probably don’t understand they can come to us with something like a sore knee straight away. They don’t have to go to ED for an X-ray.” O’Connor said she had been in touch with the primary health organisation Think Hauora to see how they could work together to promote physiotherapy as an alternative to GP appointments or ED visits. She said physiotherapists could help people with long-term conditions such as osteoarthritis and joint pain, but unless people had relevant health insurance, that came at a cost to the patient.

Physiotherapy New Zealand chief executive Sandra Kirby said there was capacity for physiotherapists to see more people now, while primary health care was under pressure, and in future as the health reforms bedded in. She said there was international and national evidence that physiotherapy could help manage muscle and joint pain, and was better than painkillers in improving people’s quality of life and delaying the need for hip and knee surgery. The problem was that it was not funded. “What stops people asking for us is that they don’t know they can come to us directly, and that it’s not subsidised unless it’s an accident.” She said the establishment of Health New Zealand gave physiotherapists hope that their long-term patients might be funded in future. Physiotherapists were talking to health leaders and primary health organisations, and there were some pilots underway for funded access, but not in MidCentral. “What we are calling for, and what the language being used suggests it might happen, is that people get access to funded primary care from physiotherapists. “But the only way that will happen at the moment is if primary health organisations give us some funding to enable people to access our services.” Kirby said although there was a shortage of physiotherapists in parts of the country, they still outnumbered GPs, and had capacity to help. “If everything was fully funded, then we would need more of us.”

Managing Long COVID in Aotearoa

Published on on 16th of May 2022.

Research shows that as many as one in eight COVID-19 patients could get Long COVID, which means there are likely hundreds of New Zealanders still experiencing symptoms 12 weeks after testing positive. New Zealand physiotherapists have been working closely with their counterparts overseas to find out more about Long COVID and how best to support those suffering long-term effects.

Physiotherapy New Zealand (PNZ) spokesperson Dr Sarah Rhodes says it is understandable that patients with Long COVID are increasingly frustrated that their recovery is so slow as the symptoms can persist for months and years in some cases. PNZ calls on the government to support people’s access to effective treatment for Long COVID, just as they have supported people through the pandemic. “We know that COVID-19 affects people differently and it is the same with Long COVID. It doesn’t only affect those who are hospitalised with an acute COVID infection. It can also affect those whose initial symptoms are mild and even those who are asymptomatic with the acute COVID-19 infection.”

“The desire to get back to normal life after COVID-19 is understandably important for all of us. With today’s busy lifestyles, it’s often hard to be that person who needs to rest instead of going back to work, getting back into your leisure activities, and looking after children and/or older family/whānau members. However, rest is an essential part of managing an acute COVID-19 infection as it is likely to reduce the risk of developing Long COVID,” says Dr Rhodes.

Members of PNZ’s Cardio-Respiratory Special Interest Group have developed some general tips to help guide people through a prolonged period of symptoms.


This is the most common symptom of Long COVID. Undertaking daily activities which were easily managed prior to COVID-19, such showering, can be exhausting.

Be kind to yourself. Don’t take on too much. Ask for help.
Working out which tasks require more or less energy can help you prioritise your time and activities so that you stay within your available energy levels. Keeping a diary of how you feel after each activity can be useful in identifying which activities make you more or less fatigued.
Pace yourself by doing small tasks or breaking up activities and allowing yourself to take rests in between. Choose some activities that you give you pleasure to help support your mental well-being.
Plan out your week to allow for periods of activity and periods of rest and recovery.
Take regular breaks throughout the day and if you need a rest, listen to your body. Don’t push through the feeling of exhaustion.
When fatigue is worsened by physical or mental effort, this may indicate you have post exertional symptom exacerbation (PESE). Exercise is not recommended for rehabilitation of people experiencing PESE as it can worsen symptoms. A physiotherapist can help support you in managing your fatigue.
Remember that some activities, like being with friends, may contribute to symptom exacerbation. Connecting with others is important for your mental well-being so you may need to reduce the time you spend with others to conserve your energy for other activities in the day.
Adapt activities to make them easier. e.g., sitting down to prepare the vegetables for dinner.
Getting outside and spending time in nature can have benefits for both your mental and physical health.

Breathlessness is another commonly experienced symptom in those with Long COVID.

Feeling breathless can be a frightening experience.
Seek support from a physiotherapist about positions and breathing techniques that can help alleviate feelings of breathlessness.
It is important to get an individual assessment of your breathing as a one-size-fits-all approach doesn’t work.
A physiotherapist can also screen for disruptions in your pattern of breathing that may contribute to some of the symptoms you are experiencing.
Muscle and Joint Pain

Some patients with Long COVID experience muscle aches and joint pain. Gentle stretching and yoga may help relieve these symptoms.
Check with your health professional before starting any exercises.
Return to exercise

Exercise is not recommended if it worsens your fatigue.
If you are not experiencing worsening symptoms, a cautious approach to commencing exercise is recommended. Your response to exercise should be monitored carefully. A safe return to exercise requires careful clinical decision making and a physiotherapist can support you through this.
Physiotherapy can help manage symptoms of Long COVID. However, for some patients a multi-disciplinary approach, involving other health professionals, is recommended.

The Physiotherapy New Zealand Cardio-Respiratory Special Interest Group represents cardio-respiratory interests among the physiotherapy profession. Cardio-respiratory physiotherapists are present in ED, the acute wards and ICU, where they are fully involved in the acute care of patients admitted to hospital with COVID-19 symptoms and help with their breathing and rehabilitation needs. Cardio-respiratory physiotherapists also work on rehabilitation wards in hospitals and in the community.