Resistance training may help people with long COVID

For individuals with persisting COVID-19 symptoms, a 3-month resistance exercise program appears to yield greater improvements in physical function and psychological well-being compared with usual care alone, as shown in a study.

The primary outcome of distance achieved in the Incremental Shuttle Walk Test increased by 83 m from baseline with resistance exercise vs 47 m with usual care (adjusted mean difference, 36.5 m, 95 percent confidence interval [CI], 6.6–66.3; p=0.02). [JAMA Netw Open 2025;8:e2534304]

Resistance exercise was also associated with greater improvements in health-related quality of life (adjusted mean difference in EQ-5D-5L score, 0.06, 95 percent CI, 0.01–0.11; p=0.02), anxiety and depression (adjusted mean difference in the Patient Health Questionnaire score, 0.05, 95 percent CI, 0.02–0.08; p=0.01), and handgrip strength (adjusted mean difference, 2.6 kg, 95 percent CI, 0.9–4.2; p=0.002).

These findings indicate that resistance training may be a generalizable therapy for individuals with persisting physical symptoms after COVID-19 infection in primary and secondary care, according to the investigators.

“Individuals living with long COVID may experience impairments in physical function and skeletal muscle energetics… Hence, muscle strength after COVID-19 represented a target for the resistance exercise intervention in this trial, with the overall aim of improving functional capacity,” they pointed out. [Phys Ther 2020;100:1717-1729; Radiology 2024;313:e233173]

Resistance exercise interventions may enhance muscle strength and aerobic fitness—factors that determine functional capacity—through mechanisms involving improvements in type II muscle fibre recruitment, flow-mediated vasodilatation, and ventricular stroke volume. [Br J Sports Med 2020;54:341-348; Med Sci Sports Exerc 2015;47:1922-1931; Sports Med 2023;53:1161-1174; J Physiol 2011;589:5443-5452]

Population characteristics

The study included 233 adults (median age 53.6 years, 62.7 percent female, 93.1 percent White, 39.1 percent were hospitalized) with a diagnosis of COVID-19 infection in the preceding 12 months, of which 39.1 percent had been hospitalized. All participants had circulating immunoglobulin G (IgG) antibodies to SARS-CoV-2, consistent with prior COVID-19 and/or vaccination. Most of them (62.2 percent) had had symptoms 90 days or more after the diagnosis of COVID-19.

These participants were randomly assigned to undergo resistance exercise intervention for 3 months (n=117) or receive treatment as usual in line with guidelines from the National Institute for Healthcare Excellence guideline (n=116). Participants in both groups received rehabilitation as per standard care. [https://www.nice.org.uk/guidance/ng188]

“The exercise program was personalized according to the needs and preferences of the individuals… [and] was unsupervised. Hence, this participant-led intervention had minimal or no dependency on healthcare staff,” the investigators said.

Participants in the resistance exercise group received an instructional pack that contained a guidance document, an exercise log, and links to online videos during the initial visit. A nurse or therapist helped to select the most suitable category (ie, confined to bed, able to sit up, ambulatory) and level of exercise for the participants. Guidance and support were provided via telephone or video consultations every 2 weeks.

High adherence

“Adherence with resistance exercise was reasonably high, and postexercise malaise and adverse events were not increased with the exercise intervention,” according to the investigators.

The median percentage adherence with the exercise intervention was 71 percent, which was equivalent to performing the exercises 5 days per week. The overall withdrawal rate was 11.2 percent.

Hospitalizations occurred in one participant in the resistance exercise group and five participants in the usual care group, none of which were deemed related to the intervention. Among the 99 participants who completed the DePaul Symptom Questionnaire at the 3-month follow-up, 40 of 48 (83.3 percent) in the resistance exercise group and 42 of 51 (82.4 percent) in the usual care group experienced postexertional malaise. There were no deaths documented.

The investigators acknowledged several study limitations. First, the Incremental Shuttle Walk Test and interviews were conducted by study personnel who were aware of the treatment allocation. Second, adherence to the exercises was self-reported. Finally, the participants in the exercise group received more contact with site staff compared with those in the usual care group and the lack of data on the reasons for being lost to follow-up.

“These limitations are relevant but should not undermine the overall validity of this trial, which involved a pragmatic intervention and a multicentre design with broad inclusion criteria. Most of the participants were female. Because there was no evidence of intervention effect heterogeneity across prespecified groups, the results may be considered generalizable,” they said.