TOPLINE:

Compared with usual care, a personalised, 3-month resistance exercise programme led to improvements in walking distance, anxiety, depression, health-related quality of life, and handgrip strength in individuals recovering from COVID, without an increase in adverse events or postexertional malaise.

METHODOLOGY:

• Researchers in Scotland conducted a multicentre randomised clinical trial of 233 individuals who had SARS-CoV-2 infection (median age, 53.6 years; 62.7% women) to determine the impact of a resistance exercise intervention on exercise capacity, health outcomes, and safety.
• Individuals who had a community or hospital diagnosis of COVID within the previous 12 months and persistent symptoms were randomly assigned to either the intervention group (n = 117) or the control group (n = 116).
• The intervention group completed a personalised, 3-month resistance exercise programme with periodic support and exercise logging, and the control group received usual care for long COVID.
• The primary outcome was the distance covered (in meters) during the incremental shuttle walk test — a paced walking test used to measure exercise capacity at 3 months post-randomisation; secondary outcomes included respiratory and physical function, health-related quality of life, and adverse events.

TAKEAWAY:

• Overall, the median adherence to the exercise intervention was 71.0%, equivalent to performing the exercises 5 days per week.
• The intervention group had a greater increase in the incremental shuttle walk test distance at 3 months from baseline than the control group (mean change, 83 vs 47 m; adjusted mean difference, 36.5 m; P = .02).
• Furthermore, the intervention group experienced greater improvements in health-related quality of life, symptoms of anxiety and depression, and handgrip strength than the control group (P < .05 for all).
• No deaths or intervention-related hospitalisations occurred, and rates of postexertional malaise were similar between the two groups.

IN PRACTICE:

"The intervention did not increase adverse events or postexertional malaise. This pragmatic intervention may be a generalizable therapy for individuals with persisting physical symptoms after COVID-19 infection," the authors wrote.

SOURCE:

This study was led by Colin Berry, MBChB, PhD, British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland. It was published online on November 10, 2025, in JAMA Network Open.

LIMITATIONS:

The study personnel who conducted the incremental shuttle walk test and interviews were not blinded to treatment allocation. The exercise programme was unsupervised, adherence was self‑reported, and the intervention group had more contact with site staff than the control group. Reasons for loss to follow‑up were not available.

DISCLOSURES:

This study was funded by a project grant from the Chief Scientist Office of the Scottish Government and by a British Heart Foundation Centre of Excellence Award. Berry reported receiving grants from the study funder and being an employee of the University of Glasgow, which held consultancy and research agreements related to his work with various pharmaceutical companies. Two authors reported receiving grants from multiple organisations and companies, and one of them had a pending international patent.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.