Telerehabilitation has emerged as a useful option for managing Long COVID. Especially for patients who are not fit for in person consultations, these options can be helpful.
Multiple studies have assessed the benefits of telerehabilitation. Improvements in physical function, respiratory health, and quality of life have been observed. This article reviews recent evidence to evaluate how telerehabilitation can support recovery in Long COVID.
Overview of Telerehabilitation’s Potential
In a recently published Review, 16 randomized controlled trials with a total of 1,129 patients were analyzed. The review included studies with varying durations, ranging from 2 to 17 weeks. Most programs involved around 3 sessions per week. Included techniques ranged from breathing exercises to aerobic conditioning, strength training, and virtual cognitive-behavioral support.
The analysis noted several key differences based on the duration and techniques used:
Duration of programs:
- Shorter programs (under 6 weeks): While beneficial for immediate symptom relief, these programs often showed less sustained improvement in physical function and respiratory health. Programs under 6 weeks typically yielded gains in fatigue reduction and physical exertion scores but were less effective in long-term improvement of physical activity according to a 6-minute walking test or 30-second sit-to-stand test (see EPOCA in Altea Care).
- Longer Programs (6 to 17 weeks): Studies that implemented telerehabilitation for 6 weeks or more observed more sustained improvements in physical metrics and quality of life measures. In 8-week or longer programs, participants often demonstrated greater increases in walking distance and lower levels of perceived fatigue.
Techniques:
- Breathing and Respiratory Exercises: Breathing-focused interventions, especially those using inspiratory muscle training, were particularly effective for patients experiencing dyspnea (difficulty breathing) and respiratory limitations. Studies with structured breathing exercises showed improved respiratory scores and reduced dyspnea levels, though these benefits often required at least a 6-week duration to become statistically significant.
- Combined Aerobic and Strength Training: Programs that integrated both aerobic and resistance training tended to yield the best results in physical function metrics like the 6-minute walking test. These combined programs, especially when conducted over 8 or more weeks, consistently showed improvements in walking distance and overall stamina.
- Cognitive-Behavioral Support (CBS): Some programs included a cognitive-behavioral component, using virtual consultations and telemonitoring for psychological support. CBS-focused programs demonstrated notable reductions in anxiety and depressive symptoms, particularly in studies that ran for longer durations. Psychological support within telerehabilitation programs seemed to enhance compliance and motivation, which were crucial for sustained benefits from physical exercises.
While the review concluded that telerehabilitation generally enhanced physical function across studies, these findings suggest that longer programs with a mix of aerobic, strength, and respiratory training offer the most comprehensive benefits. The inclusion of cognitive support further bolstered outcomes, underscoring telerehabilitation's holistic potential for Long COVID recovery.
Recent studies show an improvement of respiratory symptoms and physical activity after telerehabilitation.
In a recent study published in September 2024, 64 patients were divided into two groups, one receiving a structured telerehabilitation program over a 7-week period (18 sessions of 40 min) while the other followed a “wait-and-see” approach with standard medical care.
This study assessed physical exertion, dyspnea, and health-related quality of life at four intervals: baseline, program completion, and at 1 and 3-month follow-up. Patients in the telerehabilitation group showed improvements in perceived physical exertion during daily activities, dyspnea severity, health-related quality of life and 6-minute walking test. Moreover, oxygen saturation levels at rest and heart rate after 6-minute walking test were improved compared to the control group.
In another study from this year, 120 patients who were randomized 1:1 to an experimental group participating in a telerehabilitation program three times a week and a control group were examined over a 12-week period. The primary endpoints were changes in fatigue severity and respiratory symptoms.
The results showed an improvement in walking behavior, physical activity, exercise self-efficacy, and sleep quality. However, no improvement in cardiorespiratory fitness or health-related quality of life was observed.
A smaller study published in August 2024 included 35 participants. The examined intervention consisted of a 12-week telerehabilitation program focusing on fatigue and functional status, quality of life and feasibility.
No significant differences in fatigue were observed in patients who received telerehabilitation versus those who did not. However, telerehabilitation was associated with improvements in 6-minute walk test, 30s sit-to-stand test, and physical quality of life. Improvements were sustained over 6 months.
Overall, telerehabilitation has been reported to bring a potential benefit for various symptoms of Long COVID. Especially for patients who are not able to attend in person programs due to their symptoms or other constraints, telerehabilitation represents a useful alternative.
