Physiotherapy management of Long-COVID: an evidence-based approach.
Jack Reeves, Enya Daynes, Tania Janaudis-Ferreira and 4 others
Physiotherapy for Long-COVID should centre on pacing and energy conservation, individualised exercise (not fixed-protocol graded exercise), and screening for post-exertional malaise before any physical testing.
Most exercise evidence comes from hospitalised patients, and the condition is too varied for one-size-fits-all protocols.
Key findings
1Three RCTs (TERECO, REGAIN, PHOSP-R) showed significant improvements in exercise capacity and quality of life with structured exercise programmes, but the authors note the data are biased toward hospitalised patients and that further research in non-hospitalised Long-COVID is needed.
2Pacing and energy conservation are recommended as a key management tool for fatigue-dominant Long-COVID, but the authors state the evidence base for pacing as a standalone intervention is limited.
3Guidelines recommend against graded exercise therapy in anyone reporting post-exertional malaise; high fatigue alone does not indicate PEM, so a thorough PEM assessment is needed to avoid both unnecessary exclusion from effective exercise and harm from inappropriate progression.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
No systematic search strategy, inclusion criteria, or quality assessment of the evidence is described; this is a narrative synthesis, not a systematic review. The condition is novel and long-term data are lacking, so prognosis and treatment trajectories are uncertain. Exercise rehabilitation evidence is biased toward hospitalised patients; applicability to non-hospitalised Long-COVID is unproven. The evidence base for pacing and energy conservation as a standalone intervention is explicitly described as limited. Inspiratory muscle training evidence comes from seven studies with variable designs, instruments, and quality; the authors call for standardised, high-quality research. Long-COVID is highly heterogeneous (over 200 symptoms reported), so findings from any single trial or intervention may not generalise to all patients. The review draws on ME/CFS literature by analogy, but the two conditions, while overlapping, are not identical.
Declared interests
The authors declare no competing interests. The paper notes it was produced 'in-kind' (i.e., as a service rather than through a funded grant). No industry sponsor is named.
The easy way to misread this
Do not read the three cited RCTs as proof that a standard exercise programme will help every Long-COVID patient — the authors themselves flag that the data are biased toward hospitalised patients, the condition is too heterogeneous for one protocol, and exercise must be stopped immediately if post-exertional malaise appears. A patient who crashes after a session is not failing the programme; the programme is wrong for them.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →