Individualized online exercise therapy aids recovery in pediatric long-COVID - Findings from an exploratory randomized controlled trial

Purpose To evaluate the feasibility, safety, and effectiveness of an individualized online exercise therapy (IOET) designed to improve physical capacity and quality of life in children and adolescents with long-COVID. Methods In this prospective, randomized, single-centre controlled trial, 14 patients aged 9–17 years (11 females, 3 males) with long-COVID (median symptom duration: 21 months) were assigned to either 6 or 12 weeks of IOET. The intervention comprised twice-weekly, telemedicine-delivered sessions tailored to individual ability and symptom burden, supplemented with diaries, activity trackers, and handouts for self-studies. Primary outcomes were physical performance (6-Minute Walk Test [6MWT], Sit-to-Stand Test [STST], Handgrip Strength Test [HST]). Secondary outcomes included school attendance, quality of life (PedsQL), physical activity, safety, and self-reported recovery. Results All participants showed clinically relevant improvements. In the 12-week IOET group, 6MWT increased from 396.0 m to 616.3 m, STST from 25.4 to 32.6 repetitions, and HST from 16.6 kg to 27.1 kg. The 6-week group improved comparably (6MWT: 429.0 m to 601.6 m; STST: 21.6 to 31.7; HST: 17.3 to 22.1 kg). School attendance rose from 58% to 97%, and PedsQL scores reflected improved quality of life and reduced fatigue. No adverse events or post-exertional symptom exacerbations occurred. Improvements persisted at 3-month follow-up, although some decline from peak performance was noted. Conclusions IOET is feasible, safe, and associated with improved physical function, reintegration in every day life and it’s quality in pediatric long-COVID. These findings highlight IOET as a promising rehabilitation strategy and justify larger multicentre trials to confirm effectiveness and define optimal programme duration.