Rehabilitation in long COVID: a systematic review and meta-analysis

Background

The long-term effects of rehabilitation in individuals with long COVID remain unclear. This systematic review and meta-analysis evaluated the short- and long-term impacts of rehabilitation programmes on exercise capacity, health-related quality of life (HRQoL), pulmonary function, chronic dyspnoea, anxiety, depression, and fatigue in people with long COVID.

Methods

Following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions, five databases were searched, with the final search updated in August 2025. Eligible studies included adults with long COVID who underwent rehabilitation interventions. Outcomes were synthesised using meta-analyses and narrative synthesis where appropriate. The risk of bias was assessed using appropriate tools for both randomised and non-randomised studies. The review was prospectively registered on PROSPERO (CRD42024535365).

Results

12 studies (n=1403 participants) published between 2020 and 2025 were included. In the short term, rehabilitation compared with usual care significantly increased exercise capacity (6MWT; mean difference [MD] 102.34 m; 95% CI: 44.48 to 160.21 m; p<0.0001), reduced dyspnoea (mMRC; MD −1.44; 95% CI: −2.72 to −0.16), and anxiety symptoms (HADS-A; MD −1.64; 95% CI: −3.02 to −0.26; p=0.02). Studies showed wide variation in educational content and delivery. No significant long-term effects were observed in pooled quantitative analyses for HRQoL or dyspnoea; however, qualitative findings indicated sustained improvements in HRQoL in some longitudinal studies

Conclusion

Rehabilitation programmes yielded short-term benefits in exercise capacity, dyspnoea, and anxiety. Evidence for long-term efficacy remains limited and inconsistent. Further high-quality, follow-up studies are needed to determine the durability of these effects in people with long COVID.