Short answer: yes, for many people, but the honest version has limits. Randomized trials and a 2025 review of 37 trials find that pulmonary rehab improves walking distance, breathlessness, fatigue and quality of life in long COVID. The gains are real but modest, programs of 4 to 8 weeks look best, and remote programs have improved walking distance less than face to face programs in the one trial that compared them directly. If your symptoms get worse after activity, the way the program is run matters more than whether you do one at all.
This page walks through what the published evidence actually says, including where it is weak, so you can judge whether a rehab program is worth your time. If you are new to the condition, start with our overview of long COVID care at Bloom.
What long COVID does to breathing
NIH MedlinePlus defines long COVID as symptoms that persist for 4 or more weeks after a case of COVID-19. Among the symptoms it lists are fatigue that makes daily activities hard, difficulty breathing or shortness of breath, cough, chest pain, and worsening symptoms after vigorous physical or mental activity. MedlinePlus lists pulmonary rehabilitation among the treatment options for long COVID, alongside progressive exercise, physical therapy, occupational therapy and mental health care.
That last symptom, symptoms getting worse after effort, is the one that changes how a program should be built. It is why a long COVID program is not simply a COPD program with a different label.
What the research says about pulmonary rehab for long COVID
Exercise capacity improves
The largest synthesis to date is a 2025 systematic review and meta-analysis in Therapeutic Advances in Respiratory Disease that pooled 37 randomized controlled trials and 3,363 patients. Compared with controls, pulmonary rehab improved physical capacity measured by the 6 minute walk test, the 30 second sit to stand test and handgrip strength, improved lung function measures including FEV1, FVC and inspiratory and expiratory pressures, improved health related quality of life, and reduced fatigue, breathlessness and anxiety. The effect on depression did not reach statistical significance.
A 2025 pragmatic randomized trial, PuRe-COVID, tested whether this works outside specialist hospital centers. Seventy six patients with long COVID, average age 49, were randomized to a 12 week stepwise program in primary care or to no rehab. At 12 weeks the rehab group walked about 39 meters further in 6 minutes than the control group, with a 95 percent confidence interval of 18 to 59 meters. Fatigue scores fell by 6 points, and the rehab group was more likely to reach a clinically meaningful improvement in walking distance, fatigue, inspiratory pressure and breathlessness score. The authors concluded that individual rehab may improve these outcomes and may be a promising option. That is a smaller claim than it is often reported as.
Breathing exercises are part of why it works
The 2025 review broke results down by exercise type. Breathing exercises on their own improved 6 minute walk distance, FEV1, FVC and quality of life. Multicomponent exercise improved walk distance and reduced fatigue. The combination of both produced the broadest set of improvements, and the authors concluded that a 4 to 8 week program combining breathing exercises with multicomponent training was the most effective approach they found. A 2024 systematic review in Respiratory Research reached a similar conclusion: a well structured program combining aerobic and strength exercise with breathing techniques and inspiratory muscle work was the most effective form of treatment for post COVID respiratory problems.
Inspiratory muscle training has its own, smaller evidence base. The InsCOVID trial, published in 2022, randomized just 26 patients who had been hospitalized with COVID pneumonia and found that 12 weeks of home based inspiratory muscle training improved peak oxygen uptake and quality of life compared with usual care. With 26 participants this is a small single center trial and should be read as a signal rather than a settled result.
Where the evidence is weaker than the headlines
Three findings are worth knowing before you start, because no one benefits from an oversold program.
- Fitness does not always move. A 2024 randomized trial in Annals of Physical and Rehabilitation Medicine enrolled 182 people with long COVID in a 12 week telerehabilitation program. The program increased walking behavior, total physical activity, exercise self efficacy and sleep quality, but found no significant difference in any measure of cardiorespiratory fitness or in quality of life at 12 weeks. Only 67 percent of participants completed the study.
- Short programs may show nothing at first. A 12 month follow up of a 4 week pulmonary telerehab trial, published in 2026, followed 29 of the original 50 participants. The primary outcome did not improve, though several secondary measures did, and the authors reported that participants experienced some recovery at 12 months despite not improving during the 4 week program itself.
- Remote is not automatically equal to in person. See the next section.
Does virtual pulmonary rehab work for long COVID?
One trial tested this directly. PHOSP-R, published in the European Respiratory Journal in 2025, randomized 181 people with post COVID syndrome after a COVID hospital stay to an 8 week face to face program, the same program delivered remotely, or usual care. Shuttle walk distance improved by about 52 meters with face to face rehab and about 34 meters with remote rehab, both compared with usual care alone. Neither arm changed self reported quality of life or symptoms over 8 weeks.
Read that carefully. Remote rehab beat doing nothing, which is the comparison most people are actually facing. It did not beat the in person arm, and its confidence interval ran from 1 to 66 meters, which is wide. The honest summary is that remote delivery is a legitimate option, particularly when the alternative is no program at all, and that it has not been shown to be identical to going in person. Our page on whether virtual pulmonary rehab is as effective as in person goes deeper on this comparison across conditions.
The American Lung Association notes that you may be able to receive certain forms of pulmonary rehabilitation in your own home or online, and also makes the point that rehab is more than exercise: it is education and support.
Breathing technique travels well over video, which is part of why remote programs are workable at all. The American Lung Association describes pursed lip breathing as breathing in through your nose and breathing out at least twice as long through your mouth with pursed lips, counting the inhale as 1, 2 and the exhale as 1, 2, 3, 4. A therapist can watch you do that on camera and correct it in real time.
Why post-exertional symptoms change how the program should be run
If activity reliably makes you worse for a day or two afterward, a fixed exercise prescription is the wrong tool. The published programs that worked were individually prescribed and supervised, and the stepwise structure in PuRe-COVID is part of what was being tested. Nothing in this evidence base supports handing someone a standard workout and expecting a long COVID response to follow a COPD timeline.
In practice that means a program for long COVID should be able to do the following.
- Set the starting workload from how you respond, not from a template.
- Change the workload inside a session, not only at a weekly review.
- Teach breathing technique explicitly, since breathing exercises carried part of the benefit in the pooled trials.
- Track how you feel in the 24 to 48 hours after a session, not just during it.
- Stop and reassess when symptoms worsen, rather than pushing through.
That is only possible if a clinician is actually watching the session. If breathlessness is tangled up with panic for you, our page on breathing anxiety covers that cycle, and what actually happens in a pulmonary rehab session describes a session end to end.
What to check before you sign up for a virtual program
Virtual lung programs are not all built the same way, and the differences are concrete rather than a matter of branding. Four questions separate them.
- Who runs the session? Some programs are led by exercise coaches, physical therapists or general health coaches. At Bloom, a licensed respiratory therapist leads every session.
- Is it one to one or a group? Some virtual programs run group cohorts on a shared video call, or make individual attention a paid upgrade. At Bloom one to one is the standard, which is what makes session by session adjustment possible. See group versus one to one pulmonary rehab.
- Is it live, or an app? Pre-recorded videos and app based exercise plans are not the same intervention that was tested in supervised trials. Rehab versus exercising on your own explains the difference.
- How is it paid for? Some programs run on cash subscriptions. Bloom bills commercial insurance directly, with a private pay option. See the coverage breakdown.
No program should claim a breakthrough, a new technique or a cure for long COVID. The evidence above does not support that, and neither do we.
Who is a reasonable candidate
Bloom treats adults with commercial insurance who have COPD, moderate to severe asthma, interstitial lung disease, pulmonary fibrosis or long COVID. For long COVID specifically, the people most likely to get something out of a program are those whose main problems are breathlessness, reduced walking tolerance, deconditioning or fatigue, and who are medically stable enough to exercise at some level. Your own physician is the right person to confirm that.
Most commercial plans want a physician order, and our page on referrals explains how that works. Bloom’s program is not covered by Medicare, Medicaid, or federal or supplemental insurance plans.
When to stop and get emergency care
This is education, not medical advice. NIH MedlinePlus says to seek emergency care if you have trouble breathing, chest pain or pressure, confusion or inability to wake up, blue or gray lips or face, or any other symptoms that are severe or concern you. Call 911 if that happens. Do not wait for a rehab session to work through something like that.
Frequently asked questions
In randomized trials it often does, though the gains are modest and not universal. A 2025 systematic review of 37 randomized trials covering 3,363 patients concluded that pulmonary rehab improves physical capacity, lung function and quality of life and eases breathlessness, fatigue and anxiety in people with long COVID, with no significant effect on depression. A 2025 pragmatic trial of 76 patients found that a 12 week program added about 39 meters to 6 minute walk distance compared with no rehab. The authors of that trial wrote that rehab may improve exercise capacity, fatigue and breathlessness, and that wording matters: this is promising evidence, not a cure.
The 2025 review found that programs lasting 4 to 8 weeks produced the broadest set of improvements, including walking distance, lung function, quality of life and fatigue. Programs shorter than 4 weeks improved walking distance only, and programs longer than 8 weeks improved quality of life and fatigue. A separate 12 month follow up of a small 4 week telerehab trial found participants had recovered somewhat by 12 months even though they had not improved during the 4 week program itself, which suggests short programs may be too brief to show a result.
Yes, and it has been tested head to head. In the PHOSP-R trial, published in the European Respiratory Journal in 2025, 181 people with post COVID syndrome after a hospital stay were randomized to face to face rehab, remote rehab or usual care. Remote rehab improved shuttle walk distance by about 34 meters versus usual care, and face to face rehab by about 52 meters. Both beat usual care. Neither changed self reported quality of life over 8 weeks. The remote result was smaller and the confidence interval was wide, so remote delivery looks useful but the trial does not show it is identical to in person care.
Tell your clinician before you start. NIH MedlinePlus lists “worsening symptoms after vigorous physical or mental activity” as a recognized long COVID symptom. If that describes you, the amount of effort has to be set deliberately and adjusted session by session rather than pushed. This is the main reason a one to one program with a clinician watching you work is different from a generic exercise plan: the person running the session can change the workload the moment your response tells them to.
Bloom Medical Group bills commercial insurance plans, including Aetna, Cigna, Anthem BCBS, Horizon BCBS and UnitedHealthcare, and offers a private pay option. Bloom’s program is not covered by Medicare, Medicaid, or federal or supplemental insurance plans. Coverage for a specific plan depends on your benefits and documentation, so the fastest way to find out is to call 1-866-972-8228 or submit the eligibility form.
See if your plan covers it
Bloom Medical Group provides one on one virtual pulmonary rehab with licensed respiratory therapists, delivered from your home and billed to commercial insurance. To find out whether you qualify, call 1-866-972-8228 or complete our 2 minute see if you qualify form. Our page on whether insurance covers pulmonary rehab covers what plans typically require.
Sources
- Li S, et al. Ther Adv Respir Dis. 2025;19:17534666251323482. PMID 40083165. https://pubmed.ncbi.nlm.nih.gov/40083165/
- Volckaerts T, et al. BMJ Open Respir Res. 2025;12(1):e003653. PMID 41253410. https://pubmed.ncbi.nlm.nih.gov/41253410/
- Daynes E, et al. Eur Respir J. 2025;65(5):2402152. PMID 39978856. https://pubmed.ncbi.nlm.nih.gov/39978856/
- Lai CY, et al. Ann Phys Rehabil Med. 2024;67(5):101853. PMID 38824899. https://pubmed.ncbi.nlm.nih.gov/38824899/
- Ortiz-Ortigosa L, et al. Respir Res. 2024;25(1):248. PMID 38890699. https://pubmed.ncbi.nlm.nih.gov/38890699/
- Palau P, et al. BMJ Open Respir Res. 2022;9(1):e001439. PMID 36549786. https://pubmed.ncbi.nlm.nih.gov/36549786/
- Reeves JM, et al. J Rehabil Med. 2026;58:jrm44828. PMID 41744352. https://pubmed.ncbi.nlm.nih.gov/41744352/
- NIH MedlinePlus Medical Encyclopedia. Long COVID. https://medlineplus.gov/ency/article/007791.htm
- American Lung Association. Pulmonary Rehabilitation. https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/pulmonary-rehab
- American Lung Association. Breathing Exercises. https://www.lung.org/lung-health-diseases/wellness/breathing-exercises
Reviewed for accuracy against the sources listed above. This article is for education and is not medical advice. Talk with your doctor about what is right for you.
