Effectiveness of Physical Activity in Long COVID-19 Rehabilitation: A Systematic Review and Meta-analysis

Abstract Background: Long COVID-19 (LC), also known as post-acute sequelae of SARS-CoV-2 infection, is characterised by persistent symptoms such as fatigue, dyspnoea and cognitive impairment that extend beyond the acute phase. Exercise-based rehabilitation has been proposed as a therapeutic strategy; however, evidence regarding its effectiveness remains inconclusive. Objective: To evaluate the effectiveness of exercise-based interventions in improving clinical outcomes among individuals with LC through a systematic review and meta-analysis of randomised controlled trials (RCTs). Methodology: This review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD42023430937). A systematic search was performed in PubMed and MEDLINE up to April 2025. Eligible studies were RCTs involving exercise interventions for individuals diagnosed with LC, selected using predefined Population, Intervention, Comparator/Control, Outcome and Study Design criteria. Data extraction included sample size, intervention characteristics and relevant outcomes. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. A random-effects meta-analysis was conducted using R software, reporting standardised mean differences (SMDs) with 95% confidence intervals (CIs), and heterogeneity assessed via the I 2 statistic. Results: Exercise interventions showed a statistically significant improvement in VO 2 max (SMD = 0.37; 95% CI: 0.28–0.45) and SF-12 physical activity (SMD = 0.64; 95% CI: 0.45–0.84) with minimal heterogeneity ( I 2 = 0%). However, no significant effects were observed for forced expiratory volume in 1 s/forced vital capacity, 6-min walk test (6MWT), handgrip strength or modified Medical Research Council (mMRC) dyspnoea scale scores. Although individual studies reported varying degrees of improvement in fatigue, dyspnoea and physical function, pooled estimates for many outcomes were non-significant, reflecting inconsistencies across interventions and populations. The overall methodological quality of studies was moderate to high. Conclusion: Exercise-based rehabilitation demonstrates modest benefits in improving cardiorespiratory fitness and physical functioning in individuals with LC. However, the evidence for its effects on pulmonary function, strength and respiratory symptoms remains limited and inconsistent. Personalised exercise programmes and further high-quality RCTs are warranted to optimise post-COVID-19 rehabilitation strategies.