Protocol Safety and Effectiveness of an Exercise-Based Telerehabilitation Program in Myalgic Encephalomyelitis and Post COVID Syndrome…, 2025, Fricke-Comellas+

SNT Gatchaman

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Safety and Effectiveness of an Exercise-Based Telerehabilitation Program in Myalgic Encephalomyelitis and Post COVID Syndrome: Protocol for a Randomized Controlled Clinical Trial
Fricke-Comellas, Hermann; Infante-Cano, Marta; Heredia-Rizo, Alberto Marcos; Martín-Fernández, Ariadna; Escudero-Pérez, Pablo; Fernández-Seguín, Lourdes María

BACKGROUND/OBJECTIVES
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post-COVID Syndrome (PCS) are chronic conditions that share relevant pathophysiological mechanisms. Conventional rehabilitation programs have often been associated with patient dissatisfaction and frequent adverse events (AEs), highlighting the need for safer and more effective clinical approaches. This study aims to compare the effects of a telerehabilitation program based on conscious movement with those of conventional low-intensity exercise in individuals with ME/CFS or PCS.

METHODS
This is a prospective, single-blind, three-arm, parallel, superiority randomized clinical trial. A total of 147 participants (aged 18–70) with ME/CFS or PCS will be recruited and randomly assigned to one of three groups: (a) conscious movement; (b) low-intensity exercise; or c) usual care. All interventions will be delivered via telehealth over 12 weeks, with weekly 45-min sessions combining health education and individually tailored exercises. Participants will be encouraged to practice daily using the provided materials. Adherence rates and potential AEs will be recorded. The primary outcome is the total score on the 14-item Chalder Fatigue Scale at 12 weeks (post-intervention). Secondary outcomes include heart rate variability, functional performance, pain intensity and interference, mental health, interoceptive awareness, quality of life, sleep quality and fear of movement. Measurements will be collected at baseline, post-intervention, and at 3-month follow-up.

DISCUSSION
Recent evidence suggests that both autonomic and cognitive activity modulate immune function. Conscious movement, which integrates exercise with interoception and mindfulness-based strategies, may provide greater benefits than low-intensity exercise alone. Study limitations should be considered when interpreting the results.

TRIAL REGISTRATION
Registered at ClinicalTrials.gov on 15 May 2025 (NCT06978582). Protocol version 4 (29 September 2025). Ethics Committee code: 2025-0180.

Web | DOI | PDF | Healthcare | Open Access
 
Conscious movement-based exercise, or mind–body exercise (MBE), may reduce physical activity-related AEs by fostering pacing and symptom-titrated effort. Its core feature is movement awareness and continuous appraisal of bodily sensations and context. Sustained interoceptive focus may enhance interoceptive awareness in people with chronic conditions, enabling real-time adjustments in effort and recovery, thereby reducing the risk of PEM.

Hold up. I thought we were paying too much attention to bodily symptoms?
 

5. Trial Status​

The trial is ongoing and is currently during the recruitment phase. Recruitment was initiated on 1 July 2025, and is expected to be completed by the end of January 2026.
Protocol version 4 (29 September 2025). The trial was registered at ClinicalTrials.gov (NCT06978582) on 15 May 2025, and the most recent update was posted on 29 September 2025.
According to the registration, they changed the primary outcome from CFQ and HRV to just CFQ in the most recent update, three months after recruitment started.

They also seem to think that these are useful objective outcomes:
Posterior chain flexibility will be measured using the MSRT. Participants will sit on a firm surface (e.g., floor) with legs extended, ankles neutral, and a one-fist gap between the knees.
Static balance will be assessed using the OLST.
Lower-limb strength and endurance will be evaluated with the STS-60. Participants will perform repeated sit-to-stand movements from a standard armless chair for 60 s, with arms crossed over the chest.
As far as I can tell, there is no mention of thresholds for efficacy.

Ay least they say they will post all of the data online.
 
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