Long COVID: supervised rehabilitation shows benefits, but evidence remains limited

A review of 27 trials, without an overall effect estimate

The researchers brought together 27 randomised trials involving 1,998 adults with long COVID defined according to World Health Organization criteria. The interventions were supervised and delivered in person. They were compared with usual care, a placebo, a sham intervention or another active treatment.

The review covers physical, psychological and other non-drug interventions. Given the clinical and methodological differences between trials, the authors conducted a narrative synthesis rather than a meta-analysis. The available abstract therefore provides no pooled numerical estimate of benefit.

Results vary by intervention

Supervised cardiopulmonary rehabilitation and exercise programmes combining several modalities consistently improved cardiorespiratory fitness and walking capacity in the relevant trials. These findings concern specific functional abilities, not a cure for long COVID.

Cognitive behavioural therapies and lifestyle adjustments reduced fatigue and subjective concentration complaints. The latter measure should not be confused with a demonstrated improvement in performance on objective cognitive tests.

For neuromodulation, complementary approaches and oxygen-based therapies, results were heterogeneous, often showing no benefit over placebo. The review therefore does not support the general effectiveness of all non-drug approaches.

Useful signals, not a programme to follow on your own

Only 18.5% of trials had a low risk of bias. Small sample sizes, lack of blinding and short follow-up periods limit confidence in the findings. The abstract also does not establish the magnitude of the benefits or whether they persist over the long term.

Supervision matters: these findings do not validate a self-directed exercise programme suitable for everyone with long COVID. The abstract neither details which patient profiles might benefit from each intervention nor provides enough safety information to derive a protocol.

The authors consider the results promising but call for larger trials and longer follow-up to confirm effectiveness and inform clinical recommendations.

What we can take away

Supervised rehabilitation and cognitive behavioural therapies appear to improve some symptoms or abilities in long COVID. The evidence does not establish them as a universal solution or allow an individual programme to be defined.