Trial Report Resistance Exercise Therapy for Long COVID: a Randomized, Controlled Trial 2025 Berry et al.

[forestglip]

From the newest comment:

Following analysis of the results by biostatisticians independent of the clinical research team, there was no evidence of post-exertional malaise (PEM) based on use of a validated questionnaire of PEM

I assume they meant there was no evidence of increased PEM. There was clearly evidence of PEM:

Of 99 individuals who completed the DePaul Symptom Questionnaire, 40 of 48 (83.3%) in the intervention group and 42 of 51 (82.4%) in the control group experienced postexertional malaise at 3-month follow-up (eTables 25-28 in Supplement 2).

Also, as I highlighted before:

1. There's no baseline data, so they can't say there's no increase.
2. Even if they assume the groups were equal at baseline, a lack of increase in the percent of people with PEM only shows that people without PEM don't suddenly get it from exercise. It does not show that the intervention is safe for people who already have PEM.

They do have results for other PEM-related questions from the DePaul questionnaire that provide evidence that the intervention group is worse off than the standard care group at 3 months. I wonder why they didn't highlight these percentages in the paper.

eTable 27. Post-Exertional Malaise at 3-Months, Part 2 (DePaul Symptom Questionnaire, Short Form) Additional Questions

If you were to become exhausted after actively participating in extracurricular activities, sports, or outings with friends, would you recover within an hour or two after the activity ended? (% for "No")

• Standard Care: 49.0%
• Intervention: 66.7%

Do you experience a worsening of your fatigue/energy related illness after engaging in minimal physical effort? (% for "Yes")

• Standard Care: 62.7%
• Intervention: 70.8%

Do you experience a worsening of your fatigue/energy related illness after engaging in minimal mental effort? (% for "Yes")

• Standard Care: 49.0%
• Intervention: 60.4%

 

[Peter T]

think of rehabilitation in an area like stroke where there's good evidence of benefit

Though many accept this, and I am more than twenty five years out of date, do we have evidence that rehabilitation does facilitate improved function rather that just reflecting spontaneous improvement that would have happened any way.

 

[Utsikt]

Though many accept this, and I am more than twenty five years out of date, do we have evidence that rehabilitation does facilitate improved function rather that just reflecting spontaneous improvement that would have happened any way.

If Cochrane is to be trusted, there is not much good evidence for anything:

https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD001920.pub4&doi=10.1002/14651858.CD001920.pub4&type=cdsr&contentLanguage=

Most people will naturally try to do as much as they can, so I assume the important question is if any one way of doing things is better than the others.

My gut tells me that you should practice what you want to do, so there is little need for rehab. Temporary or permanent help might be needed in general if you’re significantly impaired, but that has nothing to do with rehab.

Having a stroke and recovering from a stroke is probably scary and challenging, so it might be best to focus on taking care of the human and facilitating stepping stone exercises if they are too impaired to practice on real life tasks yet.