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

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.