Trial Report Improved functional exercise capacity after primary care pulmonary rehabilitation in patients with long COVID (PuRe-COVID): [RCT], 2025, Volckaerts+

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Improved functional exercise capacity after primary care pulmonary rehabilitation in patients with long COVID (PuRe-COVID): a pragmatic randomised controlled trial

Spoiler: Authors

Volckaerts, Tess; Ruttens, David; Quadflieg, Kirsten; Burtin, Chris; Cops, Dries; De Soomer, Kevin; Roelant, Ella; Verhaegen, Iris; Daenen, Marc; Criel, Maarten; Vissers, Dirk; Lapperre, Therese

Background
Pulmonary rehabilitation (PR) improves physical status and symptoms in patients with long COVID, but access to specialised hospital-based centres is challenging. This trial studied the effect of primary care PR on functional exercise capacity and symptoms in patients with long COVID.

Methods
In this pragmatic randomised controlled trial (PuRe-COVID), patients with long COVID were randomised to a 12-week stepwise PR programme in primary care, or to a control group without PR. The primary end point was change in 6 min walk distance (6MWD) from baseline to 12 weeks. Additional outcomes, measured at 6, 12, 24 and 36 weeks, included patient-reported outcomes, physical activity, maximal inspiratory (MIP) and expiratory pressures and hand grip strength.

Results
In total, 76 patients were randomised (PR/control group (n=39/37); mean age 49±13 years).

The change in 6MWD at 12 weeks was estimated to be +39 m in the PR group compared with the control group (95% CI (18 to 59), p<0.001). Furthermore, a decrease in Checklist Individual Strength (CIS)-fatigue was found for the PR group (−6 points; 95% CI (−10 to –2), p=0.011).

At 12 weeks, patients in the intervention group were more likely to have a clinically significant improvement in 6MWD (OR 5.7, 95% CI (2.0 to 16.1), p=0.001), CIS-fatigue (OR 3.8, 95% CI (1.2 to 12.0), p=0.020), MIP (OR 3.7, 95% CI (1.05 to 12.7), p=0.036) and modified Medical Research Council dyspnoea score (OR 5.2, 95% CI (1.6 to 16.4), p=0.003).

Conclusions
Primary care stepwise individual PR may improve functional exercise capacity, fatigue and dyspnoea in patients with long COVID. It therefore may be a promising treatment option in primary care for patients with long COVID experiencing fatigue and/or respiratory symptoms. Trial registration number NCT05244044 .

Web | DOI | BMJ Open Respiratory Research

 

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Only 76 out of 381 were recruited. Their target was 134, almost double.

Baseline characteristics are presented in table 1 for the intention-to-treat population (n=76). Patients had borderline normal 6MWD values (intervention group: 83.4±11.9% predicted, control group: 83.2±14.6% predicted).

They had almost normal 6MWT results at baseline, which brings into question how appropriate the measurement is as a primary outcome, and how physically impaired the patients actually were.

Figure 2

Mean 6MWD, CIS-fatigue, MIP and mMRC dyspnoea scale values over time with 95% CI per time point per group. P values from post hoc contrasts of change from baseline at each time point between groups, estimated with the linear mixed model (corrected for multiple testing using Bonferroni-Holm correction). 6MWD, 6 min walk distance; CIS, Checklist Individual Strength; MIP, maximal inspiratory pressure; mMRC: modified Medical Research Council. ·P<0.1, *p<0.05, **p<0.01 and ***p<0.001.

There is some discussion about the limitations of this study and especially the generalisability of the findings, but as is tradition, the authors still go on to make a generalised conclusion:

this PR programme in primary care, consisting of five phases, is a safe and effective intervention that may improve functional exercise capacity, fatigue and dyspnoea in patients with long COVID.