Safety and Physical Outcomes of a Novel Australian Multidisciplinary Long COVID Clinic That Incorporates Exercise, 2025, Buettikofer+

[SNT Gatchaman]

Safety and Physical Outcomes of a Novel Australian Multidisciplinary Long COVID Clinic That Incorporates Exercise: A Prospective Observational Study

Spoiler: Authors

Tanya Buettikofer; Allison Maher; Mary Johnson; Susan Hartono; Veronica Rainbird; Marc Nickels; Michelle Bennett; Hsin-Chia Carol Huang; Philip Gaughwin; Miriam Alexandra Vandermeide; Rory Carlyle; Wendy Ho; Madeleine Brady; Kacie Patterson; Jo Morris; Imogen Mitchell; Jennifer Paratz; Nicole Freene; Bernie Bissett

BACKGROUND
Exercise therapy remains somewhat controversial in those with Long COVID (symptoms lasting > 3 months), due to concerns for safety and the potential for harm.

PURPOSE
This study describes the safety and physical outcomes of an Australian multidisciplinary Long COVID Recovery Clinic that incorporates personalised exercise prescription including respiratory and peripheral muscle strengthening, carefully monitored cardiovascular training and pacing of activity.

PATIENTS AND METHODS
Prospective observational study of adults (≥ 18 years) engaging with a single site Long COVID Recovery Clinic (March 2022 to June 2023). Clinic eligibility required symptoms > 12 weeks which impaired activities of daily living. Safety was pre-defined as < 10% of participants experiencing a minor adverse event, and no serious disability or death as a result of participation in exercise. Physical outcomes included Modified COVID-19 Yorkshire Rehabilitation Scale, changes in exercise capacity (6-minute-walk-test), inspiratory muscle strength (maximum inspiratory pressure), Timed-Up-and-Go and ten-metre-walk-test. Data analysis included repeated measures Multivariate Analysis of Variance (MANOVA) to explore assessment and reassessment measures collectively, and repeated measures t-test.

RESULTS
Of 207 consumers referred, (62% male, median age 45, range 18– 84), 119 (57% of the total referred) enrolled to participate in the program. Of these, 72 (61%) completed the program, median participation duration 112 days (range 5– 384). There were no adverse events as a result of participation in exercise. Consumers who completed the program showed improvement in Modified COVID-19 Yorkshire Rehabilitation Scale Other Symptoms (MD − 1.5, p=0.003), Overall Health Score (MD1.3, p< 0.001), Total Score (MD − 6.5, p=0.02); maximum-inspiratory-pressure (MD 11.7 cmH2O, p=0.002); Timed-Up-and-Go (MD − 1.0 sec, p< 0.001); ten-metre-walk-test comfortable speed (MD 0.7 m/sec, p=0.006) and fast speed (MD 0.2 m/sec, p< 0.001); and 6-minute-walk-test distance (MD 63.0 m, p< 0.001).

CONCLUSION
This multidisciplinary therapy program that incorporates exercise was safe and associated with improvements in physical and functional outcomes for participants who completed the program.

PLAIN LANGUAGE SUMMARY
Few studies in Australia have investigated the impact of exercise in people with Long COVID. This observational study describes the safety and physical outcomes of 72 adults who completed an Australian multidisciplinary Long COVID clinic that incorporates supervised cardiovascular and strength training over several weeks. For those who completed the program, there were no adverse events, while multiple physical outcome measures improved relative to baseline. This study shows that exercise can be safely incorporated in a multidisciplinary clinic for people recovering from Long COVID.

Web | DOI | PDF | Journal of Multidisciplinary Healthcare | Open Access

 

[SNT Gatchaman]

This prospective observational study was conducted at a single centre where the newly established Long COVID Recovery clinic was the only service of its kind in the Australian Capital Territory.

briefly it involves a multidisciplinary team (rehabilitation specialists, physiotherapists, occupational therapists, exercise physiologists, dieticians and other allied health staff) providing comprehensive, individualised assessment and tailored rehabilitation intervention to consumers in both individual and group formats. Typical attendance was 1–2 times per week for 1–2 hours, 2 to 3 months in an outpatient rehabilitation setting.

Ahhhh... "Novel", "Multi-disciplinary", "Incorporates Exercise"

 

[SNT Gatchaman]

Post-exertional symptom exacerbation (PESE) has recently been reported as a common feature of Long COVID.

Intriguingly, multidisciplinary coordinated care, including exercise, is not yet standard practice for Long COVID.

To manage the risk of postexertional symptom exacerbation (PESE), consumers were screened at baseline assessment for PESE triggered by participation in activities of daily living. Once consumers were able to participate in the exercise group, clinicians checked in weekly regarding PESE and modified advice and exercise prescription accordingly. Exercise included strength training of both peripheral and inspiratory muscle training (IMT) as well as whole-body cardiovascular training. Peripheral strength training was prescribed at a submaximal threshold, due to the risk of PESE, using Borg Rating of Perceived Exertion Scale 31 4–6/10 as a baseline, and included 4–6 functional exercises in global muscle groups 3 days per week. Progression was guided by symptom monitoring to further minimise the risk of PESE in peripheral strength training.

Enrolled 119 (62% male)
Non-completers 47 (40%)

Exercise per week following COVID-19 infection (self-reported)
No exercise 53 (43%)
< 150 min/ week 38 (31%)
≥ 150 min/week 10 (8%)
Unclear 20 (17%)

The main finding of this observational study was that our multidisciplinary Long COVID Recovery Clinic model was safe, with no major adverse events or deterioration in physical function across the 72 participants who completed the program. This is consistent with emerging international evidence, with a recent systematic review of 8 randomised controlled trials [15] finding that exercise therapy in Long COVID populations is safe and not associated with adverse events.

[15] Effectiveness and tolerance of exercise interventions for long COVID: a systematic review of randomised controlled trials (2025, BMJ Open)

 

[Sean]

This is consistent with emerging international evidence, with a recent systematic review of 8 randomised controlled trials [15] finding that exercise therapy in Long COVID populations is safe and not associated with adverse events.​

Between the appalling dropout rate, and the failure rate to maintain the exercise regime, how can they know that?

Plus,

Lack of control group.

No mention of long-term follow-up.

The gain on the 6-minute-walk-test distance was modest (MD 63.0 m, p< 0.001), better than PACE (35m, and only for the GET arm) but not strikingly so, and still low by general health and rehab standards. They did exceed the Minimal Clinically Important Difference, though the gain was very modest, and the MCID they used (25m) is quite low, with the reference population being patients with coronary artery disease and heart failure, which may not be an appropriate comparison, particularly for a patient group (LC) who are supposed to be aiming for recovery.

The ten-metre-walk-test also exceeded the MCID (0.16 m/s), though the comparison group was a subacute stroke population.

While there is some value in comparing outcomes between different conditions, there are also some constraints and risks with it, and outcomes should also be referenced to the general and healthy populations.

These measures did not reach significance: spirometry forced vital capacity (FVC), fraction expired in 1 sec (FEV1), ratio of FEV1/FVC and peak expiratory flow.

These measures lacked sufficient data to analyse: Oxford scale, dynamometry, Patient Generated Subjective Global Assessment, Functional Gait Assessment, Step Test and Modified Clinical Test of Sensory Interaction in Balance.

Overall the gains were basically marginal, and hence in line with outcomes on other LC exercise studies, as well as exercise ME/CFS studies. Which is not good for a focused physical rehab program with a median duration time of 111 days, and that given the clinic's name was Long Covid Recovery Clinic, the program presumably aims for recovery.

Whatever else could be said about the outcomes, it can't be said that the patients recovered in any meaningful sense.

In short, it's a bust. They have demonstrated nothing more than was already known, including from ME/CFS studies.

I am sure there are other limitations and issues to find (I did not dig into the critical issue of selection criteria, for example). But that is enough already and I couldn't be bothered reading any more.

https://www.dovepress.com/article/fulltext_file/562296/aW1n/JMDH_A_562296_O_F0003g.jpg

https://www.dovepress.com/article/fulltext_file/562296/aW1n/JMDH_A_562296_t0002.jpg

https://www.dovepress.com/article/fulltext_file/562296/aW1n/JMDH_A_562296_t0003.jpg

 

[rvallee]

The main finding of this observational study was that our multidisciplinary Long COVID Recovery Clinic model was safe, with no major adverse events or deterioration in physical function across the 72 participants who completed the program.

If you don't count the clients who left in disgust and loudly complained about being served inedible slop, all of this restaurant's clients are satisfied.

They don't even understand the concepts they are dealing with. The numbers are atrocious. No actual benefits. This is presenteeism, being present while doing something and saying whatever about it, self-rated gold stickers.

I have no idea where they take the notion that this rehabilitation stuff isn't standard. It was literally standard on day 1, and remains "somewhat controversial", a factor which they put no effort into figuring out, or probably didn't like what they saw and covered it up.

However, the absence of a control group precludes conclusions regarding the efficacy of the Long COVID Recovery Clinic for improving strength or enhancing physical outcomes.

So instead they're going with "well, it's safe if you only look at the people who didn't drop out".

we lack data on those who did not complete the program, largely as they were uncontactable The reasons for non-attendance could be an opportunity for further research to enhance attendance at Long COVID recovery services in Australia.

This is actually disturbing. About the only rational interpretation of why 39% were 'uncontactable' is that those participants wanted nothing to do with the study or what the researchers tried to do. This is ridiculous.

However, many consumers did not completely recover as reflected in the Modified COVID-19 Yorkshire Rehabilitation Scale physical score, which only improved by 3.4 points. This lack of complete resolution also echoes our qualitative study in which consumers reported that their recovery was incomplete and additional services were required to augment recovery.

This is even more ridiculous, literally "imagine if our treatment worked, then it would probably work if we did more of what doesn't work"-based medicine. Why would additional services make a difference here? This is all super basic stuff, it doesn't nearly that long to recondition and this is what they operationalized here, there is no other reason to do exercise rehabilitation therapy.

The main strength of this study is the highly pragmatic and widely inclusive sample.

This is not a strength. The trial isn't even controlled and they had huge dropouts who literally cut off contact with them. What is even "highly pragmatic" as a strength? I have no idea what it means in this context, and formally it just means "we don't know why we do what we do but we do it because we think it's good". This fully describes all alternative medicine.

Lastly, our analyses were exploratory. We did not present the net improvement in outcomes following exposure to the physical activity programme.

Because there wasn't any. If there had been, they would have emphasized it. But there isn't, so instead they're saying "gosh, we only tested whether it was safe, we're not saying it's effective, we're just saying it's probably effective since it's safe if you discount the high number of dropouts".

Even comically corrupt industries are more coherent and rational, because ultimately no one wants to lose money on something that doesn't work. Well, no one outside of health care, clearly, where evidence and outcomes don't even matter.

 

[NelliePledge]

Reinventing the emperor’s outfit