Effectiveness of physical, psychological, and alternative interventions for post-COVID-19 condition: a systematic review.

Abstract

Objective To evaluate supervised physical, psycho-logical, and alternative non-pharmacological interventions for improving patient-reported and objective functional outcomes in adults with post-COVID-19 condition. Design Systematic review of randomized controlled trials. Methods PubMed, Web of Science Core Collection, APA PsycInfo, and Scopus were searched from 1 January 2020 to 29 January 2026. Eligible studies were supervised, face-to-face trials evaluating physical, psychological, or alternative non-pharmacological interventions against usual care, placebo/sham, or active comparators in adults with World Health Organization defined post-COVID-19 condition. Risk of bias was assessed using Cochrane RoB 2. Due to clinical and methodological heterogeneity, a narrative synthesis was performed. Results 27 trials (1,998 participants) were included and evaluated physical, psychological, and alternative therapies. Supervised cardiopulmonary rehabilitation and multimodal exercise consistently improved cardiorespiratory fitness and walking capacity. Cognitive-behavioural therapy and lifestyle adjustments significantly reduced fatigue and subjective concentration complaints. Findings for neuromodulation, complementary, and oxygen therapies were heterogeneous, often showing no benefit over placebo. Only 18.5% of trials had low risk of bias, limited by small samples, unblinding, and short follow-ups. Conclusion Supervised physical rehabilitation and CBT show promising evidence for improving functional capacity and symptoms in post-COVID-19 condition. Larger trials with longer follow-up are needed to confirm effectiveness and inform clinical guidelines.