Enhancing exercise intervention for patients with post-acute COVID-19 syndrome using mobile health technology: The COVIDReApp R..., 2024, Duenas et al

[rvallee]

Enhancing exercise intervention for patients with post-acute COVID-19 syndrome using mobile health technology: The COVIDReApp randomised controlled trial protocol
https://journals.sagepub.com/doi/10.1177/20552076241247936

Abstract

Objectives
To analyse the effectiveness of a physical exercise programme guided by a mobile health technology system (COVIDReApp) for patients with post-acute COVID-19 syndrome. This syndrome is a multisystem disease that occurs in people with a history of COVID-19 between 1 and 3 months after the onset of the disease. This study will assess the impact of the intervention on fatigue, post-exertional dyspnoea, quality of life, pain severity, physical fitness, anxiety, depression and cognitive function. We also aim to analyse whether there are associations between the variables studied and the evolution of these associations during follow-up.

Design
A single-blind randomised controlled trial.

Methods
One hundred patients diagnosed with post-acute COVID-19 will be enrolled and randomly assigned to two groups. The experimental group will perform the intervention through a physical exercise programme guided by the COVIDReApp system, whereas the control group will perform the programme in paper format. Study outcomes will be collected at baseline and at 4, 12 and 24 weeks. Student's t-tests or Mann–Whitney U-tests will be used to analyse differences between groups, mixed ANOVA for differences over time and longitudinal structural equations for associations between variables at follow-up.

Discussion
This study is based on current evidence regarding exercise prescription recommendations for patients with post-acute COVID-19 syndrome. Our intervention is supported by a solid theoretical framework; however, challenges include tailoring the physical exercise programme to everyone's predominant symptoms and ensuring adherence to the programme.

 

[rvallee]

They are assuming that exercise rehabilitation is already effective. The comparison is between a mobile app and paper versions.

Regarding rehabilitation programmes, research has mainly focused on the application of physical exercise programmes and respiratory exercises, showing beneficial physical effects with these therapies.5 In this sense, the use of mobile wireless technologies for public health or mHealth,6 to support the treatment of patients with various pathologies has already been observed as a useful tool, as well as conventional treatment,7 allowing them to take a more active part in the management of their disease.

Regarding rehabilitation programmes for patients with COVID-19, the current literature outlines the benefits of physical rehabilitation therapy through aerobic, endurance, and respiratory exercise training in terms of parameters such as functional capacity, lung function, quality of life and mental health status.17 In this sense, current recommendations18 state the need to tailor exercise prescription to the type of patient and the severity of their symptoms, especially for those with post-exertional malaise (PEM). PEM is the most characteristic symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is highly prevalent in at least 45.2% of patients with PACS.19 Indeed, Fairbank18 has drawn attention to the detrimental effects that physical exercise programmes can have on people with PACS with PEM, contraindicating their use. Moreover, it is recommended to include face-to-face supervision sessions on exercise technique and intensity throughout home exercise programmes.16

This intervention focuses on providing physical exercise guidance, and its effectiveness will be measured by analysing several outcomes such as fatigue, post-exertional dyspnoea, quality of life, pain severity, physical fitness, anxiety, depression, and cognitive function. We also aim to analyse the relationship between fatigue, post-exertional dyspnoea, quality of life, pain severity, physical fitness, anxiety, depression and cognitive function in patients with PACS during follow-up. We also intend to assess user satisfaction with the COVIDReApp application.

 

[rvallee]

Both study groups will perform a 6-month physical exercise programme of 40 to 60 minutes, three times per week, in line with the recommendations for the management of ME/CFS from the National Institute for Health and Care Excellence (NICE).25 In addition, users will be advised to personalise the exercise programme, intensity, and duration according to their physical self-perception and symptoms, as proposed in the Covid Rapid Guidelines1926 and recommendations for physical exercise prescription for people with ME/CFS.25 Each daily session consists of a warm-up, aerobic exercise, strengthening exercises and cool-down (Table 1).

Obviously if everything is personalized to each participant's abilities, there is nothing to compare as they are not doing the same things.

The exercises are detailed, for once, consisting mostly of some walking and some weights and calisthenics. Which they are then expected to gradually increase:

In addition, to progressively increase the intensity and duration of the main part of the physical exercise programme, three phases of the programme will be carried out during the 6 months of the intervention (Table 2).

The reference to:

in line with the recommendations for the management of ME/CFS from the National Institute for Health and Care Excellence (NICE)

Is the updated 2021 guideline, which explicitly advises against this. So I guess they didn't read it, or something like that.

LOL, LMAO even:

Patients randomly assigned to the control group will receive the same intervention (Table 1) for 24 weeks but traditionally (on paper) without using the mobile health system. Participants will receive a leaflet with pictures and details of the exercises that they must perform. Adherence to the intervention will not be recorded in this group.

As Mythbusters put it so well: "remember kids, the only difference between screwing around and science is writing it down".

 

[Eleanor]

The reference to:
in line with the recommendations for the management of ME/CFS from the National Institute for Health and Care Excellence (NICE)
Is the updated 2021 guideline, which explicitly advises against this. So I guess they didn't read it, or something like that.

ChatGPT-generated, perhaps.