Exercise training in long COVID: the EXER-COVID trial

Extract

Post-COVID-19 syndrome, also referred to as long COVID is a multisystemic condition characterized by fatigue, headaches, attention deficits, low energy, functional impairment, sleep disturbance, and dyspnea.¹ While the underlying mechanisms of long COVID remain unclear, several hypotheses have been proposed, including persisting viral reservoirs, immune dysregulation, alterations in the host microbiome, autoimmunity, and endothelial dysfunction.² Treatments such as vaccinations, pharmacotherapy, nutritional support, rehabilitation, and physical exercise have been shown to improve symptoms.^3–5

A 2023 review¹ highlighted that existing research is insufficient to definitively improve outcomes for patients with long COVID. ‘The authors emphasized an urgent need for evidence-based rehabilitation interventions to support individuals affected by long COVID, noting that current guidelines are largely based on expert opinion and observational data’.⁵ Recent evidence suggests that exercise-based rehabilitation can enhance physical fitness, reduced symptoms of depression and anxiety, and improved long COVID outcomes.^3,4 A systematic review further indicated that exercise-based rehabilitation is associated with improvements in functional exercise capacity, dyspnea, and quality of life (QoL), with a higher likelihood of better outcomes than standard care.³ Progressive resistance training (PRT), in particular, has been shown to alleviate dyspnea and discomfort in respiratory conditions and to reverse age-related declines in skeletal muscle.^4,6,7 However, despite the general tolerance of exercise, guidelines cautioning against exercise in similar populations may require reconsideration.^5,8 These recommendations are supported despite the well-established detrimental effects of physical inactivity, which is closely linked to secondary health conditions and declining QoL.⁹