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Review
. 2025 Aug 4;13(15):1897.
doi: 10.3390/healthcare13151897.

Physical Training Protocols for Improving Dyspnea and Fatigue in Long COVID: A Systematic Review with Meta-Analysis

Lisa Fernanda Mazzonetto  1   2 , Jéssica Fernanda Correa Cordeiro  2   3 , Igor Massari Correia  2   4 , Alcivandro de Sousa Oliveira  1   2 , Chimenny Moraes  2   4 , Joana Brilhadori  1   2 , Eurípedes Barsanulfo Gonçalves Gomide  2   5 , Michal Kudlacek  6 , Dalmo Roberto Lopes Machado  1   2   3   4   7 , Jeferson Roberto Collevatti Dos Anjos  1   2 , André Pereira Dos Santos  1   2   3   4   8
Affiliations
Review

Physical Training Protocols for Improving Dyspnea and Fatigue in Long COVID: A Systematic Review with Meta-Analysis

Lisa Fernanda Mazzonetto et al. Healthcare (Basel). .

Abstract

Objective: This study aimed to evaluate physical training protocols for alleviating long COVID symptoms, especially dyspnea and fatigue, through a systematic review with meta-analysis. Method: Data were collected from EMBASE, LILACS, PubMed, Scopus, CINAHL, Web of Science, and grey literature (Google Scholar, medRxiv). Studies evaluating dyspnea and/or fatigue before and after physical rehabilitation, using validated questionnaires, were included. Studies lacking pre- and post-assessments or physical training were excluded. Two reviewers independently extracted data on intervention type, duration, frequency, intensity, and assessment methods for dyspnea and fatigue. Bias risk was evaluated using the Cochrane tool. Results: Combined methods, such as respiratory muscle training with strength and aerobic exercise, were common for long COVID symptoms. Aerobic exercise notably improved dyspnea and/or fatigue. Among 25 studies, four had a low risk of bias. Meta-analysis of two studies found no significant reduction in fatigue. Conclusion: Combined training methods, particularly aerobic exercise, alleviate dyspnea and fatigue in long COVID. More high-quality studies are needed to confirm these findings.

Keywords: exercise; persistent symptoms; post-COVID-19; shortness of breath.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flowchart for new systematic reviews that only included database and registry searches.
Figure 2
Figure 2
Risk of bias of included studies [11,12,13,14,15,16,17,18,19,20,21,22,23,25,26,27,28,29,30,31,32,33,34,35].
Figure 2
Figure 2
Risk of bias of included studies [11,12,13,14,15,16,17,18,19,20,21,22,23,25,26,27,28,29,30,31,32,33,34,35].
Figure 3
Figure 3
Forest plot illustrating the effect of the physical training protocol on fatigue in people with long-COVID [13,28].
See this image and copyright information in PMC

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