Therapeutic advances in respiratory diseaseMar 14, 2025

Pulmonary rehabilitation's effects for patients with long COVID-19: a review and combined analysis of clinical trials

Long Covid Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 5, 2026

Abstract

A total of 3363 patients were included in the analysis of pulmonary rehabilitation (PR) for long COVID-19.

PR significantly improved physical capacity, lung function, health-related quality of life, fatigue, dyspnea, and anxiety compared to control groups.
Programs lasting 4 to 8 weeks were particularly effective in enhancing physical capacity and lung function.
Breathing exercises alone improved physical capacity and lung function, while multicomponent exercises reduced fatigue.
Combining breathing exercises with multicomponent training led to the most significant improvements in physical capacity, lung function, and quality of life.

Simplified

BACKGROUND: Pulmonary rehabilitation (PR) has demonstrated efficacy in managing long COVID-19, underscoring the need to refine and tailor PR strategies for optimal patient outcomes.

OBJECTIVES: To evaluate the impact of PR on patients with long COVID-19 and to compare the efficacy of different types and durations of PR interventions.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES AND METHODS: We systematically searched randomized controlled trials (RCTs) of the effectiveness of PR in long COVID-19 patients published before April 2024. The primary outcomes were physical capacity assessed by the 6-minute walking test (6MWT), lung function measured by forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC), health-related quality of life (HRQoL), and fatigue. Secondary outcomes were thirty-second sit-to-stand test (30STST), handgrip strength tests, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), dyspnea, depression, anxiety, perceived effort, and adverse events.

RESULTS: A total of 37 studies with 3363 patients were included. Compared to controls, PR improved physical capacity (6MWT, 30STST, handgrip), lung function (FEV1, FVC, MIP, MEP), HRQoL, fatigue, dyspnea, and anxiety but did not reach statistical significance for depression. Subgroup analyses of PR duration indicated that programs of ⩽4 weeks improved 6MWT; those between 4 and 8 weeks significantly improved 6MWT, lung function (FEV1, FVC), HRQoL, and reduced fatigue; and programs over 8 weeks improved HRQoL and reduced fatigue. Exercise type analysis revealed that breathing exercises improved 6MWT, lung function (FEV1, FVC), and HRQoL; multicomponent exercises enhanced 6MWT performance and reduced fatigue; the combination of both types improved 6MWT, FEV1 (L), FVC (%pred), HRQoL, and reduced fatigue.

CONCLUSION: PR improves physical capacity, lung function, and quality of life and alleviates dyspnea, fatigue, and anxiety in long COVID-19 patients. A 4- to 8-week PR program and a combination of both breath exercises and multicomponent training is most effective for managing long-term COVID-19 syndromes.

TRIAL REGISTRATION: PROSPERO ID: CRD42024455008.

Key numbers

3363

Participants

Total number of patients included in the meta-analysis.

77.95 m

Improvement in 6MWT

Mean difference in 6-minute walking test distance after PR.

4 to 8 weeks

PR duration

Recommended duration for pulmonary rehabilitation programs.

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Pulmonary rehabilitation's effects for patients with long COVID-19: a review and combined analysis of clinical trials

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