Table 2.
Characteristic of included studies.
| Study | Location | Patient characteristics | Mean age (SD),years |
Sex (Female) (n, %) |
Treatment |
Follow-up | |||
|---|---|---|---|---|---|---|---|---|---|
| Intervention | Control | Intervention | Control | Intervention | Control | ||||
| Exercise training: physical training programs aimed at improving physical fitness, cardiopulmonary endurance, or muscle strength, including aerobic exercise, resistance training, or a combination of both. | |||||||||
| 1.Bai 2024 | China | Long-COVID symptoms for more than 2 months after the diagnosis of COVID-19 | 46.85 (15.26) | 43.42 (14.96) | 4 (33.3%) | 10 (83.3%) | 4-week exercise plan consisting of 12 times aerobic training | follow the guideline-based recommendations for a healthy lifestyle and WHO guideline | 4 weeks |
| 2.Barz 2024 | Germany | fatigue symptoms for more than 3 months after mild to moderate course of COVID-19 | 53.5 (11.9) | 53.5 (12.3) | NA | NA | resistance and aerobic training 1–3 times per week for 8 weeks | NA | 8 weeks |
| 3.Besnier 2024 | Canada | dyspnea and/or fatigue symptoms for more than 3 months after the diagnosis of COVID-19 | 53.89 (12.13) | 52.53 (11.29) | 13 (72%) | 11 (65%) | resistance and aerobic training 3 times per week for 8 weeks | maintained their daily habits | 8 weeks |
| 4.Calvo-Paniagua 2024 | Spain | moderate respiratory and/or functional impairments after the acute SARS-CoV-2 infection | 50.8 (8.4) | 49.4 (10.0) | 18 (56.3%) | 22 (68.8%) | a comprehensive program (consisting of sanitary education sessions, respiratory therapy, aerobic exercise, active mobilizations and motor control exercises) in alternate days for 7 weeks | conventional medical care recommendations | 3 month |
| 5.Demir 2025 | Turkey | patients diagnosed with COVID-19 | 49.5 (12.8) | 38.33 (14.83) | 9 (75%) | 10 (83.3%) | supervised exercises programme 3 times per week for 6 weeks | the same exercises programme without supervision | 6 weeks |
| 6.de Araujo Furtado 2023 | Brazil | recovery from COVID-19 for more than 20 days | 47.50 (12) | 49.20 (13) | 8 (50%) | 10 (62.5%) | An 8-week exercise plan consisting of 24 times exercise training and remote lectures (each 15 days) on health education | remote lectures for 8 weeks (each 15 days) on health education | 8 weeks |
| 7.Elyazed 2024 | Egypt | fatigue, dyspnea, and exercise intolerance symptoms more than 1 month after the diagnosis of COVID-19 | 56.9 (6.7) | 55.5 (7.1) | 14 (46.7%) | 13 (43.3%) | exercise program and usual medical care for 12 weeks | usual medical care for 12 weeks | 12 weeks |
| 8.Ibrahim 2023 | Saudi Arabia | Long-COVID symptoms | 62.55 (4.57) | 62.7 (4.3) | 25 (52%) | 16 (66.7%) | aerobic exercises 4 times per week for 10 weeks | medical care and advice | 10 weeks |
| 9.Kaczmarczyk 2024 | Poland | one or more of the post-COVID signs and symptoms after the diagnosis of COVID-19 | 67.1 (5.6) | 74.2 (7.2) | 11 (42.3%) | 12 (60%) | resistive training 2 times per week for 8 weeks | NA | 8 weeks |
| 10.Kaddoussi 2024 | Tunisia | dyspnea symptom for three months after the diagnosis of COVID-19 | 53 (14) | 52 (14) | 10 (50%) | 6 (60%) | an exercise training 3 times per week for 6 weeks | maintain their usual level of sedentary physical activities | 6 weeks |
| 11.Kerling 2024 | Germany | a continuing impairment of physical or mental health after the diagnosis of COVID-19 | 47.1 (12.5) | 46.9 (10.1) | 22 (73.3%) | 20 (62.5%) | an exercise plan 150 min per week for 3 months | continue with their current lifestyle and everyday activities | 3 months |
| 12.Keskin 2023 | Turkey | Being diagnosed with COVID-19 | 38.65 (11.56) | 36.36 (10.97) | 15 (39.47%) | 15 (39.47) | an exercise programme 3 days per week for 6 weeks | NA | 6 weeks |
| 13.Lai 2024 | Taiwan | Persistent Long-COVID symptoms after the diagnosis of COVID-19 | 38.9 (11.1) | 40.8 (14.0) | 37 (41%) | 33 (36%) | A telerehabilitation training programme 3 times per week for 12 weeks | maintain their usual lifestyles | 12 weeks |
| 14.Li 2022 | China | mMRC dyspnea score of 2–3 after the diagnosis of COVID-19 | 49.17 (10.75) | 52.03 (11.10) | 32 (54.2%) | 34 (56.7%) | An exercise programme 3–4 times per week for 6 weeks | short educational instructions | 6 weeks |
| 15.Longobardi 2023 | Brazil | Being diagnosed with COVID-19 | 60.8 (7.1) | 61.2 (7.7) | 13 (52%) | 12 (48%) | a home-based exercise training programme 3 times per week for 16 weeks | standard of care | 16 weeks |
| 16.McGregor 2024 | UK | ongoing substantial covid-19 related physical and/or mental health sequelae after the diagnosis of COVID-19 | 56.1 (12.1) | 56.2 (12.3) | 162 (54%) | 143 (50%) | A rehabilitation programme for 8 weeks | best practice usual care | 8 weeks |
| 17.Oliveira 2023 | Brazil | Long-COVID symptoms after the diagnosis of COVID-19 | 53.74 (11.21) | 50.75 (10.14) | 17 (54.8%) | 17 (60.7%) | Multicomponent exercise 2 times per week for 12 weeks | educational orientation and performed activities of daily living | 12 weeks |
| 18.Paneroni 2024 | Italy | unable to walk >70% of the predicted distance during a 6MWT after a diagnosis of COVID-19 | 66.7 (10.2) | 67.6 (10.6) | 14 (35%) | 8 (20%) | home-based exercise program and regular nurse teleconsultation 6 times per week for 4 weeks | a remote teleconsultation from nursing staff | 4 weeks |
| 19.Pleguezuelos 2023 | Spain | Long-COVID symptoms after the diagnosis of COVID-19 | 54.6 (11.7) | 54.5 (10.9) | 28 (21.4%) | 28 (21.4%) | a telerehabilitation program combined with aerobic and strength exercises 3 times per week for 15 weeks | no telerehabilitation program and carrying out their routine daily life activities. | 15 weeks |
| 20.Pleguezuelos 2024 | Spain | post-COVID sequelae more than 3 months after the diagnosis of COVID-19 | 65.0 (5.2) | 64.3 (5.0) | 15 (14.2%) | 26 (24.5%) | a telerehabilitation program combined with aerobic and strength exercises 3 times per week for 12 weeks | no telerehabilitation programme and carrying out their routine activities of daily living. | 12 weeks |
| 21.Rodariguez-Blanco 2022 | Spain | Being diagnosed with COVID-19 | 34.81 (11.82) | 42.36 (11.84) | 12 (46.2%) | 12 (54.5%) | Strength exercise program once a day for 14 days | NA | 14 days |
| 22.Rodariguez-Blanco 2023 | Spain | COVID-19 symptom more than 40 days after the diagnosis of COVID-19 | 38.75 (15.40) | 42.58 (11.40) | 13 (27.08%) | 13 (27.08%) | therapeutic exercise telerehabilitation protocol for 14 days | relative rest at home | 14 days |
| 23.Romanet 2023 | France | Dyspnea symptom after a diagnosis of COVID-19 | 57 (14.28) | 59 (9.94) | 11 (40%) | 12 (36%) | exercise training rehabilitation 2 times per week for 10 weeks | standard physiotherapy | 10 weeks |
| 24.Senen 2024 | Spain | Long-COVID symptoms after the diagnosis of COVID-19 | 48.83 (7.0) | 45.17 (6.9) | 14 (77%) | 13 (69%) | a therapeutic physical exercise program for 8 weeks | recommendations on physical exercise and healthy habits based on recommendations for the general population | 8 weeks |
| 25.Sick 2025 | Austria | a laboratory-confirmed SARS coV-2 infection at more than 12 weeks |
41.6 (14.7) | 40.3 (10.8) | 10 (71.4%) | 11 (78.6%) | resistance and endurance exercise 3 times per week for 12 weeks | Maintaining current physical activities without an exercise programme | 12 weeks |
| Respiratory muscle training: targeted interventions aimed at strengthening the respiratory muscles, especially the diaphragm and inspiratory muscles. These programs may include incentive spirometry, diaphragmatic breathing, inspiratory muscle training (IMT), or comprehensive cardiopulmonary rehabilitation. Training may be conducted with or without resistance, and often includes structured frequency and duration. | |||||||||
| 1.Abo Elyazed 2024 | Egypt | presented easy fatiguability and/or shortness of breath and/or cough after mild-to-moderate COVID-19 | 39.25 (4.43) | 40.4 (5.4) | 16 (40%) | 10 (50%) | incentive spirometry, diaphragmatic breathing and standard care for 8 weeks | Standard care | 8 weeks |
| 2.del Corrala 2023 | Spain | fatigue and dyspnea for at least 3 months after the COVID-19 diagnosis | 47.7 (8.95) | 45.15 (11.4) | 33 (75%) | 30 (68.2%) | a home-based respiratory muscle training programme, 40 min/day, split into two 20-min sessions (morning and afternoon), 6 times per week, for 8 weeks. | Sham respiratory muscle training (without resistance) | 8 weeks |
| 3.Gomes Dos Santos 2024 | Brazil | respiratory or/and functional symptoms after the diagnosis of COVID-19 | 50.76 (11.28) | 44 (11.28) | 10 (58.82%) | 10 (62.5%) | cardiopulmonary rehabilitation (respiratory, aerobic, and resistance muscle training) for 6 weeks | remote lectures on health education for 6 weeks | 6 weeks |
| 4.McNarry 2022 | UK | dyspnea symptoms after the diagnosis of COVID-19 | 46.76 (12.03) | 46.13 (12.73) | 95 (86%) | 35 (95%) | inspiratory muscle training for 8 weeks | usual care | 8 weeks |
| 5.Mila 2024 | Spain | Long-COVID symptoms (dyspnea, loss of smell and taste) after the diagnosis of COVID-19 | 23 (14) | 22 (13) | 59 (59%) | 42 (42%) | A rehabilitation programme (including inspiratory muscle training and aerobic exercise) 2–3 times per week for 31 days | usual care | 31 days |
| 6.Pietranis 2024 | Poland | systemic post-COVID-19 complications or dyspnea after the diagnosis of COVID-19 | 65.41 (11.23) | 57.90 (16.02) | 67 (26%) | 60 (13%) | Respiratory muscle training and exercise training for 6 weeks | aerobic exercise and sham respiratory muscle training (without resistance) | 6 weeks |
| 7.Sari 2022 | Turkey | pulmonary involvement after the diagnosis of COVID-19 | 53.5 (5.39) | 59 (7.63) | NA | NA | Breathing exercise, resistance training and inspiratory muscle training for 6 weeks | Breathing exercise and resistance training | 6 weeks |
| 8.Spiesshoefer 2024 | Germany | persistent exertional dyspnea with diaphragm muscle weakness after the diagnosis of COVID-19 | 59.6 (14.08) | 60 (20.28) | 3 (33.3%) | 4 (4.44%) | inspiratory muscle training for 6 weeks | Sham inspiratory muscle training (without resistance) | 6 weeks |
| Telerehabilitation: delivery of rehabilitation training, guidance, and supervision to patients remotely through online platforms, mobile applications, video conferencing, or telephone. The interventions typically include multimodal exercise, respiratory training, and health education. | |||||||||
| 1.Carpallo-porcar 2023 | Spain | Long-COVID symptoms after the diagnosis of COVID-19 | 58.00 (2.00) | 59.00 (2.00) | 11 (55.00) | 9 (45.00) | multimodal program via a telerehabilitation platform accessible through a website or through a mobile app for 12 weeks | the same multimodal program but through a home rehabilitation paper explanatory booklet |
12 weeks |
| 2.da silva 2023 | Brazil | after the diagnosis of COVID-19 | 57 (9.0) | 54.0 (13.0) | 10 (35.7%) | 13 (44.8%) | a physical therapy session and some sessions were supervised by the physical therapist via video-conference for 8 weeks |
The same physical therapy session via video-conference but without supervision | 8 weeks |
| 3.Demir 2025 | Turkey | patients diagnosed with COVID-19 | 49.5 (12.8) | 38.33 (14.83) | 9 (75%) | 10 (83.3%) | supervised exercises programme 3 times per week for 6 weeks | the same exercises programme without supervision | 6 weeks |
| 4.Jorge 2025 | Brazil | long-COVID symptoms for more than 12 weeks after the diagnosis of COVID-19 | 49.2 (18.6) | 43.2 (15.41) | 11 (55%) | 16 (84.2%) | supervised exercises programme 2 times per week for 8 weeks | a guidebook containing home exercises and health care instructions without supervision |
8 weeks |
| 5.Okan 2022 | Turkey | Dyspnea symptom after the diagnosis of COVID-19 | 48.85 (10.85) | 52.19 (14.84) | 11 (42.3%) | 14 (53.8%) | breathing exercises under the supervision of the researchers for 5 weeks | a brochure explaining breathing control, pursed lip breathing, and diaphragmatic breathing exercise. | 5 weeks |
| 6.Pehlivan 2022 | Turkey | diagnosed with COVID-19 and discharged after treatment, still in the first 4 weeks after discharging, | 53.88 (13.92) | 42.15 (13.36) | 3 (18%) | 6 (35%) | an exercise program 3 times per week for 6 weeks with the supervision of the physiotherapist in all exercise. | one session of exercise training and a brochure including similar exercises as the intervention group by smartphone without supervision of the physiotherapist | 6 weeks |
| 7.Sahin 2023 | Turkey | being diagnosed with COVID-19 | 57.67 (8.42) | 63.67 (7.90) | 8 (38%) | 6 (28.6%) | a home-based pulmonary rehabilitation programme for 8 weeks with phone calls from a physiotherapist once a week. | The same home-based pulmonary rehabilitation programme without phone calls from a physiotherapist | 8 weeks |
| 8.Samper 2023 | Spain | Persistent long-COVID symptoms more than 12 weeks after the diagnosis of COVID-19 | 48.25 (10.36) | 48.31 (8.01) | 44 (84.5%) | 48 (68.75%) | the treatment as usual methods established by their general practitioner via Recovery APP for 3 months | the same treatment without using Recovery APP | 3 months |
| 9.Sarmento 2024 | Canada | mild to severe persistent respiratory symptoms more than 3 months after confirmed or suspected COVID-19 infection | 50 (9) | 49 (9) | 7 (87%) | 5 (83) | an exercise program (aerobic, strengthening, and breathing exercises) three times per week for 8 weeks led by a physiotherapist via video conference | The same exercise program following a pre-recorded video | 8 weeks |
| Transcranial direct current stimulation (tDCS): non-invasive brain stimulation technique that delivers a low-intensity direct current via electrodes placed on the scalp to modulate cortical excitability. It is used to target specific brain regions for therapeutic purposes. | |||||||||
| 1.Oliver-Mas 2023 | Spain | Symptoms of fatigue and Diagnosis of COVID-19 with positive RT-PCR results at least 6 months before | 47.26 (9.05) | 44.12 (9.83) | 15 (65.21%) | 22 (91.66%) | anodal transcranial direct current stimulation (2 mA, 20 min/time) on the left dorsolateral prefrontal cortex 4 times per week for 2 weeks | electrodes were placed in the same regions without the current during the 20 min session. | 2 weeks |
| 2.Santana 2023 | Brazil | diagnosis of PASC-related fatigue and three to 12 months after acute confirmed SARS-CoV-2 infection | 51.63 (15.87) | 54.46 (19.01) | 24 (69%) | 21 (60%) | high-definition transcranial direct current stimulation (3 mA, 30 min/time) targeting the left primary motor cortex program. 2 times per week for 5 weeks. | the device targeting the same place provided a 30-s ramp-up period to the full 3 mA, followed immediately by a 30-s ramp down. | 5 weeks |
| Olfactory training: repeated exposure to a set of specific odors over a defined period to stimulate and potentially restore olfactory function. | |||||||||
| 1.Berube 2023 | Canada | Olfactory dysfunction after the diagnosis of COVID-19 | 44.9 (7.4) | 44.5 (10.1) | 16 (64%) | 17 (68%) | Patients exposed themselves to four odors (floral, fruity, aromatic resinous) and 2 time per day for 12 weeks | Patients were asked to sniff four glass vials that were identical in appearance to the ones distributed to the intervention group, but odorants were odorless propylene glycol | 12 weeks |
| 2.Mila 2024 | Spain | Long-COVID symptoms (dyspnea, loss of smell and taste) after the diagnosis of COVID-19 | 23 (14) | 22 (13) | 59 (59%) | 42 (42%) | A rehabilitation programme (including inspiratory muscle training and aerobic exercise) 2–3 times per week for 31 days | usual care | 31 days |
| Steroid nasal spray: Use of intranasal corticosteroid sprays, such as mometasone furoate, often combined with olfactory training, aimed at reducing nasal inflammation and improving olfactory function. | |||||||||
| 1.Abdelalim 2021 | Egypt | sudden recent anosmia or hyposmia after the diagnosis of COVID-19 | 28.83 (13.36) | 27.5 (5.72) | 26 (52%) | 28 (56%) | mometasone furoate nasal spray once daily (100 μg) in each nostril for 3 weeks and olfactory training | only olfactory training | 3 weeks |
| 2.Kasiri 2021 | Iran | olfactory dysfunction for two weeks and after the diagnosis of COVID-19 | 35.4 (9) | 33.2 (8.5) | 19 (48.7%) | 19 (50%) | mometasone furoate nasal spray twice daily (100 μg) in each nostril for 4 weeks and olfactory training | saline spray in each nostril twice daily and olfactory training. | 4 weeks |
| Palmitoylethanolamide and Luteolin (PEA-LUT): use of ultramicronized Palmitoylethanolamide combined with Luteolin (PEA-LUT) as an oral supplement, often combined with olfactory training, aimed at reducing neuroinflammation and supporting olfactory recovery. | |||||||||
| 1.Cantone 2024 | Italy | smell disturbances | 44.8 (11.81) | 52.1 (11.8) | 11 (65%) | 13 (57%) | ultramicronized Palmitoylethanolamide and Luteolin once daily (Glialia 700 + 70; Epitech) and olfactory training for 180 days | only olfactory training | 180 days |
| 2.D'Ascanio 2021 | Italy | post-infection olfactory impairment that persisted ≥90 days after SARS-CoV-2 negative testing | NA | NA | 5 (71.4%) | 3 (50%) | weekly olfactory rehabilitation plus daily oral supplement with PEA and Luteolin for 30 days | two times a day olfactory rehabilitation alone | 30 days |
| 3.Di Stadio 2022 | Italy | olfactory disturbances after SARS-CoV-2 infections | 36.7 (11.8) | 50.5 (12.7) | 49 (52%) | 21 (58%) | daily treatment with co-ultra-micronized PEA 700 mg and Luteolin 70 mg and olfactory training for 90 days | a placebo supplement therapy and olfactory training | 90 days |
| 4.Di Stadio 2023 (1) | Italy | prior COVID-19 and persistent olfactory impairment more than 6 months after follow-up SARS-CoV-2 negative testing | 42.1 (14.5) | 47 (14.6) | 83 (63.8%) | 38 (69%) | daily co-ultra-micronized PEA 700 mg and Luteolin 70 mg and olfactory training for 90 days | daily treatment with placebo and olfactory training | 90 days |
| 5.Di Stadio 2023 (2) | Italy | presence of persistent anosmia or persistent hyposmia after the diagnosis of COVID-19 | 42.7 (13.5) | 40.9 (11.7) | 40 (71.4%) | 26 (68.4%) | Daily co-ultra-micronized Palmitoylethanolamide 700 mg and Luteolin 70 mg and olfactory training for 90 days | daily placebo supplement therapy and olfactory training | 90 days |
6MWT, 6-Minute Walk Test; mMRC, Modified Medical Research Council Dyspnea Scale; NA, not addressed; PASC, Post-Acute Sequelae of SARS-CoV-2 infection; PEA-LUT, Palmitoylethanolamide and Luteolin; SD, standard deviations; tDCS, Transcranial direct current stimulation.