Rehab with exercise improves quality of life for patients with long COVID, study suggests

Key takeaways:

• Rehabilitation interventions were linked to improvements in quality of life, functional exercise capacity and dyspnea in those with long COVID.
• Providers should carefully monitor patients during interventions.

Exercise-based rehabilitation interventions were associated with improvements in quality of life and functional exercise capacity for patients with long COVID, according to the results of a meta-analysis published in JAMA Network Open.

An estimated 65 million people globally have long COVID, but “the number is likely much higher due to many undocumented cases,” Dimitra V. Pouliopoulou, MSc, a PhD candidate at Western University in Ontario, Canada, and colleagues wrote. As it stands, research is insufficient to improve health outcomes for those with long COVID.

Guidelines are currently based on observational data and expert opinion, they wrote, and “there is an urgent need for evidence-based rehabilitation interventions to support” patients who have long COVID.

“The latest systematic review with meta-analysis on rehabilitation interventions for patients with [long COVID] ... suggested that rehabilitation interventions may be associated with improvements in functional exercise capacity, but the association of rehabilitation interventions with respiratory function was inconsistent across studies,” the researchers wrote.

Additional studies on long COVID have since been published, and this meant that Pouliopoulou and colleagues could now “conduct a more comprehensive, methodologically sound, and stable analysis.”

They searched CINAHL, MEDLINE, Scopus and the Clinical Trials Registry from January 2020 to February 2023, including randomized clinical trials that compared exercise-based rehabilitation and respiratory training interventions with control groups. Of the 1,193 records screened, they ultimately included 14 trials with 1,244 patients, 45% of whom were women.

In the treatment group, the most common interventions were breathing exercises, either alone (six trials with 815 participants) or combined with aerobic and/or resistance training (five trials with 298 participants). One trial included aerobic exercises only, and two included aerobic and strengthening exercises but without a breathing exercise component.

Pouliopoulou and colleagues found that rehabilitation interventions were linked to improvements in quality of life, functional exercise capacity and dyspnea, with moderate certainty evidence for quality of life and functional exercise capacity and low certainty evidence for the other outcomes.

In seven trials with 389 participants, moderate certainty evidence supported the association between exercise-based rehabilitation interventions and improvements in functional exercise capacity (standardized mean differences [SMD] = 0.56; 95% credible intervals [CrI], 0.87 to 0.22). Compared with current standard care, the improvements had a 99% posterior probability of superiority.

However, there was significant imprecision and uncertainty regarding the likelihood of exercise-induced adverse events (OR = 1.68; 95% Crl, 0.32-9.94). Because of the uncertainty, Pouliopoulou and colleagues wrote that “additional trials with enhanced monitoring of adverse events are necessary.”

They also stressed that health care providers should “closely monitor” patients with long COVID who undergo respiratory training and exercise-based rehabilitation to ensure their safety “until more definitive evidence is available.”