Clinical efficacy of exercise in the treatment of post-COVID-19 syndrome: a systematic review and network meta-analysis, 2025, Du et al.

[SNT Gatchaman]

Clinical efficacy of exercise in the treatment of post-COVID-19 syndrome: a systematic review and network meta-analysis

Spoiler: Authors

Du, Shaojie; Cui, Zeyu; Xu, Xiangqian; Liu, Te; Ye, Jie

BACKGROUND
Post-COVID-19 syndrome (PCS) describes a constellation of persistent or new symptoms lasting beyond the acute phase of SARS-CoV-2 infection. Emerging evidence suggests that exercise is a cost-effective and accessible intervention that may enhance pulmonary function, improve cardiopulmonary circulation, regulate emotional status, and alleviate symptoms of PCS. However, robust evidence supporting the efficacy of exercise therapy in PCS remains limited. This systematic review and meta-analysis aimed to elucidate the therapeutic potential of exercise therapy in PCS.

METHOD
A search of the PubMed, Embase, Web of Science, and Ovid databases up to March 25, 2025 yielded 33 randomized controlled trials (with 2,895 participants) for meta-analysis.

RESULT
The results showed that exercise therapy significantly improved the multi-dimensional outcomes of patients with PCS. Bayesian network meta-analysis indicated that the combination of aerobic exercise and respiratory muscle training had the best effect on lung function. Multimodal exercise significantly improved the results of the six-minute walk test, the dyspnea score, and peak oxygen uptake. Mental Health and Mental Component Summary scores improved significantly in the group that received exercise therapy (P<0.01).

CONCLUSION
The results of this meta-analysis confirm that exercise can significantly improve quality of life and the emotional state of patients with PCS. They also provide evidence for a treatment strategy in patients with post-COVID-19 sequelae.

SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD420251034187.

Web | DOI | PDF | Frontiers in Physiology | Open Access

 

[SNT Gatchaman]

Two researchers independently evaluated the methodological quality of the included randomized controlled trials based on the Cochrane risk of bias criteria and classified each quality item as low risk, high risk, or uncertain risk. The seven items of bias in each trial evaluation included randomized sequence generation, allocation concealment, subject and personnel blinding, outcome assessment blinding, incomplete outcome data, selective reporting, and other biases.

With regard to participant and personnel blinding, most studies were assessed as high risk because of the inability to blind the intervention (exercise therapy). The blinding methods used for assessment of outcomes were differentiated. Most studies assessed objective indicators (such as pulmonary function tests) in a blinded manner, so they were considered to be low risk for bias. However, some studies used subjective indicators and were deemed to be high risk because they did not clarify the blinding method (red). Incomplete outcomes data are marked in red because of the high rate of loss to follow-up. Some studies were considered high risk because of an imbalance of baseline characteristics or an inadequate sample size.

The results of this meta-analysis of the existing literature underscore the effectiveness of exercise therapy in patients recovering from COVID-19. However, which type of exercise is most effective and its exact content have not been clarified, and whether there is a difference in effect between long-term exercise and short-term exercise has not been explored.

Proceeds to not mention high risk of bias in the study designs. Concludes —

The existing treatments are symptomatic only, and there is no cure for this illness. Therefore, patients need to engage with other rehabilitation strategies. Exercise is becoming increasingly popular as a convenient and effective treatment. Using a seven-item data scale, we have confirmed that exercise therapy can significantly improve lung function, physical activity status, and emotional status in patients with PCS. Combined with the existing evidence, we believe that exercise is a safe and effective treatment for these patients.

Why bother to go to the trouble of a risk-of-bias assessment if you're going to ignore it? And as far as "Exercise is becoming increasingly popular as a convenient and effective treatment" I have to ask: who is it convenient for? Not the patients, just the doctors it would seem.

 

[Sean]

What about selection criteria? In particular, are they differentiating properly for PEM?

I suspect that failure to do that is the main means by which these LC exercise studies are getting away with this stuff.

 

[rvallee]

Using a seven-item data scale, we have confirmed that exercise therapy can significantly improve lung function, physical activity status, and emotional status in patients with PCS

All they confirmed with those methods is that those methods aren't worth a damn. The whole damn thing. They distort reality by saying there is no cure for Long Covid, when they should have said there are no treatments, and if exercise therapy is not supposed to be a treatment, then what the hell do words even mean? They try to work around the idea of rehabilitation being this magical thing that is not a cure, not a treatment, but it works just the same, which is complete bullshit.

Except it doesn't work. It's widely known that there are no treatments, and that when patients say that they obviously include all of this rehabilitation stuff that has been tried literally on millions of people at this point, and obviously doesn't even need any supervision anyway. This is partly why it's so alluring, any GP can simply say "just exercise", it costs nothing and all the pretense about supervision doesn't change this is how it goes most of the time. This is 6 years into this and it's still being promoted like this thing people haven't tried, while being fully aware this is completely false.

At this point even LLMs aren't this mindless about pursuing goals. The number of things that have to go wrong to get to this point is literally everything.