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Tele-rehabilitation for individuals with Long COVID. A Randomized Clinical Trial BackgroundMost trials in long COVID rehabilitation included only previously hospitalized patients and omitted outcome measures such as mobility, an important outcome for assessing life impact. Primary objective: to investigate whether an 8-week tele-rehabilitation program for individuals with long COVID improves functional mobility compared to usual care.Methods and FindingsRandomized controlled trial involving individuals with long COVID and persistent symptoms of reduced mobility, muscle weakness, dyspnea, or fatigue. Participants were randomized to either an individualized 8-week tele-rehabilitation program plus usual care or usual care. In both groups, usual care was supplemented with generic guidance on physical activity and symptom management. Primary outcome: Activity Measure for Post-Acute Care (AM-PAC) mobility. Secondary outcomes: dyspnea, fatigue, quality of life, physical function, mental health, acceptability, and adverse events.132 participants were randomized (65 intervention; 67 control; 48±11.8 years; 75% female), with 78% not previously hospitalized. Adherence was high (96%), though 39% of intervention participants were unable to progress their exercises. No significant between-group differences were found in AM-PAC mobility (mean difference (MD): 0.61; 95% CI −0.91 to 2.13). The intervention group showed greater improvements in EQ-5D-5L pain (MD: −0.36; 95% CI −0.70 to −0.03), health status (MD: 7.74; 95% CI 1.05 to 14.43), fatigue (MD: −0.90; 95% CI −1.78 to −0.02), and dyspnea (MD: 1.24; 95% CI 0.10 to 2.37). No serious adverse events occurred.ConclusionsIn the context of limited evidence around exercise in non-hospitalized individuals with long COVID, our study offers important insights into feasibility, safety and clinical relevance. https://publications.ersnet.org/content/erjor/early/2026/02/16/2312054101434-2025