Effects of a ... physical activity intervention on exercise capacity, fatigue & health related [QOL] in patients w/post-COVID-19 syndrome 2024 Kerling

[Andy]

Full title: 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.

Background
The Post-COVID-19 syndrome (PCS), which can occur after acute respiratory syndrome coronavirus 2 infection, leads to restrictions in everyday activity. Our study assessed the impact of an online-guided intervention which intended to facilitate physical activity on the mental and physical capability of PCS patients.

Methods
We randomized 62 patients with PCS (20 male/ 42 female; age: 46 ± 12 years; body mass index: 28.7 ± 6.7 kg/m2) with a score ≥ 22 in the fatigue assessment scale (FAS) to a 3-month exercise-focused intervention (IG n = 30) or control period (CG n = 32). We assessed changes in exercise capacity (bicycle exercise test with measurements of gas exchange), fatigue, markers of health-related quality of life (HrQoL) and mental health.

Results
The FAS score decreased significantly in both study groups (IG: 35.1 ± 7.4 to 31.8 ± 8.5 points; CG: 35.6 ± 7.4 to 32.6 ± 7.5 points, both p < 0.01). Exercise capacity did not increase in the CG or IG (within-group changes for IG: peak oxygen uptake: 0.9 ± 2.6 ml/min/kg, p = 0.098; peak power output: 6.1 ± 17.8 W, p = 0.076) with no significant changes in HrQoL and work ability. Patients with a FAS score at baseline ≥ 35 (severe fatigue) showed no change in exercise capacity with the 3-month intervention whereas the sub-group of patients with FAS < 35 points (moderate fatigue) showed improvements, independent of the study group.

Conclusions
Our 3-month intervention seems appropriate for patients with moderate fatigue, whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance.

Open access, https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-024-00817-5

 

[SNT Gatchaman]

The minimum clinically important difference (MCID) for a V̇O2peak change (i.e. primary outcome) is considered 1.0 ml/min/kg favoring the intervention group. Therefore the obtained change in exercise capacity after the 3-month intervention is not only non-significant between study groups but also did not reach the MCID for V̇O2peak in our studied patients.

We assume that the training intensities that were achievable across all recruited patients were too low to attain an improvement in exercise capacity.

Taking into account that exercise is contraindicated in extreme fatigue and in order to prevent PEM and the occurrence of a crash, an individualized exercise program, adapted to the patient’s individual performance, was implemented according to the WHO recommendations.

Fatigue, depressive symptoms and deteriorated HrQoL often occur together in PCS. The improvement of the FAS in both groups independent of the implementation of training is indicative of a healing tendency over time.

However, our data also show a dependency of the improvement of V̇O2peak and FAS in relation to the FAS baseline value, i.e. the higher the FAS was, the lower the improvement was. We assume that with increasing fatigue, physical exertion becomes less feasible and only a relatively low level of physical activity is possible.

Patients with severe fatigue did not show any improvement in performance, whereby their initial level could at least be maintained. Regardless of the intervention, both groups with an FAS < 35 showed a significant improvement in physical performance. In addition, recovery seems to be delayed in patients with severe fatigue.

 

[Trish]

I have read through the paper. They did not find any useful effect from their carefully planned, well supported by experts and individualised exercise program. It's good that they acknowledge that

Contrary to our hypothesis, we did not observe effects in exercise performance or mental and physical capability in PCS patients.

It's interesting, I think, that they used wearable step counters throughout the 3 months and found no between group difference in activity levels. So all their careful and supportive and expert advice had basically no effect on patients overall activity.

I was surprised to see the high step counts at the start, with averages in each group around 7 to 8 thousand steps. Yet they described the patients after the treatment as too fatigued to increase their physical activity significantly. They do mention PEM as a restricting factor for increasing activity.

I had a look at the Fatigue assessment scale. It's odd in that it doesn't ask patients how severe their fatigue is on each descriptor or how much each restricts their activity, instead the severity rating for each is how much of the time do you experience this particular aspect of fatigue. So how does it discriminate between someone who feels a bit tired or unmotivated all the time from someone who is too crushingly exhausted to get out of bed?
https://novopsych.com.au/assessments/health/fatigue-assessment-scale-fas/

I'm not sure what to make of the comment on mental state in the conclusion:

Our 3-month intervention seems appropriate for patients with moderate fatigue, whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance.

They seem to be attributing at least part of patients' inability to increase activity to lack of motivation rather than to physical incapacity.

 

[Jonathan Edwards]

The peculiar thing is the statement 'our 3-month intervention seems appropriate'.
It seems a waste of time.

One might perhaps draw the conclusion that people with Post Covid problems cannot benefit physiologically from training. That would make sense to me - that they are in a state in which the body regulatory systems are set to 'do not increase capacity'. Increasing capacity must have costs -otherwise we would all be super fit all the time. Maybe there is a post-illness regulatory mechanism that blocks training.

In which case the intervention would be very inappropriate.

 

[Sid]

whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance.

Totally inappropriate conclusion.

 

[rvallee]

So it:

1. Makes no notable difference
2. Even in patients who don't have significant PEM or exhaustion
3. Does not even increase exercise capacity
4. Is expensive and resource-intensive
5. Takes precious energy away from patients who often struggle with ADLs
6. Seems appropriate

The Aristocrats
Evidence-based medicine

And that doesn't even take into account the fact that Long Covid involves a huge range of health issues, that span from hearing or smelling loss to new onset diabetes as well as GI issues and a whole lot of PEM and so-exhausted-they-are-bedbound-for-years.

How does any of this make sense? They even notice an improvement in both groups that, and this has been known and obvious for years, explains any improvements from any intervention of any type to being about time, in some, probably most, patients. Which not only nullifies any claims of treatment-specific improvements, but demands a much higher threshold for any claims of benefits.

What's even more absurd is that despite the low quality of this study, it must be commended for merely recognizing basic facts about what they're doing, in that they are doing better than the average evidence-based pragmatic trial. Despite making an invalid conclusion that contradicts those basic facts. Because that's how low the bar is.

It's been blatantly obvious for years that any improvement in any chronic illness patient population is down to biological factors that are completely unrelated to any treatment attempt in the vast majority of cases. Which all point to an obvious biological mechanism.

But, sure, let's go ahead and pretend that paying hundreds of millions per year to subject a tiny % of this patient population to some useless, and often harmful, rehabilitation "seems appropriate" simply because the medical profession cannot handle the truth about having majorly screwed up and gaslighted us for decades in the insane pursuit of fairy tales from the 19th century. Or maybe it's because they have been completely asleep at the wheel about this predictable outcome. Nevertheless, millions of people are paying with their lives, or years of their lives, for this massive ego trip by a clearly unaccountable, sometimes reckless, profession.