Effects of exercise programs on cardiopulmonary function and signs and symptoms in patients with post-COVID-19 condition: a systematic review and meta-analysis

Background: Exercise is increasingly recognized as an effective adjuvant therapy for individuals with post-COVID-19 condition. However, exercise interventions vary widely in intensity, frequency, setting, and duration. To date, no systematic review and meta-analysis has evaluated programs lasting at least 6 weeks in this population. This study aimed to assess the effects of exercise on cardiopulmonary function and clinical symptoms in patients with post-COVID-19 condition. Methods: We systematically searched for studies involving patients with post-COVID-19 condition in the Embase, MEDLINE/PubMed, and Scopus databases. The databases were searched using keywords including COVID-19 OR coronavirus OR SARS-CoV-2, AND exercise OR physical exercise OR rehabilitation program, AND pulmonary function OR lung function OR signs and symptoms, AND randomiz* contro* trial OR clinical trial OR RCT on July 2024. The risk of bias of individual trials and the certainty of the body of evidence were evaluated using the Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was used to describe the study selection process. The mean (± standard deviation) for continuous data and the frequency (n) and percentage (%) for dichotomous data were estimated, and the effects across trials were combined using a meta-analysis with random-effects models. Results: We included 10 randomized controlled trials comprising 602 participants. The age of participants ranged from 18 to 70 years. The average exercise duration across the 10 studies was 8.6 weeks (ranging from 6 to 16 weeks). Most exercise programs included aerobic exercise, resistance exercise, breathing exercise, thoracic mobility exercise, chest expansion exercise, and respiratory muscle training. The exercise programs included home-based or telehealth-based programs, center-based programs, and combined center- and home-based programs. Compared with control groups (e.g., usual care, exercise advice, or no structured exercise), exercise interventions significantly improved exercise capacity (6-min walk distance), pulmonary function (forced vital capacity and forced expiratory volume in 1 s), dyspnea (the modified Medical Research Council scale), physical pain, and health-related quality of life domains. The overall certainty of evidence for all outcome measures ranged from moderate to high. Conclusion: Exercise programs of at least 6 weeks are associated with improved cardiopulmonary function, reduced dyspnea and pain, and enhanced physical and health-related outcomes in patients with post-COVID-19 condition. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024538786.