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Journal Article Randomized Controlled Trial Epublish 37 citations

PubMed: 39978856 DOI: 10.1183/13993003.02152-2024

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation.

Eur Respir J 65(5)

Authors: Enya Daynes, Rachael A Evans, Neil J Greening, Nicolette C Bishop, Thomas Yates, Daniel Lozano-Rojas, Kimon Ntotsis, Matthew Richardson, Molly M Baldwin, Malik Hamrouni, Emily Hume, Hamish McAuley, George Mills, Dimitrios Megaritis, Matthew Roberts, Charlotte E Bolton, James D Chalmers, Trudie Chalder, Annemarie B Docherty, Omer Elneima, Ewen M Harrison, Victoria C Harris, Ling P Ho, Alex Horsley, Linzy Houchen-Wolloff, Olivia C Leavy, Michael Marks, Krishna Poinasamy, Jennifer K Quint, Betty Raman, Ruth M Saunders, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Sarah Terry, Louise V Wain, William D-C Man, Carlos Echevarria, Ioannis Vogiatzis, Christopher Brightling, Sally J Singh

Affiliations

  • The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.
  • Department of Respiratory Sciences, University of Leicester, Leicester, UK.
  • The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.
  • National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
  • NIHR Leicester Biomedical Research Centre - Diabetes, Leicester, UK.
  • Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
  • Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
  • Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
  • NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
  • University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
  • Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
  • Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK.
  • MRC Human Immunology Unit, University of Oxford, Oxford, UK.
  • NIHR Oxford Biomedical Research Centre, Oxford, UK.
  • Manchester University NHS Foundation Trust, Manchester, UK.
  • Department of Population Health Sciences, University of Leicester, Leicester, UK.
  • Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
  • Hospital for Tropical Diseases, University College London Hospital, London, UK.
  • Asthma and Lung UK, London, UK.
  • School of Public Health, Imperial College London, London, UK.
  • Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
  • Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
  • Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • National Heart and Lung Institute, Imperial College, London, UK.
  • King's Centre for Lung Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
  • The Newcastle upon Tyne Hospitals NHS Foundation Trust, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.

Abstract

OBJECTIVE

Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≥12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19.

DESIGN

This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping.

RESULTS

181 participants (55% male, mean±sd age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19-85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1-66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8 + T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31).

CONCLUSION

Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.

MeSH

Exercise, Quality Of Life, Respiratory Tract Diseases, Respiration, Rehabilitation, Signs And Symptoms, Covid-19

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