Exercise effectiveness on fatigue in Long-COVID: systematic review and meta-analysis

Patients with Long COVID commonly experience fatigue-related distress, often leading to low energy, reduced activity endurance, and exertional dyspnea, all of which negatively impact quality of life. Although studies have increasingly explored the effects of exercise on Long COVID-related fatigue, a comprehensive synthesis of the evidence is lacking.

To examine the effectiveness of exercise in improving fatigue among patients with Long COVID through a systematic review and meta-analysis.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness. Airiti Library, Cumulative Index to Nursing and Allied Health, Cochrane Library, Embase, PubMed, ProQuest, and Index of the Taiwan Periodical Literature System databases were searched before July 2025. Two reviewers used the JBI randomized controlled trial checklist to assess the methodological quality of included studies. Extracted data were entered and analyzed using RevMan 5.4 software. Inverse variance and Mantel-Haenzel random effect model was used to estimate effect sizes. Subgroup and sensitivity analysis were performed.

Fourteen randomized controlled trials were reviewed. Meta-analysis reveals that the exercise training group significantly improved fatigue severity (standardized mean difference [SMD] = -0.59, P = .002) and dyspnea severity (SMD = -0.89, P = .005) compared to the usual care group. Improvements were also observed in muscle strength and endurance.

Exercise training may help reduce physiological and psychological fatigue in patients with Long COVID. The available evidence suggests that individualized single-modality and multimodal exercise programs may be beneficial for patients experiencing fatigue symptoms. The included interventions generally consisted of 30-60 min sessions, performed 3-6 times per week over at least 8-12 weeks. However, given the moderate-to-very-low certainty of the evidence, exercise programs should be individualized based on patient response and tolerance. Particular attention should be paid to preventing postexertional malaise, with the goal of reducing fatigue and supporting the recovery of daily functioning in patients with Long COVID.

PROSPERO: CRD420251113419 https://www.crd.york.ac.uk/PROSPERO/view/CRD420251113419.