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

## TL;DR

An online exercise program helped children and teens with long-COVID improve physical ability, school attendance, and quality of life safely and effectively.

## Contribution

This study shows individualized online exercise therapy is a feasible, safe, and effective treatment for pediatric long-COVID.

## Key findings

- Participants showed significant improvements in 6-minute walk test, sit-to-stand test, and handgrip strength after 6 or 12 weeks of therapy.
- School attendance increased from 58% to 97%, and quality of life improved with no adverse effects.
- Improvements were maintained at 3-month follow-up, supporting the long-term benefits of the therapy.

## Abstract

The purpose of this study is 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. In a prospective, randomized, single-center exploratory trial, 14 patients aged 9–17 years with long-COVID (median symptom duration: 21 months) received either 6 or 12 weeks of IOET. Sessions were held twice weekly via telemedicine and individually adapted to physical ability and symptoms. Primary outcomes were functional performance (6-minute walk test [6MWT], sit-to-stand test [STST], and handgrip strength test [HST]). Secondary outcomes included school attendance, quality of life (PedsQL), safety, and self-reported recovery. All participants showed clinically improvements. In the 12-week IOET group, 6MWT increased from 396.0 to 616.3 m (+ 220.3 m, 95% CI 98.2–342.4), STST from 25.4 to 32.6 repetitions (+ 7.2, 1.9–12.5), and HST from 16.6 to 27.1 kg (+ 10.5 kg, 4.8–16.1). The 6-week group improved comparably (6MWT: 429.0 m to 601.6 m, (+ 172.6 m, 64.7–280.6); STST: 21.6 to 31.7 (+ 10.1, 3.1–17.1); HST: 17.3 to 22.1 kg (+ 4.8 kg (0.7–8.9)). School attendance rose from 58 to 97%, and PedsQL reflected improved quality of life and reduced fatigue. No adverse events or post-exertional symptom exacerbations occurred. Improvements persisted at the 3-month follow-up. Conclusions: IOET is feasible, safe, and associated with improved physical function, reintegration in everyday life, and its quality in pediatric long-COVID. These findings highlight IOET as a promising rehabilitation strategy and justify larger multicenter trials to confirm effectiveness and define optimal duration.
What is Known:• Children and adolescents with long-COVID often experience persistent fatigue, impaired physical capacity, and reduced quality of life, with limited evidence-based treatment options available.• Exercise therapy has shown beneficial effects in other chronic pediatric conditions such as cancer- or fatigue-related syndromes, improving strength, well-being, and social participation.What is New:• This exploratory randomized controlled trial demonstrates that individualized online exercise therapy is feasible, safe, and associated with clinically relevant improvements in physical function, quality of life, and school attendance in pediatric long-COVID, without negative side effects.• The findings highlight the potential of telemedicine-based rehabilitation strategies as accessible and effective treatment approaches for children and adolescents with post-infectious conditions such as long-COVID.

What is Known:

• Children and adolescents with long-COVID often experience persistent fatigue, impaired physical capacity, and reduced quality of life, with limited evidence-based treatment options available.

• Exercise therapy has shown beneficial effects in other chronic pediatric conditions such as cancer- or fatigue-related syndromes, improving strength, well-being, and social participation.

What is New:

• This exploratory randomized controlled trial demonstrates that individualized online exercise therapy is feasible, safe, and associated with clinically relevant improvements in physical function, quality of life, and school attendance in pediatric long-COVID, without negative side effects.

• The findings highlight the potential of telemedicine-based rehabilitation strategies as accessible and effective treatment approaches for children and adolescents with post-infectious conditions such as long-COVID.

The online version contains supplementary material available at 10.1007/s00431-025-06705-5.