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A recent study found that pulmonary rehabilitation significantly improved physical capacity, respiratory function, HRQOL, fatigue, and anxiety in long COVID-19.

Pulmonary rehabilitation (PR) enhances physical capacity, pulmonary function, and health‐related quality of life (HRQOL) and reduces dyspnea, fatigue, and anxiety in patients with long COVID-19, according to a systematic review and meta-analysis published online in Therapeutic Advances in Respiratory Disease.

“Early initiation of rehabilitation and 4-8 weeks duration of PR are important in managing long COVID-19 syndromes, with longer PR durations potentially offering additional benefits,” wrote study author Jian Kang, MD, The First Affiliated Hospital of China Medical University, and colleagues. “The integration of both breathing exercises and multicomponent training within PR is found to be the most beneficial for patients with long COVID-19.”

Enhanced Physical & Respiratory Function

The review synthesized data from 37 randomized controlled trials published through March 2024, involving 3,363 patients with long COVID-19, and compared PR against usual care, no treatment, educational materials, or sham devices. Across studies, PR consistently produced significant gains compared to controls in the 6-minute walking test (6MWT), 30-second sit-to-stand test, and handgrip strength test, indicating robust improvements in physical capacity. The researchers found that pulmonary metrics likewise improved: forced expiratory volume in one second (FEV1), forced vital capacity (FVC), maximal inspiratory pressure, and maximal expiratory pressure all showed statistically significant increases compared with controls.

The authors reported that these functional gains resulting from PR translated into better patient‐reported outcomes. HRQOL scores rose appreciably, while measures of dyspnea, fatigue, and anxiety declined following PR. Depression scores, however, did not differ significantly between groups. The authors underscored that these multidimensional benefits make PR an essential component of long COVID-19 management.

Optimizing PR Duration

Duration of PR emerged as a critical moderator of efficacy. Programs shorter than four weeks yielded measurable improvements in the 6MWT, suggesting that even brief interventions confer a meaningful benefit, according to the authors. PR of four to eight weeks produced the most consistent improvements across physical capacity (6MWT), pulmonary function (FEV1, FVC), HRQOL, and fatigue. “The improvement in the 6MWT was greater for PR periods 4 weeks or less (116.80 m) than for 4 and 8 weeks (66.58 m), which may suggest that early initiation of PR may be more beneficial to patients with long COVID-19,” the authors wrote. Regarding PR exceeding eight weeks, the authors noted, “…some benefits may continue to accrue with extended PR, but no additional improvements in the 6MWT and lung function were observed. This may indicate that extended programs may indeed offer additional benefits, but physical performance improvements may plateau after 4–8 weeks.”

Tailoring Exercise Modalities

The review also evaluated the relative merits of different PR exercise components. The researchers reported that breathing exercises (pursed lip breathing, diaphragmatic breathing, incentive spirometer use, airway clearance techniques, and coughing training) alone led to improvement in 6MWT, FEV1, FVC, and HRQOL, but had no effect on fatigue. Multicomponent exercises—combinations of aerobic training, resistance training, balance exercises, functional activities, stretching, and biobehaviourally informed elements—enhanced 6MWT performance and reduced fatigue without impacting lung function or HRQOL.

“Multicomponent exercises may not improve the pressure-generating capacity of the inspiratory muscles,” the authors noted.

Crucially, integrated PR programs that combined breathing exercises with multicomponent exercises delivered the broadest spectrum of improvements, driving gains in 6MWT, FEV1, FVC, and HRQOL, while also reducing fatigue. The authors wrote, “…an individualized rehabilitation approach including both breathing exercises and multicomponent exercises could play a crucial role in reducing the consequences of long-term COVID-19 symptoms.”

Limitations & Implications

The authors listed several limitations of the review, including low to moderate Grading of Recommendations, Assessment, Development, and Evaluations criteria certainty, potential bias in study design, high heterogeneity across interventions and patient characteristics limiting subgroup analysis, and inconsistent measurement tools for key outcomes, which may have resulted in inaccurate estimation of treatment effects.

Nonetheless, the authors concluded, “This systematic review and meta-analysis found that PR significantly improves physical capacity, respiratory function, HRQOL, fatigue, and anxiety in patients with long COVID-19.”