Exercise rehabilitation in post COVID-19 patients: a randomized controlled trial of different training modalities 2024 Sick et al

[Andy]

BACKGROUND: Long-lasting symptoms (>12 weeks) following a COVID-19 infection are defined as the post-COVID-19 syndrome (PCS), often manifesting as fatigue and reduced exercise capacity. Thus, exercise has been suggested as a non-pharmacological therapy.
AIM: To investigate the effects of endurance vs. concurrent exercise on physical function, symptoms and quality of life in individuals with PCS, that did not need hospital admission during acute COVID-19.

DESIGN: Parallel-group, single-center, randomized controlled trial.

SETTING: This study was conducted at the University of Vienna.

POPULATION: Adult individuals with a SARS-CoV-2 infection at least 12 weeks prior to enrollment who reported at least one symptom specific to PCS and did not experience post-exertional malaise.

METHODS: Participants were randomized to either 12 weeks of supervised endurance training (ED) or concurrent training (CT), or a non-exercising control group (C). As the primary outcome, VO2peak was assessed pre and post intervention. Secondary outcomes were handgrip and lower body strength, heart rate variability, symptoms, health-related quality of life (HRQoL) and concentration performance. The main effects for time and group as well as the time*group interaction were assessed via a 2x2 analysis of variance. Additionally, within-group pre-post testing was performed.

RESULTS: Taking the study protocol into account, 42 subjects could be included in the analysis (N.=14 in each group). A significant time*group interaction favoring both exercise conditions was found for VO2peak (partial Eta2=0.267; ED: +3.9 mL/min/kg; CT: +3.2 mL/min/kg). The Fatigue Severity Score significantly decreased in ED (Hedges’ g=0.63) and CT (Hedges’ g=0.82) from pre to post, but not in C. Breathlessness and lower body strength improved most in CT. Significant within-group improvements in HRQoL and the number of PCS symptoms occurred in all groups.

CONCLUSIONS: Both exercise regimes led to increases in VO2peak and lower fatigue scores in subjects with PCS. Improvements in HRQoL occurred in all groups, however more pronounced after the exercise interventions. No definite conclusion about the superiority of either training modality can be drawn.

CLINICAL REHABILITATION IMPACT: The results show that in this population both exercise regimes are feasible and safe and lead to improvements in various health domains.

Open access, https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y9999N00A24121201

 

[Yann04]

POPULATION: Adult individuals with a SARS-CoV-2 infection at least 12 weeks prior to enrollment who reported at least one symptom specific to PCS and did not experience post-exertional malaise.

And it’s a randomised controlled trial? And objective primary outcome measures? That’s probably the best methodology I’ve seen on a Rehabilitation study yet.

 

[Yann04]

Both exercise regimes led to increases in VO2peak and lower fatigue scores in subjects with PCS. Improvements in HRQoL occurred in all groups, however more pronounced after the exercise interventions. No definite conclusion about the superiority of either training modality can be drawn.

Given these results though. It sounds like the main effect was that: “people with Long COVID (without PEM) who exercise tend to improve exertional capacity”

And not “people with Long COVID (without PEM) have an improvement in their illness due to exercise”. Because the main improvement not linked to exercise capacity was in “fatigue” which is super subjective for a non-blinded study.

 

[Hutan]

That's a lot of dropouts. e.g 24 participants in the endurance group, of which 10 dropped out for various reasons
20 controls, 6 dropped out

The CONSORT flow chart is depicted in Figure 1. Af- ter screening for inclusion and exclusion criteria, 66 participants were included and randomized to either Ed (N.=24), ct (N.=22) or the control condition (c; N.=20). During the intervention, 10 and 8 participants of ED and ct, respectively, and 6 control participants discontinued the study. the most common reasons for dropout were illness due to non-coVid viral or bacterial infections (N.=8), COVID-19 reinfection (N.=6) and compliance issues and others (N.=6). 2 participants of the training groups stopped due to a worsening of their symptoms in response to the intervention. in total, 42 participants were analyzed.

due to an injury, one participant (ct) could not perform the assessment of leg strength at follow-up and was thus excluded from the analysis of this parameter. for the fss score, one participant (Ed) was excluded from the analy- sis because of missing data at follow-up.

 

[bobbler]

BACKGROUND: Long-lasting symptoms (>12 weeks) following a COVID-19 infection are defined as the post-COVID-19 syndrome (PCS), often manifesting as fatigue and reduced exercise capacity. Thus, exercise has been suggested as a non-pharmacological therapy.
AIM: To investigate the effects of endurance vs. concurrent exercise on physical function, symptoms and quality of life in individuals with PCS, that did not need hospital admission during acute COVID-19.

DESIGN: Parallel-group, single-center, randomized controlled trial.

SETTING: This study was conducted at the University of Vienna.

POPULATION: Adult individuals with a SARS-CoV-2 infection at least 12 weeks prior to enrollment who reported at least one symptom specific to PCS and did not experience post-exertional malaise.

METHODS: Participants were randomized to either 12 weeks of supervised endurance training (ED) or concurrent training (CT), or a non-exercising control group (C). As the primary outcome, VO2peak was assessed pre and post intervention. Secondary outcomes were handgrip and lower body strength, heart rate variability, symptoms, health-related quality of life (HRQoL) and concentration performance. The main effects for time and group as well as the time*group interaction were assessed via a 2x2 analysis of variance. Additionally, within-group pre-post testing was performed.

RESULTS: Taking the study protocol into account, 42 subjects could be included in the analysis (N.=14 in each group). A significant time*group interaction favoring both exercise conditions was found for VO2peak (partial Eta2=0.267; ED: +3.9 mL/min/kg; CT: +3.2 mL/min/kg). The Fatigue Severity Score significantly decreased in ED (Hedges’ g=0.63) and CT (Hedges’ g=0.82) from pre to post, but not in C. Breathlessness and lower body strength improved most in CT. Significant within-group improvements in HRQoL and the number of PCS symptoms occurred in all groups.

CONCLUSIONS: Both exercise regimes led to increases in VO2peak and lower fatigue scores in subjects with PCS. Improvements in HRQoL occurred in all groups, however more pronounced after the exercise interventions. No definite conclusion about the superiority of either training modality can be drawn.

CLINICAL REHABILITATION IMPACT: The results show that in this population both exercise regimes are feasible and safe and lead to improvements in various health domains.

Open access, https://www.minervamedica.it/en/journals/europa-medicophysica/article.php?cod=R33Y9999N00A24121201

So the 2021 Nice guideline underlines how important the longest time period for follow up is ie the long term IS the effect on the illness

and we still get this nonsense having the gall to think they can make the claim safe whilst not focusing on whether people are iller at the 1 and 2yr mark due to this snd if so which individuals

it’s like they don’t care whether it harms

 

[Sean]

it’s like they don’t care whether it harms

It's like the lessons they are learning from NICE, et al, are how to avoid robust methodology and actually subjecting their claims to adequate testing.