Resistance exercise therapy after COVID-19 infection: a randomized, controlled trial

Abstract

Importance: Long COVID presents an unmet therapeutic need. Objective: To determine the effects of a resistance exercise intervention on exercise capacity in adults after COVID-19 infection. Secondary objectives included assessments of health status. Design: A two-arm randomized, controlled clinical trial including adults with a hospital or community diagnosis of COVID-19 in the preceding 12 months was undertaken during June 2021-April 2024. Setting: Community and secondary care, multicenter. Participants: 233 individuals with Long-COVID were randomized. 117 (50.2%) individuals were assigned to the intervention group, and 116 (49.8%) individuals were assigned to the control group. Shuttle walk tests at baseline and 3-months were completed in 224 and 193 participants, respectively. Intervention: Personalized resistance exercise intervention for 3-months. Control: Treatment-as-usual. Main outcome measures: The primary outcome was the distance achieved (m) in the incremental shuttle walk test undertaken 3-months after randomization. Secondary outcome measures included health-related quality of life (EQ-5D-5L), anxiety and depression (Patient Health Questionnaire) and grip strength. Results: 233 adults (median (interquartile range) 53.6 (43.8, 60.8) years; 146 (62.7%) female, 91 (39.1%) hospitalized with COVID-19) were randomized (n=117 (50.2%) intervention group, n=116 (49.8%) control group). The median (interquartile range) percentage adherence with the exercise intervention was 71.0 (47.8, 96.8), equivalent of performing the exercises on 5 days/week. The mean (SD) distances achieved in the incremental shuttle walk test at baseline and at follow-up were 328 (225) m and 389 (249) m, in 224 and 193 individuals, respectively. The change in incremental shuttle walk test distance at three months compared to baseline was 83 (118) m in the intervention group (n=94) and 47 (95) m in the control group (n=98) (effect estimate (95%) confidence interval 36.5 (6.6, 66.3) m; p=0.017). By three months, compared to the control group, greater improvements in the intervention group were also observed for the health-related quality of life utility score (EQ-5D-5L) (0.06 (0.01, 0.11); p=0.018), Patient Health Questionnaire category (0.5 (0.2, 0.8); p=0.013) and handgrip strength (2.58 (0.92, 4.24) kg; p=0.002). Conclusions and Relevance: In this randomized clinical trial, a program of resistance exercise for 3 months in adults after COVID-19 infection improved exercise capacity and appeared to improve health-related quality of life, anxiety and depression, and grip strength.

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DOI

https://doi.org/10.1001/jamanetworkopen.2025.34304

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https://eprints.gla.ac.uk/359063/