Trial Report Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled trainin

Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled training study
Kogel et al

Abstract
Background and purpose

No evidence-based treatment is available for patients with persisting symptoms post-COVID-19 infection. We hypothesized that physical exercise may represent a safe and effective treatment option for post-COVID.


Methods

We performed a systematic search of the literature that revealed a lack of randomized training studies in patients post-COVID. Based on these findings, a prospective randomized controlled study with open-label and blinded endpoint evaluation was designed. 272 patients with symptoms of fatigue persisting over 6 weeks post-COVID infection were screened. Patients with pathological cardiovascular findings were excluded. 57 patients consented and were randomized to 4 weeks of supervised personalized strength and endurance training or usual care. The follow-up period was 3 and 6 months.


Results

There were no adverse events related to the training. Spiroergometry of the training group showed a significantly higher increase in VO2peak (10.0 ± 12.7% vs. 0.1 ± 8.9%, p < 0.01, respectively) and oxygen pulse (9.8 ± 10.8% vs. 0.0 ± 13.9%, p < 0.05, respectively). Parameters of the Multidimensional Fatigue Inventory-20, McGill Quality of Life Questionnaire, and Post-COVID-19 Functional Status were improved after 4 weeks in both groups. In the follow-up period, the total physical activity per week was significantly greater in the exercise group than in controls (1280 ± 1192 min vs. 644 ± 554 min, p < 0.05, respectively). The improvements in fatigue and quality of life were not statistically different between the training and usual care groups.


Conclusion

Exercise is safe and improves maximal exercise capacity in post-COVID patients. Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of their allocation.

https://link.springer.com/article/10.1007/s00392-023-02300-6

 

at end of the main paper it says:
"Exercise had no beneficial effect on fatigue symptoms or quality of life in our study."

??

 

I suppose anybody improved that was part of the study, which is to be expected, and exercise didn't have beneficial effects on fatigue symptoms or quality of life in the study, but the only way to then still sell exercise as a treatment is to frame it as "Fatigue and quality of life improve over time in individuals that are willing to participate in a training study irrespective of their allocation". i.e. when it's proven that exercise doesn't help, instead of saying that, we instead invite you to an exercise study where you will be in the control arm and won't be doing anything because that is beneficial but we will sell it as exercise studies are beneficial.

 

Don't quite understand why the group effects in table 3 show no significant differences, while the text says: "A group effect was found for VO2peak (p<0.01) and oxygen pulse (p<0.05) between exercise and control, respectively."

I also don't think they corrected for multiple comparisons or differences in baseline values.

 

Yes interesting that they (think they) found differences in objective findings from exercise testing but for questionnaires, quite the opposite of ME/CFS trials.

They used the Multidimensional Fatigue Inventory-20, the McGill Quality of Life Questionnaire (MQOL), and the Post-COVID-19 Functional Status (PCFS) and none seem to have shown relevant differences between the exercise and control group.

 

This is an impressively biased study. Completely unserious. They paid no attention to what has been happening from the start. Did a quick search for confirming evidence, and found few? I'm not sure how that's possible, there has already been a significant number of such studies. All poorly done. So they devised their own, obviously assuming and planning to cherry-pick positive results.

They report over 100 records for such studies. After filtering they kept 15. That's a huge number of filtered out studies, but still how is 15 not enough to make conclusions? So they decide to quickly make one more? Hell, they even report that most of the other studies were "better", at least on one dimension:

That's just false. In fact none have any follow-up, and neither does this study.

It's just so blatant how they just create whatever evidence they feel should be out there. This is completely unserious.

By their own admission, those were already published. This is all fabricated. Everything is cherry-picked and evidence is irrelevant.

In their abstract, they cite:

But it already has been used from the start. Tens, probably hundreds, of thousands of people have been subjected to those. There is still no effective treatment. So how does any of this make any sense?!

In their conclusion, they basically lie:

Right above this in the results:

Although, no, I guess they're admitting that it's useless, they just phrased it in a way that sounds like it works, "regardless of allocation", when that actually means no difference between treatment and controls. They make it as if merely having the motivation to exercise works just as... poorly? This is extremely misleading language, and they obviously did it with intent to mislead.

And this still got published. What a joke this industry is. This entire methodology is worthless. It's worse than nothing.

 

So out of 272 people they identified as potential participants at the start (most either couldn't due to cardiovascular or clearly said 'I don't think so') it whittled down to 20 who completed to 3-6months

A success?!! For all? Based on comparing the ones most attracted to carrying on with it vs those who got dumped into the control perhaps not whittling out those who had PEM and found they'd end up more disabled if they carried on, thereby their presence dragging down the 'average VO2 MAX'?

Yeahhh on wat planet is that not Krypton Factor filter technique - watch a Workwell video authors, I'm pretty sure if we looked closely at your data and techniques you've just replicated their findings:

if you take a big group of people some of whom have PEM and force them to exercise for 3-6months then you remove those with PEM and the worst illness and end up with a better 'average VO2 max' than if you take the same group and don't get them to do exercise that harms those with PEM.

Are they really that deluded that they think they've got the same drop-outs in their control as for the activity group?

I simply don't believe their claims of individualised and think regulators need to step-in and say there needs to be detailed reporting on the drop-outs, with their own narrative on why they felt they couldn't continue and whether in the short-term there was deterioration from the 'treatment'.

The idea people like this can just use this loophole to whittle out the sickest from their intervention group vs control and claim that (even in their own heads) means their results generalise to all the people who were whittled out, and was their treatment. Well isn't that delusion?

 

I feel like there needs to be an annual competition now for what you could use this technique to claim to prove - come up with the silliest of possibilities.

My starter for ten:

I'll recruit 250 schoolkids and ask them to spend 4 hours a week practising music at grade 8 violin level.

200 of these kids will say 'no way, I've never played the violin, am not naturally musical, starting at grade 8, enough to worry about and fit into my week' and so on.

Divide the other 50 into two groups.

One group of 25 makes the kids try and play grade 8 music for 4hrs a week, whether they've played the violin before or not for 3-6months

The other group of 25 makes the kids sit around for the same amount of time not playing the violin for 3-6months

Apparently the fact that the 10 kids who stuck out the 3-6months trying to keep up with grade 8 violin playing were generally 'on average' much better at playing the violin at the end of 3-6months than the kids who were in the control group [who didn't need to try and keep up with that for 4hrs a week] says something about 'the treatment' being a good idea for all the other kids, all 250 of them, and many more at similar schools.

Magic! Why don't all the other music teacher do this we'd have maestros everywhere and violin-playing-inability is cured safely.

And not something about how maybe all you showed was how few people, based on how good at the violin you already have to be in order to, make it to the end of your filter in the intervention group. Because unless you happen to already be good enough at violin playing you aren't going to stick turning up for 4hrs a week whilst everyone plays pieces well above your capability, so you and the group teacher decided it was OK for you to drop out.

Whereas those in the control just had drop-outs who didn't want to waste their time for other reasons, and those drop-outs therefore might have included those who didn't know one end of a violin from the other being as likely to stick out the 3-6months as good violin players, given noone was having to try and play.

 

So the opposite of what the abstract says as its one line conclusion?

 

Realised as I used the phrase 'Krypton Factor filter' a bit these days and it was a TV programme in the UK back in the previous century I should post a link:

https://en.wikipedia.org/wiki/The_Krypton_Factor

Basically it would involve 4 contestants being put through round testing different things like physical, obstacle course, mental agility, observation and so on to find 'the winner' and knock out the losers. And the winners would go through from those heats to the next round and so on until you had a champion.

 

The word willing is doing a lot of heavy lifting in that sentence. Unwilling due to moral failure or because they knew, based on experience, that exercise would fuck them up?

 

There are numerous errors here. But they're also performing a number of "questionable research practices" (something I've spent four hours this week having to study -- I got 100%, thanks to this place instilling all the basics in me years ago).