Effects of a Symptom-titrated Exercise Program on Fatigue and Quality of Life in People with Post-COVID Condition - a Randomized Controlled Trial

Overview

Journal Sci Rep

Specialty Science

Date 2024 Dec 16

PMID 39681609

Authors

Andreas Barz

Joshua Berger

Marco Speicher

Arne Morsch

Markus Wanjek

Jurgen Rissland

Johannes Jager

Affiliations

Soon will be listed here.

Abstract

Fatigue is the most prevalent symptom within the post-COVID condition (PCC). Furthermore, many patients suffer from decreased physical performance capacity and post-exertional malaise. Although exercise has been proposed as an effective therapeutic strategy for PCC, there is limited evidence on individualised and symptom-titrated exercise interventions in patients with fatigue and PEM. Therefore, we conducted a multi-centre randomised controlled trial to investigate the effectiveness of an individualised and symptom-titrated exercise program. We measured fatigue, health-related quality of life, hand-grip strength, endurance capacity and PEM before and after the 10-week intervention. A total of 118 individuals with PCC were included in the final intention-to-treat analysis. All tests and training sessions took place in commercial fitness and health facilities. We found significant effects on fatigue severity, health-related quality of life and physical performance capacity. Adjusting the individual exercise load to daily fatigue has proven to be an effective and safe strategy in PCC patients with fatigue. Under the guidance of qualified professionals and by utilising symptom-titrated training recommendations, commercial fitness and health facilities present an appropriate setting for outpatient exercise rehabilitation in PCC.

References

Callard F, Perego E . How and why patients made Long Covid. Soc Sci Med. 2020; 268:113426. PMC: 7539940. DOI: 10.1016/j.socscimed.2020.113426. View

Hejbol E, Harbo T, Agergaard J, Madsen L, Pedersen T, Ostergaard L . Myopathy as a cause of fatigue in long-term post-COVID-19 symptoms: Evidence of skeletal muscle histopathology. Eur J Neurol. 2022; 29(9):2832-2841. PMC: 9348124. DOI: 10.1111/ene.15435. View

Valko P, Bassetti C, Bloch K, Held U, Baumann C . Validation of the fatigue severity scale in a Swiss cohort. Sleep. 2008; 31(11):1601-7. PMC: 2579971. DOI: 10.1093/sleep/31.11.1601. View

Soriano J, Murthy S, Marshall J, Relan P, Diaz J . A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22(4):e102-e107. PMC: 8691845. DOI: 10.1016/S1473-3099(21)00703-9. View

Nguyen K, Bao Y, Mortazavi J, Allen J, Chocano-Bedoya P, Corlin L . Prevalence and Factors Associated with Long COVID Symptoms among U.S. Adults, 2022. Vaccines (Basel). 2024; 12(1). PMC: 10820629. DOI: 10.3390/vaccines12010099. View

Ghali A, Lacombe V, Ravaiau C, Delattre E, Ghali M, Urbanski G . The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome. J Transl Med. 2023; 21(1):375. PMC: 10248991. DOI: 10.1186/s12967-023-04229-w. View

Enoka R, Almuklass A, Alenazy M, Alvarez E, Duchateau J . Distinguishing between Fatigue and Fatigability in Multiple Sclerosis. Neurorehabil Neural Repair. 2021; 35(11):960-973. DOI: 10.1177/15459683211046257. View

Silva M, Ribeiro L, Gouveia M, Marcelino B, Dos Santos C, Lima K . Hyperinflammatory Response in COVID-19: A Systematic Review. Viruses. 2023; 15(2). PMC: 9962879. DOI: 10.3390/v15020553. View

Rudroff T . The challenges of post-COVID-19 fatigue research. Front Psychol. 2023; 14:1120928. PMC: 10083308. DOI: 10.3389/fpsyg.2023.1120928. View

10.

Sanal-Hayes N, Mclaughlin M, Hayes L, Berry E, Sculthorpe N . Examining Well-Being and Cognitive Function in People with Long COVID and ME/CFS, and Age-Matched Healthy Controls: A Case-Case-Control Study. Am J Med. 2024; . DOI: 10.1016/j.amjmed.2024.04.041. View

11.

Steiber N . Strong or Weak Handgrip? Normative Reference Values for the German Population across the Life Course Stratified by Sex, Age, and Body Height. PLoS One. 2016; 11(10):e0163917. PMC: 5049850. DOI: 10.1371/journal.pone.0163917. View

12.

Fietsam A, Bryant A, Rudroff T . Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19. Exp Brain Res. 2022; 241(1):211-219. PMC: 9735153. DOI: 10.1007/s00221-022-06518-0. View

13.

Singh S, Daynes E, McAuley H, Raman B, Greening N, Chalder T . Balancing the value and risk of exercise-based therapy post-COVID-19: a narrative review. Eur Respir Rev. 2023; 32(170). PMC: 10731468. DOI: 10.1183/16000617.0110-2023. View

14.

Cornelissen M, Bloemsma L, Vaes A, Baalbaki N, Deng Q, Beijers R . Fatigue and symptom-based clusters in post COVID-19 patients: a multicentre, prospective, observational cohort study. J Transl Med. 2024; 22(1):191. PMC: 10880228. DOI: 10.1186/s12967-024-04979-1. View

15.

Velez-Santamaria R, Fernandez-Solana J, Mendez-Lopez F, Dominguez-Garcia M, Gonzalez-Bernal J, Magallon-Botaya R . Functionality, physical activity, fatigue and quality of life in patients with acute COVID-19 and Long COVID infection. Sci Rep. 2023; 13(1):19907. PMC: 10645778. DOI: 10.1038/s41598-023-47218-1. View

16.

Mateo L, Chu L, Stevens S, Stevens J, Snell C, Davenport T . Post-exertional symptoms distinguish Myalgic Encephalomyelitis/Chronic Fatigue Syndrome subjects from healthy controls. Work. 2020; 66(2):265-275. DOI: 10.3233/WOR-203168. View

17.

Twomey R, DeMars J, Franklin K, Culos-Reed S, Weatherald J, Wrightson J . Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study. Phys Ther. 2022; 102(4). PMC: 9383197. DOI: 10.1093/ptj/pzac005. View

18.

Kluger B, Krupp L, Enoka R . Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology. 2013; 80(4):409-16. PMC: 3589241. DOI: 10.1212/WNL.0b013e31827f07be. View

19.

Froehlich L, Hattesohl D, Jason L, Scheibenbogen C, Behrends U, Thoma M . Medical Care Situation of People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in Germany. Medicina (Kaunas). 2021; 57(7). PMC: 8306083. DOI: 10.3390/medicina57070646. View

20.

Ladlow P, Bennett A, OSullivan O . Exercise Therapy for Post-COVID-19 Condition-Does No Harm. JAMA Netw Open. 2024; 7(4):e246959. DOI: 10.1001/jamanetworkopen.2024.6959. View