Struggling with long COVID symptoms? New research confirms that pulmonary rehabilitation can restore lung function, reduce fatigue, and improve quality of life—especially with targeted exercises over 4-8 weeks. Find out how rehabilitation could be the key to regaining your health!

Study: Effect of pulmonary rehabilitation for patients with long COVID-19: a systematic review and meta-analysis of randomized controlled trials. Image Credit: p.ill.i / Shutterstock

Can pulmonary rehabilitation improve long COVID symptoms? A recent study published in the journal Therapeutic Advances in Respiratory Disease assessed the effects of pulmonary rehabilitation (PR) on long COVID patients.

Long COVID is defined as symptoms persisting beyond three months after SARS-CoV-2 infection or worsening symptoms lasting at least two months with no alternative explanation. Over 200 symptoms have been identified, with fatigue, cognitive dysfunction, and dyspnea being the most common.

PR is a core management strategy for various cardiopulmonary conditions and is recommended for long COVID. It has been shown to improve lung function, physical capacity (as measured by the six-minute walking test [6MWT]), quality of life (QoL), exertional dyspnea, and psychological well-being. However, its effects on some outcomes, such as QoL, fatigue, and lung function, remain inconsistent.

About the Study

Researchers evaluated the effects of PR in long COVID patients by searching databases, including Web of Science, PubMed, Cochrane Central, Embase, and Scopus, for randomized controlled trials (RCTs). Eligible RCTs included adult COVID-19 patients with PR and control groups.

Primary outcomes included physical capacity (measured by the 6MWT, with improvements up to 77.95 meters), lung function (forced vital capacity and forced expiratory volume in the first second), fatigue, and health-related QoL (HRQoL). Secondary outcomes included functional and physical capacities, handgrip strength, dyspnea, anxiety, depression, respiratory muscle function, and adverse events.

RCTs were assessed for bias using Cochrane Collaboration’s RoB-2 tool, and results were evaluated based on the GRADE criteria. A meta-analysis was performed, measuring heterogeneity using the I² statistic and assessing publication bias with funnel plots.

Findings

Out of 19,700 identified records, 73 were selected for full-text review, with 37 RCTs included in the final analysis. Ten RCTs used face-to-face PR, 25 used telerehabilitation, and two used both. Twenty-two RCTs included previously hospitalized patients, nine included non-hospitalized patients, and six included both.

PR duration ranged from three days to 16 weeks. Thirteen trials focused on breathing exercises, nine used multicomponent exercises, and 15 used both, which proved most effective. Control groups received usual care, no treatment, or educational brochures. Ten RCTs had a high risk of bias, eight had a low risk, and 19 had some concerns. Only six RCTs were double-blinded.

Fourteen RCTs reported significant physical capacity improvements after PR. PR increased 6MWT performance by an average of 77.95 meters, higher than the 43.93m improvement seen in COPD patients and the 40.07m seen in interstitial lung disease patients. Handgrip strength also improved.

PR improved lung function (FEV1 and FVC) when breathing exercises were included. However, multicomponent exercises mainly enhanced physical capacity and fatigue without significantly affecting lung function. A combination of breathing and multicomponent exercises yielded the greatest overall benefits.

Nineteen RCTs assessed QoL, showing significant HRQoL improvements with PR. However, PR duration played a key role:

• ≤4 weeks: Improved physical capacity only.
• 4-8 weeks: Improved lung function, fatigue, HRQoL, and physical capacity.
• ≥8 weeks: Further improved HRQoL and fatigue, but physical capacity gains plateaued.

PR also reduced anxiety and fatigue but did not significantly improve depression, suggesting additional psychological or pharmacological interventions may be needed.

Sixteen trials reported adverse events. Nine found no adverse events, supporting PR’s safety. Some RCTs reported minor side effects such as oxygen desaturation, persistent disability, hospitalization, or COVID-19 reinfection. Adverse events, including hospitalization, occurred more frequently in control groups.

Conclusions

PR resulted in clinically and statistically significant improvements in physical capacity (6MWT), lung function (if breathing exercises were included), fatigue, anxiety, and HRQoL. PR did not significantly improve depression, indicating additional treatment may be needed.

Early PR (4-8 weeks) was optimal for managing long COVID symptoms. Longer programs provided additional fatigue and QoL benefits but did not enhance physical capacity. The most effective intervention was a combination of breathing exercises and multicomponent training.