Long COVID recovery and exercise adherence: 32-month study

Objective To evaluate symptom progression in COVID-19 survivors, adherence to prescribed exercise therapy, and its association with pre-infection physical activity at 21 days (T0), 6 months (T1), and 32 months (T2) post-discharge. Design Retrospective longitudinal study in a hospital-based rehabilitation unit in Portugal. The cohort included 276 patients (mean age 56.6 ± 13.5 years) with confirmed SARS-CoV-2 infection. Results Adherence was higher among patients reporting prior physical activity (48.8%; p = .003). Symptom prevalence declined over time: dyspnea (T0 = 22.4%, T2 = 7.3%), fatigue (T0 = 32.4%, T2 = 14.5%), and pain (T0 = 17.6%, T2 = 4.8%). Asymptomatic cases increased from 27.4% (T0) to 54.5% (T2). Early adherence, particularly by day 15, was associated with continued participation at day 21, and adherence at day 21 correlated with reduced dyspnea at follow-up (p = .02). Importantly, patients who remained symptomatic at day 21 took significantly longer to recover (t = –6.386; p < .001), indicating this time point as a prognostic marker of delayed resolution of exercise-modifiable symptoms. Conclusion Early initiation of individualized, structured exercise proved safe, adaptable, and associated with reduced symptom burden, especially dyspnea. Persistence of symptoms at day 21 highlights the prognostic value of early follow-up and underscores the decisive role of timely rehabilitation engagement. Structured home-based and tele-rehabilitation programs supported adherence and accessibility, reinforcing exercise as a cornerstone of long COVID management and potentially applicable to other post-respiratory rehabilitation contexts.