Impact of nutrition on long COVID

Subramanian Thangaleela; Chin-Kun Wang

doi:10.1016/j.smhs.2025.09.002

Sports Medicine and Health Science ›› 2026, Vol. 8 ›› Issue (2) :128 -144. DOI: 10.1016/j.smhs.2025.09.002

Reviews

research-article

Impact of nutrition on long COVID

Author information +

History +

PDF (6066KB)

Abstract

Long COVID is characterized by a group of persistent symptoms following the acute SARS-COV2 infection, which presented a multifaceted challenge to the healthcare systems all over the globe. The long COVID symptoms span various organ systems including the respiratory, cardiovascular, gastrointestinal, and neurological manifestations. Mitochondrial dysfunction and immune dysregulation play crucial roles in the long COVID pathophysiology. Recently nutritional intervention gained much attention in managing post-viral syndromes. Effective interventions like supplementation of omega-3 fatty acid, macro and micro nutrients, and vitamins help to reduce systemic inflammation and counteract muscle wasting. Other approaches like nutritional recovery, dietetic interventions, continuous nutritional care post-hospital discharge, nutritional rehabilitation programs, whole-diet approaches like Mediterranean diet, plant-based diet, and caloric optimization, improve overall functional recovery. Physical activity and exercise regimes have been shown to improve fatigue, dyspnea, and cognitive function. Tailored exercise regimes may promote safe rehabilitation. Certain ineffective interventions, such as non-personalized approaches, high dose of antioxidants, use of herbal products that are not clinically validated need to be addressed. Dietary interventions such as personalized nutritional counseling have been demonstrated to improve physical performance in long COVID patients. Further research is needed to refine protocols and identify optimal combinations of dietary and movement-based therapies to support the recovery of long-COVID patients. This narrative review focuses on the ongoing researches that reveals the intricate relationship between nutrition and long COVID recovery and also establishes effective protocols for nutritional care.

Keywords

Long COVID / Metabolic reprogramming / Immune dysregulation / Malnutrition / Nutritional intervention / Lactoferrin / Rehabilitation

Cite this article

Download citation ▾

Subramanian Thangaleela, Chin-Kun Wang. Impact of nutrition on long COVID. Sports Medicine and Health Science, 2026, 8(2): 128-144 DOI:10.1016/j.smhs.2025.09.002

登录浏览全文

4963

注册一个新账户忘记密码

CRediT authorship contribution statement

Subramanian Thangaleela: Writing - review & editing, Investigation. Chin-Kun Wang: Writing - review & editing, Supervi-sion, Conceptualization, Writing - review & editing, Methodology, Conceptualization.

Funding

None to declare.

Declaration of competing interest

Chin-Kun Wang is an Editorial Board Member for Sports Medicine and Health Science and was not involved in the editorial review or the decision to publish this article. The authors of this manuscript have no conflict of interest.

Acknowledgement

The authors gratefully acknowledge Chung Shan Medical University, Taichung city, Taiwan China, for its support.

References

Publishing order | Descend order by publishing year | Descend order by cited within

[1]	Liu X, Huuskonen S, Laitinen T, et al. SARS-CoV-2-host proteome interactions for antiviral drug discovery. Mol Syst Biol. 2021; 17(11):e10396. https://doi.org/10.15252/msb.202110396.

[2]	Banerjee AK, Blanco MR, Bruce EA, et al. SARS-COV-2 disrupts splicing, translation, and protein trafﬁcking to suppress host defenses. Cell. 2020; 183(5): 1325-1339.e21. https://doi.org/10.1016/j.cell.2020.10.004.

[3]	Wang T, Cao Y, Zhang H, et al. COVID-19 metabolism: mechanisms and therapeutic targets. MedComm. 2022; 3(3):e157. https://doi.org/10.1002/mco2.157.

[4]	Naidu AS, Shahidi F, Wang CK, et al. SARS-COV-2-induced Host Metabolic Reprogram (HMR): nutritional interventions for global management of COVID-19 and post-acute sequelae of COVID-19 (PASC). J Food Bioact. 2022; 18:1-42. https://doi.org/10.31665/jfb.2022.18306.

[5]	Hallek M, Adorjan K, Behrends U, et al. Post-COVID syndrome. Dtsch Arztebl Int. 2023; 120(4):48-55. https://doi.org/10.3238/arztebl.m2022.0409.

[6]	Davis HE, Assaf GS, McCorkell L, et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. eClinicalMedicine. 2021; 38:101019. https://doi.org/10.1016/j.eclinm.2021.101019.

[7]	Gordon DE, Jang GM, Bouhaddou M, et al. A SARS-CoV-2 protein interaction map reveals targets for drug repurposing. Nature. 2020;(583):459-468. https://doi.org/10.1038/s41586-020-2286-9.

[8]	Naidu AS, Wang CK, Rao P, et al. Precision nutrition to reset virus-induced human metabolic reprogramming and dysregulation (HMRD) in long-COVID. Npj Sci Food. 2024; 8(1):19. https://doi.org/10.1038/s41538-024-00261-2.

[9]	Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022; 28(3):583-590. https://doi.org/10.1038/s41591-022-01689-3.

[10]	Bornstein SR, Cozma D, Kamel M, et al. Long-COVID, metabolic and endocrine disease. Horm Metab Res. 2022; 54(8):562-566. https://doi.org/10.1055/a-1878-9307.

[11]	Kedor C, Freitag H, Meyer-Arndt L, et al. A prospective observational study of post-COVID-19 chronic fatigue syndrome following the ﬁrst pandemic wave in Germany and biomarkers associated with symptom severity. Nat Commun. 2022; 13(1):5104. https://doi.org/10.1038/s41467-022-32507-6.

[12]	Larsen NW, Stiles LE, Shaik R, et al. Characterization of autonomic symptom burden in long COVID: a global survey of 2,314 adults. Front Neurol. 2022; 13: 1012668. https://doi.org/10.3389/fneur.2022.1012668.

[13]	Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021; 11: 16144. https://doi.org/10.1038/s41598-021-95565-8.

[14]	Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021; 53(10):737-754. https://doi.org/10.1080/23744235.2021.1924397.

[15]	Carolin A, Frazer D, Yan K, et al. The effects of iron deﬁcient and high iron diets on SARS-CoV-2 lung infection and disease. Front Microbiol. 2024; 15:1441495. https://doi.org/10.3389/fmicb.2024.1441495.

[16]	Baig AM. Deleterious outcomes in long-hauler COVID-19: the effects of SARS-CoV-2 on the CNS in chronic COVID syndrome. ACS Chem Neurosci. 2020; 11(24): 4017-4020. https://doi.org/10.1021/acschemneuro.0c00725.

[17]	Shang C, Liu Z, Zhu Y, et al. SARS-COV-2 causes mitochondrial dysfunction and mitophagy impairment. Front Microbiol. 2022; 12:780768. https://doi.org/10.3389/fmicb.2021.780768.

[18]	Rom-ao PR, Teixeira PC, Schipper L, et al. Viral load is associated with mitochondrial dysfunction and altered monocyte phenotype in acute severe SARS-CoV-2 infection. Int Immunopharmacol. 2022; 108:108697. https://doi.org/10.1016/j.intimp.2022.108697.

[19]	Singh KK, Chaubey G, Chen JY, Suravajhala P. Decoding SARS-CoV-2 hijacking of host mitochondria in COVID-19 pathogenesis. AJP Cell Physiol. 2020; 319(2): C258-C267. https://doi.org/10.1152/ajpcell.00224.2020.

[20]	Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020; 54:1-7. https://doi.org/10.1016/j.mito.2020.06.008.

[21]	Moolamalla STR, Balasubramanian R, Chauhan R, et al. Host metabolic reprogramming in response to SARS-CoV-2 infection: a systems biology approach. Microb Pathog. 2021; 158:105114. https://doi.org/10.1016/j.micpath.2021.105114.

[22]	Shen T, Wang T. Metabolic reprogramming in COVID-19. Int J Mol Sci. 2021; 22 (21):11475. https://doi.org/10.3390/ijms222111475.

[23]	Montalvan V, Lee J, Bueso T, et al. Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg. 2020; 194: 105921. https://doi.org/10.1016/j.clineuro.2020.105921.

[24]	Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J. 2020; 41(32):3038-3044. https://doi.org/10.1093/eurheartj/ehaa623.

[25]	Stefano GB, Ptacek R, Ptackova H, et al.Selective neuronal mitochondrial targeting in SARS-CoV-2 infection affects cognitive processes to induce ‘brain fog’ and results in behavioral changes that favor viral survival. Med Sci Monit. 2021; 27: e930886. https://doi.org/10.12659/msm.930886.

[26]	Akbarialiabad H, Taghrir MH, Abdollahi A, et al. Long COVID, a comprehensive systematic scoping review. Infection. 2021; 49(6):1163-1186. https://doi.org/10.1007/s15010-021-01666-x.

[27]	Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022; 23(2):194-202. https://doi.org/10.1038/s41590-021-01104-y.

[28]	Tejera D, Mercan D, Sanchez-Caro JM, et al. Systemic inflammation impairs microglial Aβ clearance through NLRP 3 inflammasome. EMBO J. 2019; 38(17): e101064. https://doi.org/10.15252/embj.2018101064.

[29]	Holdoway A. Nutritional management of patients during and after COVID-19 illness. Br J Community Nurs. 2020; 25(Sup8):S6-S10. https://doi.org/10.12968/bjcn.2020.25.sup8.s6.

[30]	Antwi J, Appiah B, Oluwakuse B, Abu BAZ. The nutrition-COVID-19 interplay: a review. Curr Nutr Rep. 2021; 10(4):364-374. https://doi.org/10.1007/s13668-021-00380-2.

[31]	Junaid K, Ejaz H, Abdalla AE, et al. Effective immune functions of micronutrients against SARS-CoV-2. Nutrients. 2020; 12(10):2992. https://doi.org/10.3390/nu12102992.

[32]	Lechuga GC, Morel CM, De-Simone SG. Hematological alterations associated with long COVID-19. Front Physiol. 2023; 14:1203472. https://doi.org/10.3389/fphys.2023.1203472.

[33]	Lehmann A, Prosch H, Zehetmayer S, et al. Impact of persistent D-dimer elevation following recovery from COVID-19. PLoS One. 2021; 16(10):e0258351. https://doi.org/10.1371/journal.pone.0258351.

[34]	Sonnweber T, Grubwieser P, Sahanic S, et al. The Impact of iron dyshomeostasis and anaemia on long-term pulmonary recovery and persisting symptom burden after COVID-19: a prospective observational cohort study. Metabolites. 2022; 12(6):546. https://doi.org/10.3390/metabo12060546.

[35]	Klein J, Wood J, Jaycox JR, et al. Distinguishing features of long COVID identiﬁed through immune proﬁling. Nature. 2023; 623(7985):139-148. https://doi.org/10.1038/s41586-023-06651-y.

[36]	Mendelson M, Nel J, Blumberg L, et al. Long-COVID: an evolving problem with an extensive impact. S Afr Med J. 2020; 111(1):10-12. https://doi.org/10.7196/SAMJ.2020.v111i11.15433.

[37]	Del Rio C, Collins LF, Malani P. Long-term health consequences of COVID-19. JAMA. 2020; 324(17):1723-1724. https://doi.org/10.1001/jama.2020.19719.

[38]	Paneroni M, Simonelli C, Saleri M, et al. Muscle strength and physical performance in patients without previous disabilities recovering from COVID-19 pneumonia. Am J Phys Med Rehabil. 2021; 100(2):105-109. https://doi.org/10.1097/PHM.0000000000001641.

[39]	Recalcati S. Cutaneous manifestations in COVID-19: a ﬁrst perspective. J Eur Acad Dermatol Venereol. 2020; 34(5):e212-e213. https://doi.org/10.1111/jdv.16387.

[40]	Xiong Q, Xu M, Li J, et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect. 2021; 27(1):89-95. https://doi.org/10.1016/j.cmi.2020.09.023.

[41]	Helms J, Kremer S, Merdji H, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020; 382(23):2268-2270. https://doi.org/10.1056/NEJMc2008597.

[42]	Guedj E, Campion JY, Dudouet P, et al. 18F-FDG brain PET hypometabolism in patients with long COVID. Eur J Nucl Med Mol Imag. 2021; 48(9):2823-2833. https://doi.org/10.1007/s00259-021-05215-4.

[43]	Harris A, Creecy A, Awosanya OD, et al. SARS-CoV-2 and its multifaceted impact on bone health: mechanisms and clinical evidence. Curr Osteoporos Rep. 2024; 22 (1):135-145. https://doi.org/10.1007/s11914-023-00843-1.

[44]	Obitsu S, Ahmed N, Nishitsuji H, et al. Potential enhancement of osteoclastogenesis by severe acute respiratory syndrome coronavirus 3a/X1 protein. Arch Virol. 2009; 154(9):1457-1464. https://doi.org/10.1007/s00705-009-0472-z.

[45]	Wen W, Su W, Tang H, et al. Immune cell proﬁling of COVID-19 patients in the recovery stage by single-cell sequencing. Cell Discov. 2020; 6:31. https://doi.org/10.1038/s41421-020-0168-9.

[46]	Nasiri K, Mohammadzadehsaliani S, Kheradjoo H, et al. Spotlight on the impact of viral infections on Hematopoietic Stem Cells (HSCs) with a focus on COVID-19 effects. Cell Commun Signal. 2023; 21(1):103. https://doi.org/10.1186/s12964-023-01122-3.

[47]	Kronstein-Wiedemann R, Stadtmüller M, Traikov S, et al. SARS-CoV-2 infects Red Blood Cell progenitors and dysregulates hemoglobin and iron metabolism. Stem Cell Rev Rep. 2022; 18(5):1809-1821. https://doi.org/10.1007/s12015-021-10322-8.

[48]	Léon-Moreno LC, Reza-Zaldívar EE, Hernández-Sapiéns MA, et al. Mesenchymal Stem Cell-based therapies in the post-acute neurological COVID Syndrome: current landscape and opportunities. Biomolecules. 2023; 14(1):8. https://doi.org/10.3390/biom14010008.

[49]	Zeylabi F, Nameh Goshay Fard N, Parsi A, Pezeshki SMS. Bone marrow alterations in COVID-19 infection: the root of hematological problems. Curr Res Transl Med. 2023; 71(3):103407. https://doi.org/10.1016/j.retram.2023.103407.

[50]	Zioupos P, Currey JD, Hamer AJ. The role of collagen in the declining mechanical properties of aging human cortical bone. J Biomed Mater Res. 1999; 45(2):108-116. https://doi.org/10.1002/(sici)1097-4636(199905)45:2<108::aid-jbm5>3.0.co;2-a.

[51]	Elahi S. Hematopoietic responses to SARS-CoV-2 infection. Cell Mol Life Sci. 2022; 79(3):187. https://doi.org/10.1007/s00018-022-04220-6.

[52]	Shastri T, Randhawa N, Aly R, Ghouse M. Bone marrow suppression secondary to the COVID-19 booster vaccine: a case report. J Blood Med. 2022; 13:69-74. https://doi.org/10.2147/JBM.S350290.

[53]	Toom S, Wolf B, Avula A, Peeke S, Becker K. Familial thrombocytopenia flare-up following the ﬁrst dose of mRNA-1273 Covid-19 vaccine. Am J Hematol. 2021; 96 (5):E134-E135. https://doi.org/10.1002/ajh.26128.

[54]	Leng Z, Zhu R, Hou W, et al. Transplantation of ACE2- Mesenchymal Stem Cells improves the outcome of patients with COVID-19 pneumonia. Aging Dis. 2020; 11 (2):216-228. https://doi.org/10.14336/AD.2020.0228.

[55]	Thomas C, Faghy MA, Chidley C, et al. Blood biomarkers of long COVID: a systematic review. Mol Diagn Ther. 2024; 28(5):537-574. https://doi.org/10.1007/s40291-024-00731-z.

[56]	Lai YJ, Liu SH, Manachevakul S, et al. Biomarkers in long COVID-19: a systematic review. Front Med. 2023; 10:1085988. https://doi.org/10.3389/fmed.2023.1085988.

[57]	Teunissen CE, Verberk IMW, Thijssen EH, et al. Blood-based biomarkers for Alzheimer's disease: towards clinical implementation. Lancet Neurol. 2022; 21(1): 66-77. https://doi.org/10.1016/S1474-4422(21)00361-6.

[58]	Bäckström D, Linder J, Jakobson Mo S, et al. NfL as a biomarker for neurodegeneration and survival in Parkinson disease. Neurology. 2020; 95(7): e827-e838. https://doi.org/10.1212/WNL.0000000000010084.

[59]	Danielle RCS, Débora DM, Alessandra NLP, et al. Correlating COVID-19 severity with biomarker proﬁles and patient prognosis. Sci Rep. 2024; 14(1):22353. https://doi.org/10.1038/s41598-024-71951-w.

[60]	Bellone S, Siegel ER, Scheim DE, Santin AD. Increased von Willebrand and Factor VIII plasma levels in gynecologic patients with post-acute-COVID-sequela (PASC)/long COVID. Gynecol Oncol Rep. 2024; 51:101324. https://doi.org/10.1016/j.gore.2024.101324.

[61]	Fogarty H, Ward SE, Townsend L, et al. Sustained VWF-ADAMTS-13 axis imbalance and endotheliopathy in long COVID syndrome is related to immune dysfunction. J Thromb Haemostasis. 2022; 20(10):2429-2438. https://doi.org/10.1111/jth.15830.

[62]	DeKosky ST, Kochanek PM, Valadka AB, et al. Blood biomarkers for detection of brain injury in COVID-19 patients. J Neurotrauma. 2021; 38(1):1-43. https://doi.org/10.1089/neu.2020.7332.

[63]

Frontera JA, Boutajangout A, Masurkar AV, et al. Comparison of serum neurodegenerative biomarkers among hospitalized COVID-19 patients versus non-COVID subjects with normal cognition, mild cognitive impairment, or Alzheimer's dementia. Alzheimer's Dement. 2022; 18(5):899-910. https://doi.org/10.1002/alz.12556.

[64]	Peluso MJ, Sans HM, Forman CA, et al. Plasma markers of neurologic injury and inflammation in people with self-reported neurologic postacute sequelae of SARS-CoV-2 infection. Neurol Neuroimmunol Neuroinflamm. 2022; 9(5):e200003. https://doi.org/10.1212/NXI.0000000000200003.

[65]	Magdy R, Eid RA, Fathy W, et al. Characteristics and risk factors of persistent neuropathic pain in recovered COVID-19 patients. Pain Med. 2021; 23(4):774-781. https://doi.org/10.1093/pm/pnab341.

[66]	Mohammadi A, Balan I, Yadav S, et al. Post-COVID-19 pulmonary ﬁbrosis. Cureus. 2022; 14(3):e22770. https://doi.org/10.7759/cureus.22770.

[67]	Mouchati C, Durieux JC, Zisis SN, et al.Increase in gut permeability and oxidized ldl is associated with post-acute sequelae of SARS-CoV-2. Front Immunol. 2023; 14: 1182544. https://doi.org/10.3389/ﬁmmu.2023.1182544.

[68]	Atieh O, Daher J, Durieux JC, et al.Vitamins K2 and D3 improve long COVID, fungal translocation, and inflammation:randomized controlled trial. Nutrients. 2025; 17(2):304. https://doi.org/10.3390/nu17020304.

[69]	Giron LB, Peluso MJ, Ding J, et al. Markers of fungal translocation are elevated during post-acute sequelae of SARS-CoV-2 and induce NF-κB signaling. JCI Insight. 2022; 7(18):e164813. https://doi.org/10.1172/jci.insight.164813.

[70]	Al-Khrasani M, Essmat N, Boldizsár Jr I, et al. Do vitamins halt the COVID-19-evoked pro-inflammatory cytokines involved in the development of neuropathic pain? Biomed Pharmacother. 2025; 189:118346. https://doi.org/10.1016/j.iopha.2025.118346.

[71]	Bigman G, Rusu ME, Shelawala N, et al. A Comprehensive scoping review on diet and nutrition in relation to long COVID-19 symptoms and recovery. Nutrients. 2025; 17(11):1802. https://doi.org/10.3390/nu17111802.

[72]	Vaziri-Harami R, Delkash P. Can l-carnitine reduce post-COVID-19 fatigue? Ann Med Surg. 2022; 73:103145. https://doi.org/10.1016/j.amsu.2021.103145.

[73]	Rostamzadeh F, Najaﬁpour H, Yazdani R, et al. Changes in serum levels of apelin and nitric oxide in hospitalized patients with COVID-19: association with hypertension, diabetes, obesity, and severity of disease. Eur J Med Res. 2022; 27: 243. https://doi.org/10.1186/s40001-022-00852-3.

[74]	Yang CP, Chang CM, Yang CC, et al. Long COVID and long chain fatty acids LCFAs): Psychoneuroimmunity implication of omega-3 LCFAs in delayed consequences of COVID-19. Brain Behav Immun. 2022;103:19-27. https://doi.org/10.1016/j.bbi.2022.04.001.

[75]	Marzetti E, Coelho-Júnior HJ, Calvani R, et al. Mitochondria-derived vesicles and inflammatory proﬁles of adults with long covid supplemented with red beetroot juice: secondary analysis of a randomized controlled trial. Int J Mol Sci. 2025; 26(3): 1224. https://doi.org/10.3390/ijms26031224.

[76]	Koh Y, Ho C, Pan M. The role of mitochondria in phytochemically mediated disease amelioration. J Agric Food Chem. 2023; 71(18):6775-6788. https://doi.org/10.1021/acs.jafc.2c08921.

[77]	Girelli D, Marchi G, Busti F, Vianello A. Iron metabolism in infections: focus on COVID-19. Semin. Hematol. 2021; 58(3):182-187. https://doi.org/10.1053/j.seminhematol.2021.07.001.

[78]	Te Velthuis AJ, van den Worm SH, Sims AC, et al. Zn2+ inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathog. 2010; 6(11):e1001176. https://doi.org/10.1371/journal.ppat.1001176.

[79]	Tang CF, Ding H, Jiao RQ, et al. Possibility of magnesium supplementation for supportive treatment in patients with COVID-19. Eur J Pharmacol. 2020; 886: 173546. https://doi.org/10.1016/j.ejphar.2020.173546.

[80]	Wallace TC. Combating COVID-19 and building immune resilience: a potential role for magnesium nutrition? J Am Coll Nutr. 2020; 39(8):685-693. https://doi.org/10.1080/07315724.2020.1785971.

[81]

Landi F, Martone AM, Ciciarello F, et al. On behalf of Gemelli against COVID-19 post-acute care team. Effects of a new multicomponent nutritional supplement on muscle mass and physical performance in adult and old patients recovered from COVID-19: a pilot observational case-control study. Nutrients. 2022; 14(11):2316. https://doi.org/10.3390/nu14112316.

[82]	Jurek JM, Castro-Marrero J. A narrative review on gut microbiome disturbances and microbial preparations in myalgic encephalomyelitis/chronic fatigue syndrome: implications for long covid. Nutrients. 2024; 16(11):1545. https://doi.org/10.3390/nu16111545.

[83]

Rodríguez-Morán M, Guerrero-Romero F, Barragán-Zu-niga J, et al. Combined oral supplementation with magnesium plus vitamin D alleviates mild to moderate depressive symptoms related to long-COVID: an open-label randomized, controlled clinical trial. Magnes Res. 2024; 37(3):49-57. https://doi.org/10.1684/mrh.2024.0535.

[84]	Iqbal FM, Lam K, Sounderajah V, et al. Characteristics and predictors of acute and chronic post-COVID syndrome: a systematic review and meta-analysis. eClinicalMedicine. 2021; 36:100899. https://doi.org/10.1016/j.eclinm.2021.100899.

[85]	Barrea L, Grant WB, Frias-Toral E, et al. Dietary recommendations for post-COVID-19 Syndrome. Nutrients. 2022; 14(6):1305. https://doi.org/10.3390/nu14061305.

[86]	di Filippo L, Frara S, Nannipieri F, et al. Low vitamin D Levels are associated with long COVID syndrome in COVID-19 Survivors. J Clin Endocrinol Metab. 2023; 108 (10):e1106-e1116. https://doi.org/10.1210/clinem/dgad207.

[87]	Grant WB, Lahore H, McDonnell SL, et al. Evidence that Vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. 2020; 12(4):988. https://doi.org/10.3390/nu12040988.

[88]	Townsend L, Dyer AH, McCluskey P, et al. Investigating the relationship between vitamin D and persistent symptoms following SARS-CoV-2 infection. Nutrients. 2021; 13(7):2430. https://doi.org/10.3390/nu13072430.

[89]	Crowe FL, Steur M, Allen NE, et al. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, ﬁsh eaters, vegetarians and vegans: results from the EPIC-Oxford study. Public Health Nutr. 2010; 14(2):340-346. https://doi.org/10.1017/s1368980010002454.

[90]	Ebrahimzadeh-Attari V, Panahi G, Hebert JR, et al. Nutritional approach for increasing public health during pandemic of COVID-19: a comprehensive review of antiviral nutrients and nutraceuticals. HPP. 2021; 11(2):119-136. https://doi.org/10.34172/hpp.2021.17.

[91]	Gielen E, Beckwée D, Delaere A, et al. Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: an umbrella review of systematic reviews and meta-analyses. Nutr Rev. 2021; 79(2):121-147. https://doi.org/10.1093/nutrit/nuaa011.

[92]	Bradbury J, Wilkinson S, Schloss J. Nutritional support during long COVID: a systematic scoping review. J Integr Complement Med. 2023; 29(11):695-704. https://doi.org/10.1089/jicm.2022.0821.

[93]	Ochoa JB, Cárdenas D, Goiburu ME, Bermúdez C, Carrasco F, Correia MITD. Lessons learned in nutrition therapy in patients with severe COVID-19. JPEN - J Parenter Enter Nutr. 2020; 44(8):1369-1375. https://doi.org/10.1002/jpen.2005.

[94]	Fernández-Quintela A, Milton-Laskibar I, Trepiana J, et al. Key aspects in nutritional management of COVID-19 patients. J Clin Med. 2020; 9(8):2589. https://doi.org/10.3390/jcm9082589.

[95]	O'Neill LA, Kishton RJ, Rathmell J. A guide to immunometabolism for immunologists. Nat Rev Immunol. 2016; 16(9):553-565. https://doi.org/10.1038/nri.2016.70.

[96]	Iddir M, Brito A, Dingeo G, et al. Strengthening the immune system and reducing inflammation and oxidative stress through diet and nutrition: considerations during the COVID-19 Crisis. Nutrients. 2020; 12(6):1562. https://doi.org/10.3390/nu12061562.

[97]

Diabetes India. National Diabetes Obesity and Cholesterol Foundation (NDOC), and Nutrition Expert Group, India. Balanced nutrition is needed in times of COVID 19 epidemic in India: a call for action for all nutritionists and physicians. Diabetes Metabol Syndr. 2020; 14(6):1747-1750. https://doi.org/10.1016/j.dsx.2020.08.030.

[98]	Turner KL, Moore FA, Martindale R. Nutrition support for the acute lung injury/adult respiratory distress syndrome patient: a review. Nutr Clin Pract. 2011; 26(1): 14-25. https://doi.org/10.1177/0884533610393255.

[99]	Gasmi A, Tippairote T, Mujawdiya PK, et al. Micronutrients as immunomodulatory tools for COVID-19 management. Clin Immunol. 2020; 220:108545. https://doi.org/10.1016/j.clim.2020.108545.

[100]

McCullough FS, Northrop-Clewes CA, Thurnham DI. The effect of vitamin A on epithelial integrity. Proc Nutr Soc. 1999; 58(2):289-293. https://doi.org/10.1017/s0029665199000403.

[101]

Timoneda J, Rodríguez-Fernández L, Zaragozá R, et al. Vitamin A deﬁciency and the lung. Nutrients. 2018; 10(9):1132. https://doi.org/10.3390/nu10091132.

[102]

Carr AC, Maggini S. Vitamin C and immune function. Nutrients. 2017; 9(11):1211. https://doi.org/10.3390/nu9111211.

[103]

Maggini S, Pierre A, Calder PC. Immune function and micronutrient requirements change over the life course. Nutrients. 2018; 10(10):1531. https://doi.org/10.3390/nu10101531.

[104]

Chang HK, Hou WS. Retinoic acid modulates interferon-γ production by hepatic natural killer T cells via phosphatase 2A and the extracellular signal-regulated kinase pathway. J Interferon Cytokine Res. 2015; 35(3):200-212. https://doi.org/10.1089/jir.2014.0098.

[105]

Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020; 39(5):405-407. https://doi.org/10.1016/j.healun.2020.03.012.

[106]

Haryanto B, Suksmasari T, Wintergerst E, et al. Multivitamin supplementation supports immune function and ameliorates conditions triggered by reduced air quality. Vitam Min. 2015; 4(2):1000128. https://doi.org/10.4172/2376-1318.1000128.

[107]

Naidu SAG, Clemens RA, Naidu AS. SARS-CoV-2 infection dysregulates host iron (Fe)-redox homeostasis (Fe-R-H): role of feredox regulators, ferroptosis inhibitors, anticoagulants, and ironchelators in COVID-19 control. J Diet Suppl. 2023; 20(2):312-371. https://doi.org/10.1080/19390211.2022.2075072.

[108]

Crook H, Raza S, Nowell J, Young M, Edison P. Long covid-mechanisms, risk factors, and management. Br Med J. 2021;374:n1648. https://doi.org/10.1136/bmj.n1648.

[109]

Bolat E, Eker F, Kaplan M, et al. Lactoferrin for COVID-19 prevention, treatment, and recovery. Front Nutr. 2022; 9:992733. https://doi.org/10.3389/fnut.2022.992733.

[110]

Campione E, Cosio T, Rosa L, et al. Lactoferrin as protective natural barrier of respiratory and intestinal mucosa against Coronavirus infection and inflammation. Int J Mol Sci. 2020; 21(14):4903. https://doi.org/10.3390/ijms21144903.

[111]

Redel AL, Miry F, Hellemons ME, et al. Effect of lactoferrin treatment on symptoms and physical performance in long COVID patients: a randomised, double-blind, placebo-controlled trial. ERJ Open Res. 2024; 10(4):31-2024. https://doi.org/10.1183/23120541.00031-2024.

[112]

Lim HX, Khalid K, Abdullah ADI, et al. Subphenotypes of Long COVID and the clinical applications of probiotics. Biomed Pharmacother. 2025; 183:117855. https://doi.org/10.1016/j.biopha.2025.117855.

[113]

Batista KS, de Albuquerque JG, Vasconcelos MHA, et al. Probiotics and prebiotics: potential prevention and therapeutic target for nutritional management of COVID-19? Nutr Res Rev. 2023; 36(2):181-198. https://doi.org/10.1017/S0954422421000317.

[114]

Zhang D, Li S, Wang N, et al. The cross-talk between gut microbiota and lungs in common lung diseases. Front Microbiol. 2020; 11:301. https://doi.org/10.3389/fmicb.2020.00301.

[115]

Ettinger G, MacDonald K, Reid G, Burton JP. The influence of the human microbiome and probiotics on cardiovascular health. Gut Microbes. 2014; 5(6): 719-728. https://doi.org/10.4161/19490976.2014.983775.

[116]

Baud D, Dimopoulou Agri V, Gibson GR, et al. Using probiotics to flatten the curve of coronavirus disease COVID- 2019 pandemic. Front Public Health. 2020; 8:186. https://doi.org/10.3389/fpubh.2020.00186.

[117]

Zhou Y, Zhang J, Zhang D, et al. Linking the gut microbiota to persistent symptoms in survivors of COVID-19 after discharge. J Microbiol. 2021; 59(10):941-948. https://doi.org/10.1007/s12275-021-1206-5.

[118]

Martinez FO, Combes TW, Orsenigo F, Gordon S. Monocyte activation in systemic Covid-19 infection: assay and rationale. EBioMedicine. 2020; 59:102964. https://doi.org/10.1016/j.ebiom.2020.102964.

[119]

Schwabenland M, Salié H, Tanevski J, et al. Deep spatial proﬁling of human COVID-19 brains reveals neuroinflammation with distinct microanatomical microglia-T-cell interactions. Immunity. 2021; 54(7):1594-1610.e11. https://doi.org/10.1016/j.immuni.2021.06.002.

[120]

Almutairi MM, Sivandzade F, Albekairi TH, Alqahtani F, Cucullo L. Neuroinflammation and its impact on the pathogenesis of COVID-19. Front Med. 2021; 8:745789. https://doi.org/10.3389/fmed.2021.745789.

[121]

Thye AY, Law JW, Tan LT, et al. Psychological symptoms in COVID-19 patients: insights into pathophysiology and risk factors of long COVID-19. Biology. 2022; 11 (1):61. https://doi.org/10.3390/biology11010061.

[122]

Gibson GR, Hutkins R, Sanders ME, et al. Expert consensus document: the International Scientiﬁc Association for Probiotics and Prebiotics (ISAPP) consensus statement on the deﬁnition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017; 14(8):491-502. https://doi.org/10.1038/nrgastro.2017.75.

[123]

Davani-Davari D, Negahdaripour M, Karimzadeh I, et al. Prebiotics: deﬁnition, types, sources, mechanisms, and clinical applications. Foods. 2019; 8(3):92. https://doi.org/10.3390/foods8030092.

[124]

Olaimat AN, Aolymat I, Al-Holy M, et al. The potential application of probiotics and prebiotics for the prevention and treatment of COVID-19. NPJ Sci Food. 2020; 4:17. https://doi.org/10.1038/s41538-020-00078-9.

[125]

Din AU, Mazhar M, Waseem M, et al. SARS-CoV-2 microbiome dysbiosis linked disorders and possible probiotics role. Biomed Pharmacother. 2021; 133:110947. https://doi.org/10.1016/j.biopha.2020.110947.

[126]

Zhang L, Xu Z, Mak JWY, et al. Gut microbiota-derived synbiotic formula (SIM01) as a novel adjuvant therapy for COVID-19: an open-label pilot study. J Gastroenterol Hepatol. 2022; 37(5):823-831. https://doi.org/10.1111/jgh.15796.

[127]

Beatrice M, Alessandro R, Bottaro F, et al. The Role of VSL#3 in the treatment of fatigue and other symptoms in long covid-19 syndrome: a randomized, double-blind, placebo-controlled pilot study. DELong#3). 2023. https://doi.org/10.1101/2023.06.28.23291986.ClinicaltrialNCT05874089.

[128]

Zhu J, Pitre T, Ching C, et al. Safety and efﬁcacy of probiotic supplements as adjunctive therapies in patients with COVID-19: a systematic review and meta-analysis. PLoS One. 2023; 18(3):e0278356. https://doi.org/10.1371/journal.pone.0278356.

[129]

Lau RI, Su Q, Lau ISF, et al. A synbiotic preparation (SIM01) for post-acute COVID-19 syndrome in Hong Kong (RECOVERY): a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis. 2024; 24(3):256-265. https://doi.org/10.1016/S1473-3099(23)00685-0.

[130]

Santinelli L, Laghi L, Innocenti GP, et al. Oral Bacteriotherapy Reduces the occurrence of chronic fatigue in COVID-19 patients. Front Nutr. 2022; 8:756177. https://doi.org/10.3389/fnut.2021.756177.

[131]

Thomas R, Aldous J, Forsyth R, et al. The influence of a blend of probiotic Lactobacillus and prebiotic inulin on the duration and severity of ssymptoms among individuals with Covid-19. Infect Dis Diag Treat. 2021; 5:182. https://doi.org/10.29011/2577-1515.100182.

[132]

Kharaeva Z, Shokarova A, Shomakhova Z, et al. Fermented Carica papaya and Morinda citrifolia as perspective food supplements for the treatment of post-COVID symptoms: randomized placebo-controlled clinical laboratory study. Nutrients. 2022; 14(11):2203. https://doi.org/10.3390/nu14112203.

[133]

Noce A, Marrone G, Di Lauro M, et al. Potential anti-inflammatory and anti-fatigue effects of an oral food supplement in long COVID patients. Pharmaceuticals. 2024; 17(4):463. https://doi.org/10.3390/ph17040463.

[134]

Jolliffe DA, Holt H, Greenig M, et al. Effect of a test-and-treat approach to vitamin D supplementation on risk of all cause acute respiratory tract infection and covid-19: phase 3 randomised controlled trial (CORONAVIT). Br Med J. 2022; 378: e071230. https://doi.org/10.1136/bmj-2022-071230.

[135]

Sinopoli A, Sciurti A, Isonne C, et al. vitamin A, vitamin B, The efﬁcacy of multivitamin, vitamin C, and vitamin D supplements in the prevention and management of COVID-19 and long-COVID: an updated systematic review and meta-analysis of randomized clinical trials. Nutrients. 2024; 16(9):1345. https://doi.org/10.3390/nu16091345.

[136]

Charoenporn V, Tungsukruthai P, Teacharushatakit P, et al. Effects of an 8-week high-dose vitamin D supplementation on fatigue and neuropsychiatric manifestations in post-COVID syndrome: a randomized controlled trial. Psychiatr Clin Neurosci. 2024; 78(10):595-604. https://doi.org/10.1111/pcn.13716.

[137]

Fernandes AL, Sales LP, Santos MD, et al. Persistent or new symptoms 1 year after a single high dose of vitamin D3 in patients with moderate to severe COVID-19. Front Nutr. 2022; 9:979667. https://doi.org/10.3389/fnut.2022.979667.

[138]

Tehrani S, Mahmoudnejad N, Ahmadi Asour A, et al. Efﬁcacy of thiamine (Vitamin B1) on post-acute COVID-19 syndrome: an open-label, randomized, controlled trial. Arch Clin Infect Dis. 2024; 19(5):e144280. https://doi.org/10.5812/archcid-144280.

[139]

Chung TW, Zhang H, Wong FK, et al. A pilot study of short-course oral vitamin A and aerosolised diffuser olfactory training for the treatment of smell loss in long COVID. Brain Sci. 2023; 13(7):1014. https://doi.org/10.3390/brainsci13071014.

[140]

Gaylis NB, Kreychman I, Sagliani J, et al. The results of a unique dietary supplement (nutraceutical formulation) used to treat the symptoms of long-haul COVID. Front Nutr. 2022; 9:1034169. https://doi.org/10.3389/fnut.2022.1034169.

[141]

Calvani R, Gervasoni J, Picca A, et al. Effects of l-arginine plus vitamin C supplementation on l-arginine metabolism in adults with long COVID: secondary analysis of a randomized clinical trial. Int J Mol Sci. 2023; 24(6):5078. https://doi.org/10.3390/ijms24065078.

[142]

Paulus MC, Kouw IWK, Boelens YFN, et al. Feasibility challenges in protein supplementation research: insights from the convalescence of functional outcomes after intensive care unit stay in a randomised controlled trial. Clin Nutr. 2025; 46: 119-130. https://doi.org/10.1016/j.clnu.2025.01.020.

[143]

Marra AM, Giardino F, Anniballo A, et al. Beneﬁcial effects on exercise capacity associated with a combination of lactoferrin, lysozyme, lactobacillus, resveratrol, vitamins, and oligoelements in patients with post-COVID-19 syndrome: a single-center retrospective study. J Clin Med. 2024; 13(15):4444. https://doi.org/10.3390/jcm13154444.

[144]

Rossato MS, Brilli E, Ferri N, et al. Observational study on the beneﬁt of a nutritional supplement, supporting immune function and energy metabolism, on chronic fatigue associated with the SARS-CoV-2 post-infection progress. Clin Nut ESPEN. 2021; 46:510-518. https://doi.org/10.1016/j.clnesp.2021.08.031.

[145]

Galluzzo V, Zazzara MB, Ciciarello F, et al. Fatigue in Covid-19 survivors: the potential impact of a nutritional supplement on muscle strength and function. Clin Nutr ESPEN. 2022; 51:215-221. https://doi.org/10.1016/j.clnesp.2022.08.029.

[146]

Zahedipour F, Hosseini SA, Sathyapalan T, et al. Potential effects of curcumin in the treatment of COVID-19 infection. Phytother Res. 2020; 34(11):2911-2920. https://doi.org/10.1002/ptr.6738.

[147]

Campbell JL. COVID-19: reducing the risk via diet and lifestyle. J Integr Med. 2023; 21(1):1-16. https://doi.org/10.1016/j.joim.2022.10.001.

[148]

Derosa G, Mafﬁoli P, D'Angelo A, Di Pierro F.A role for quercetin in coronavirus disease 2019 (COVID-19). Phytother Res. 2021; 35(3):1230-1236. https://doi.org/10.1002/ptr.6887.

[149]

Del Bo C, Bernardi S, Cherubini A, et al. A polyphenol-rich dietary pattern improves intestinal permeability, evaluated as serum zonulin levels, in older subjects: the MaPLE randomised controlled trial. Clin Nutr. 2021; 40(5):3006-3018. https://doi.org/10.1016/j.clnu.2020.12.014.

[150]

Park M, Choi J, Lee HJ. Flavonoid-rich orange juice intake and altered gut microbiome in young adults with depressive symptom: a randomized controlled study. Nutrients. 2020; 12(6):1815. https://doi.org/10.3390/nu12061815.

[151]

Barrea L, Muscogiuri G, Frias-Toral E, et al. Nutrition and immune system: from the Mediterranean diet to dietary supplementary through the microbiota. Crit Rev Food Sci Nutr. 2021; 61(18):3066-3090. https://doi.org/10.1080/10408398.2020.1792826.

[152]

Dharmalingam K, Birdi A, Tomo S, et al. Trace elements as immunoregulators in SARS-CoV-2 and other viral infections. Indian J Clin Biochem. 2021; 36(4):416-426. https://doi.org/10.1007/s12291-021-00961-6.

[153]

Putri RWY, Noviana A, Huda M. Mediterranean diet: a nutritional suggestion for long covid management strategies - a literature review. Int J Med Sci Clin Res. 2024; 4(2):277-285. https://doi.org/10.47191/ijmscrs/v4-i02-20.

[154]

Liu RH. Dietary bioactive compounds and their health implications. J Food Sci. 2013; 78(Suppl 1):A18-A25. https://doi.org/10.1111/1750-3841.12101.

[155]

Storz MA. Lifestyle adjustments in long-COVID management: potential beneﬁts of plant-based diets. Curr Nutr Rep. 2021; 10(4):352-363. https://doi.org/10.1007/s13668-021-00369-x.

[156]

Ostfeld RJ. Deﬁnition of a plant-based diet and overview of this special issue. J Geriatr Cardiol. 2017; 14(5):315. https://doi.org/10.11909/j.issn.1671-5411.2017.05.008.

[157]

Glick-Bauer M, Yeh MC. The health advantage of a vegan diet: exploring the gut microbiota connection. Nutrients. 2014; 6(11):4822-4838. https://doi.org/10.3390/nu6114822.

[158]

Chen Y, Zhang C, Feng Y. Medicinal plants for the management of post-COVID-19 fatigue: a literature review on the role and mechanisms. J Tradit Complement Med. 2024; 15(1):15-23. https://doi.org/10.1016/j.jtcme.2024.05.006.

[159]

Karosanidze I, Kiladze U, Kirtadze N, et al. Efﬁcacy of adaptogens in patients with long COVID-19: a randomized, quadruple-blind, placebo-controlled trial. Pharmaceuticals (Basel). 2022; 15(3):345. https://doi.org/10.3390/ph15030345.

[160]

Hawkins J, Hires C, Keenan L, Dunne E. Aromatherapy blend of thyme, orange, clove bud, and frankincense boosts energy levels in post-COVID-19 female patients: a randomized, double-blinded, placebo controlled clinical trial. Compl Ther Med. 2022; 67:102823. https://doi.org/10.1016/j.ctim.2022.102823.

[161]

Teitelbaum J, Goudie S. An open-label, pilot trial of HRG80^™ red ginseng in chronic fatigue syndrome, ﬁbromyalgia, and post-viral fatigue. Pharmaceuticals (Basel). 2021; 15(1):43. https://doi.org/10.3390/ph15010043.

[162]

Zhang J, Xiaoju L, Xin L, et al. Mechanism of action of Bu Zhong Yi Qi decoction in the treatment of chronic fatigue syndrome based on network pharmacology and molecular docking. PRMCM. 2022; 4:100139. https://doi.org/10.1016/j.prmcm.2022.100139.

[163]

Sanchis-Gomar F, Lavie CJ, Mehra MR, Henry BM, Lippi G.Obesity and outcomes in COVID-19:when an epidemic and pandemic collide. Mayo Clin Proc. 2020; 95(7): 1445-1453. https://doi.org/10.1016/j.mayocp.2020.05.006.

[164]

Fernández-García JM, Romero-Secin A, Rubín-García M. Association between obesity and Long-Covid: a narrative review. Semergen. 2025; 51(3):102390. https://doi.org/10.1016/j.semerg.2024.102390.

[165]

Zheng C, Chen XK, Sit CH, et al. Effect of physical exercise-based rehabilitation on long COVID: a systematic review and Meta-analysis. Med Sci Sports Exerc. 2024; 56 (1):143-154. https://doi.org/10.1249/MSS.0000000000003280.

[166]

Jimeno-Almazán A, Franco-López F, Buendía-Romeró A, et al. Rehabilitation for post-COVID-19 condition through a supervised exercise intervention: a randomized controlled trial. Scand J Med Sci Sports. 2022; 32(12):1791-1801. https://doi.org/10.1111/sms.14240.

[167]

Woods JA, Hutchinson NT, Power SK, et al. The COVID-19 pandemic and physical activity. Sports Med Health Sci. 2020; 2(2):55-64. https://doi.org/10.1016/j.smhs.2020.05.006.

[168]

Hamilton MT. The role of skeletal muscle contractile duration throughout the whole day: reducing sedentary time and promoting universal physical activity in all people. J Physiol. 2018; 596:1331-1340. https://doi.org/10.1113/JP273284.

[169]

Jackman RW, Kandarian SC. The molecular basis of skeletal muscle atrophy. Am J Physiol Cell Physiol. 2004;287:C834-C843. https://doi.org/10.1152/ajpcell.00579.2003.

[170]

Balchin R, Linde J, Blackhurst D, et al. Sweating away depression? The impact of intensive exercise on depression. J Affect Disord. 2016; 200:218-221. https://doi.org/10.1016/j.jad.2016.04.030.

[171]

Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(7):819-824. https://doi.org/10.1001/jamacardio.2020.1096.

[172]

Yang C, Jin Z. An acute respiratory infection runs into the most common noncommunicable epidemic—COVID-19 and cardiovascular diseases. JAMA Cardiol. 2020; 5(7):743-744. https://doi.org/10.1001/jamacardio.2020.0934.

[173]

Boecker H, Sprenger T, Spilker ME, et al. The runner's high: opioidergic mechanisms in the human brain. Cerebr Cortex. 2008; 18(11):2523-2531. https://doi.org/10.1093/cercor/bhn013.

[174]

Cheng X, Cao M, Yeung WF, Cheung DST. The effectiveness of exercise in alleviating long COVID symptoms: a systematic review and meta-analysis. Worldviews Evidence-Based Nurs. 2024; 21(5):561-574. https://doi.org/10.1111/wvn.12743.

[175]

Joseph G. The impact of physical activity on long COVID symptoms among college students: a retrospective study. Int J Environ Res Publ Health. 2025; 22(5):754. https://doi.org/10.3390/ijerph22050754.

[176]

Zheng C, Chen XK, Sit CH, et al. Effect of physical exercise-based rehabilitation on long COVID: a systematic review and meta-analysis. Med Sci Sports Exerc. 2024; 56 (1):143-154. https://doi.org/10.1249/MSS.0000000000003280.

[177]

Colas C, Le Berre Y, Fanget M, et al. Physical activity in long COVID: a comparative study of exercise rehabilitation beneﬁts in patients with long COVID, coronary artery disease and ﬁbromyalgia. Int J Environ Res Publ Health. 2023; 20(15):6513. https://doi.org/10.3390/ijerph20156513.

[178]

Kerling A, Beyer S, Dirks M, et al. Effects of a randomized-controlled and online-supported physical activity intervention on exercise capacity, fatigue and health related quality of life in patients with post-COVID-19 syndrome. BMC Sports Sci Med Rehabil. 2024; 16(1):33. https://doi.org/10.1186/s13102-024-00817-5.

[179]

Llurda-Almuzara L, Rodríguez-Sanz J, López-de-Celis C, et al. Effects of adding an online exercise program on physical function in individuals hospitalized by COVID-19: a randomized controlled trial. Int J Environ Res Publ Health. 2022; 19(24):16619. https://doi.org/10.3390/ijerph192416619.

[180]

McDowell CP, Tyner B, Shrestha S, et al. Effectiveness and tolerance of exercise interventions for long COVID: a systematic review of randomised controlled trials. BMJ Open. 202;15(3):e082441. https://doi.org/10.1136/bmjopen-2023-082441.

[181]

Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, Garcia-Hermoso A. Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose-response meta-analysis of data from 1 853 610 adults. Br J Sports Med. Published online August 22, 2022. https://doi.org/10.1136/bjsports-2022-105733.

[182]

Kaczmarczyk K, Płoszczyca K, Jaskulski K, Czuba M. Eight weeks of resistance training is not a sufﬁcient stimulus to improve body composition in post-COVID-19 elderly adults. J Clin Med. 2025; 14(1):174. https://doi.org/10.3390/jcm14010174.

[183]

Berry C, McKinnley G, Bayes H, et al. Resistance exercise therapy for long COVID: a randomized, controlled trial. Preprint. 2025. https://doi.org/10.21203/rs.3.rs-6269439/v1.

[184]

Peiris S, Izcovich A, Ordunez P, et al. Challenges to delivering evidence-based management for long COVID. BMJ Evid Based Med. 2023; 28(5):295-298. https://doi.org/10.1136/bmjebm-2023-112311.

[185]

Suliman S, McClave SA, Taylor BE, et al. Barriers to nutrition therapy in the critically ill patient with COVID-19. JPEN-J Parenter Enter Nutr. 2022; 46(4): 805-816. https://doi.org/10.1002/jpen.2263.

[186]

Caccialanza R, Laviano A, Lobascio F, et al. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): rationale and feasibility of a shared pragmatic protocol. Nutrition. 2020; 74:110835. https://doi.org/10.1016/j.nut.2020.110835.