Preprint Individualized online exercise therapy aids recovery in pediatric long-COVID - Findings from an exploratory RCT, 2025, Goretzki

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Individualized online exercise therapy aids recovery in pediatric long-COVID - Findings from an exploratory randomized controlled trial

Purpose To evaluate the feasibility, safety, and effectiveness of an individualized online exercise therapy (IOET) designed to improve physical capacity and quality of life in children and adolescents with long-COVID. Methods In this prosp...
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Research Article

Individualized online exercise therapy aids recovery in pediatric long-COVID - Findings from an exploratory randomized controlled trial​

Sarah Christina Goretzki1

Email
Mara Bergelt2
Laurent Weis2
Rayan Hojeii1
Gabriele Gauß1
Miriam Götte1
Ronja Beller1
Sven Benson Prof3
Anne Schönecker1
Adela Della Marina1
Andrea Gangfuß1
Florian Stehling1
Christina Pentek1
Anna von Loewenich1
Tom Hühne1
Clara Held1
Sebastian Voigt4
Ursula Felderhoff-Müser1
Michael M. Schündeln1
Nora Bruns1
Katharina Eckert Prof2
Christian Dohna-Schwake1
Maire Brasseler1
1 University Duisburg-Essen, Children’s Hospital Essen, 45147 Essen, Germany,

2 IST University of Applied Sciences, Health Management and Public Health, Düsseldorf, Germany,

3 University Hospital Essen, University of Duisburg-Essen, Essen, Germany,

4 University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany

This is a preprint; it has not been peer reviewed by a journal.

Individualized online exercise therapy aids recovery in pediatric long-COVID - Findings from an exploratory randomized controlled trial

Purpose To evaluate the feasibility, safety, and effectiveness of an individualized online exercise therapy (IOET) designed to improve physical capacity and quality of life in children and adolescents with long-COVID. Methods In this prosp...
doi.org doi.org

This work is licensed under a CC BY 4.0 License

Abstract​


Purpose

To evaluate the feasibility, safety, and effectiveness of an individualized online exercise therapy (IOET) designed to improve physical capacity and quality of life in children and adolescents with long-COVID.

Methods

In this prospective, randomized, single-centre controlled trial, 14 patients aged 9–17 years (11 females, 3 males) with long-COVID (median symptom duration: 21 months) were assigned to either 6 or 12 weeks of IOET. The intervention comprised twice-weekly, telemedicine-delivered sessions tailored to individual ability and symptom burden, supplemented with diaries, activity trackers, and handouts for self-studies. Primary outcomes were physical performance (6-Minute Walk Test [6MWT], Sit-to-Stand Test [STST], Handgrip Strength Test [HST]). Secondary outcomes included school attendance, quality of life (PedsQL), physical activity, safety, and self-reported recovery.

Results

All participants showed clinically relevant improvements. In the 12-week IOET group, 6MWT increased from 396.0 m to 616.3 m, STST from 25.4 to 32.6 repetitions, and HST from 16.6 kg to 27.1 kg. The 6-week group improved comparably (6MWT: 429.0 m to 601.6 m; STST: 21.6 to 31.7; HST: 17.3 to 22.1 kg). School attendance rose from 58% to 97%, and PedsQL scores reflected improved quality of life and reduced fatigue. No adverse events or post-exertional symptom exacerbations occurred. Improvements persisted at 3-month follow-up, although some decline from peak performance was noted.

Conclusions

IOET is feasible, safe, and associated with improved physical function, reintegration in every day life and it’s quality in pediatric long-COVID. These findings highlight IOET as a promising rehabilitation strategy and justify larger multicentre trials to confirm effectiveness and define optimal programme duration.

Pediatric long-COVID
exercise therapy
fatigue
physical health
mental health
school participation
 
No mention of whether these children had PEM or not. Maybe if they don't have PEM this could be beneficial. I went to a U of Utah program on long COVID rehab and they specifically mentioned that the 6 minute walk test was not an appropriate measure in long COVID for those with PEM.

Do we think 6-12 weeks is long enough to show the crash, or is this a time period that you could adrenaline through?
 
Concerns that exercise might worsen symptoms, especially in children with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or post-exertional malaise (PEM), are understandable. However, no participant reported symptoms of deterioration, even though at least three met the Canadian ME/CFS criteria retrospectively. Even patients with neuromuscular comorbidities (e.g., myotonia congenita) completed the program safely. One patient reported in their diary: “I was afraid the training would make me feel worse. But instead, I feel like I got my strength back.” This supports findings by Larun and Fugazzaro et al. on safe implementation in chronic fatigue [30, 31].
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«Meeting the CCC retrospectively» seems like a very weird way of doing things. Larun also gets a mention.
wabi-sabi said:
Do we think 6-12 weeks is long enough to show the crash, or is this a time period that you could adrenaline through?
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I know from personal experience that rehab workers will tell you that you don’t have PEM even when you do, and it’s possible to exercise for many weeks without deterioration.

I was initially very happy with my 5 week stay and praised them for helping me get my life back.

The proper crash came months later.

The entire paper seems very biased to me. There are some halfway attempts at making sure it’s safe, but as most people here will tell you ME/CFS is much more complex than what’s captured by these questionnaires and tests. They didn’t even bother making any attempts at assessing their overall activity levels.
 
Utsikt said:
No dose response relationship, which might indicate that the exercise doesn’t really do much more than nudging the tests at bit.
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And no actual control group, despite the title, so it simply looks like they selected patients with few problems who would have improved anyway, the description of how they were selected suggests just that: they were selected. Which we've already known for years, although their numbers are suspiciously higher than anything shown anywhere else. They do mention how it's possible that natural recovery could explain, but have decided that it's not. OK, then.
Group 2 completed 91.7% of sessions (n = 72), while Group 1 completed 76.4% (n = 144) (Supplement Table 1).
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A big drop for the 12 week group. Despite a reported increase in activity. Doesn't make much sense, being generally able to do more would mean the exercises would be easier, and thus have a higher compliance rate. And we only have their word that other activities have increased because they are hiding the activity tracker data.

It doesn't seem like they understand anything PEM either.
However, no participant reported symptoms of deterioration, even though at least three met the Canadian ME/CFS criteria retrospectively.
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Then they could not meet the criteria. What even is this nonsense? This group of patients meets the definition of being significantly taller, however on average they are of average height. Blatant contradictions do not seem to bother anyone here.

Also they did not actually check for adverse effects:
To assess potential adverse effects of the intervention routine laboratory tests were performed (Supplement 1). There were no relevant differences between the groups.
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No adverse effects for such a group would show up on routine laboratory tests. This is actually pretty silly.
At completion of the study, 9 out of 14 participants (64%) reported full recovery from long-COVID and opted out of further follow-up, despite occasional residual symptoms after completion of the study.
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Not at all convincing as an excuse. Could just as well be that they had had enough of it. I don't see how happily recovered participants in a trial that helped them would do that.

Looking at the supplementary data, despite boasts of stable improvements, there are huge week-to-week fluctuations.

The data don't seem to support the conclusions here. And you know when someone cuts off the y-axis on a chart that something is shady:

86c9dbce1719319fc85ce449.png

It's especially suspicious that the activity tracker data aren't shown. If they were any good, they would have been:
For safety reasons, every participant received an activity tracker (Garmin Vivo Smart 5 https://www.garmin.com/de-DE/pri-vacy/connect/policy/) measuring heart rate and status of activity during the weeks of intervention to enable the timely identification of worsening vital signs daily.
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I don't think we're ever getting out of this nightmare, folks. They're content with failing the same way indefinitely, and the incentives are all set on maximum cheating.
 
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