Exercise-Based Rehabilitation in Severe COVID-19 Survivors with Long COVID: A Randomized Controlled Pilot Study, 2026, Pinto et al

[forestglip]

Exercise-Based Rehabilitation in Severe COVID-19 Survivors with Long COVID: A Randomized Controlled Pilot Study

Edson Fonseca Pinto, Nailton José Brandão Albuquerque Filho, Jéssica Costa Leite, Tatianne Moura Estrela Gusmão, Larissa Nayara de Souza, Roque Ribeiro da Silva Júnior , Maria Irany Knackfuss, Grasiela Piuvezam

Introduction
Post-hospital rehabilitation is essential for survivors of severe COVID-19, as prolonged immobility and clinical severity often lead to muscle weakness, reduced cardiovascular capacity, and impaired respiratory function. Physical exercise during and after hospitalization may mitigate these effects and support functional recovery.

This study aimed to evaluate the effectiveness of a physical exercise-based rehabilitation program in survivors of severe COVID-19.

Methodology
A randomized clinical trial was conducted with 30 survivors allocated to two groups: multicomponent exercise (GEm) and multicomponent exercise combined with inspiratory muscle training (GEmTMI).

The interventions were performed three times per week for 40–60 min. Quality of life, physical activity level, functional status, and physical capacity were assessed before and after six weeks.

Results
Comparisons between GEm and GEmTMI showed significant differences in the 6 min walk test (6MWT) at baseline (p = 0.043) and in the Physical Activity Index (IPAQ) after the intervention (p = 0.002).

When the total sample was analyzed, significant improvements were observed across all outcomes after rehabilitation, including quality of life (SF-36), functional capacity (PCFS), physical activity level (IPAQ), respiratory muscle strength, and additional functional tests.

Notable improvements included SF-36 Physical Functioning (p = 0.006) and Social Functioning (p = 0.009), PCFS (p = 0.011), IPAQ (p = 0.012), and performance in the 6MWT, STS, STS-1min, TUG, handgrip strength, PEmax, and PImax (all p < 0.001).

Discussion
Multicomponent physical rehabilitation, with or without inspiratory muscle training, produced significant gains in physical activity level, functional capacity, dynamic balance, neuromuscular fitness, respiratory muscle strength, and quality of life.

These findings underscore the importance of structured post-ICU rehabilitation to support comprehensive physical and psychosocial recovery in survivors of severe COVID-19.

Web | DOI | PDF | Med. Sci. | Open Access

 

[Utsikt]

Although the study has methodological limitations, including a small sample size and the absence of a control group, data collection occurred during a period of strict restrictions on gatherings, which constrained recruitment and service capacity. Therefore, the results should be interpreted cautiously because improvements may partially reflect natural recovery over time in addition to intervention-related effects.

Moreover, while the lack of a no-intervention control arm remains a key limitation for causal inference, this design choice is consistent with the clinical and ethical rationale reported in hospital-based COVID-19 rehabilitation research, where patients are not left without rehabilitation assistance.

Nevertheless, the findings highlight the importance of establishing post-COVID-19 rehabilitation as a priority within longitudinal care pathways. Beyond improving patients’ physical and mental health, such interventions provide a basis for future research to clarify recovery mechanisms, quantify the incremental contribution of IMT, and expand therapeutic options.

5. Conclusions​

This study demonstrated that structured physical exercise programs can support recovery in COVID-19 survivors, particularly those who experienced severe disease. Both groups, with or without inspiratory muscle training (IMT), showed significant improvements in physical capacity, strength, and endurance.

Although between-group differences were not statistically significant, the findings suggest clinically meaningful benefits, especially in social functioning and reductions in physical limitations.

Nevertheless, these results should be interpreted with caution, given the possibility that some improvements may reflect the natural course of recovery.

Even more rehabbers that don’t care about the fatal methodological limitations even though they appear to (kind of) understand them.

 

[Peter T]

I have just glanced at the paper, though it seems they made no attempt to distinguish between those suffering the after effects of an acute illness requiring such as ventilation and those that may have a new ongoing condition, such as ME/CFS, triggered by the Covid infection. Indeed frustratingly no attempt seems to have been made to address the issue of whether any of the issues in Long Covid, including cardiac or neurological issues, reflect one off damage resulting from the acute phase or ongoing pathological processes. One would assume that the former may be more responsive to a rehabilitation approach than the later which could require different management approaches.

Though we lack well defined clinical tools to identify PEM, I would have liked to see some awareness of its existence and the possibility that some of their cohort have had ME/CFS triggered by the acute infection, so are unlikely to respond well to a more traditional rehabilitation approach.