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

PHOSP-COVID Study Collaborative Group, 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. DochertyOmer 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

*Corresponding author for this work

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Abstract

Objective
Post-COVID syndrome involves prolonged symptoms with multi-system and functional impairment lasting at least 12 weeks after acute 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 of acute COVID-19.

Design
This single-blind randomised controlled trial compared two COVID 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 eight-week program of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following eight 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 [95% CI 19 to 85]m, p=0·002) and remote rehabilitation (mean 34 [95% CI 1 to 66]m, p=0·047) compared to usual care alone. There were no differences between groups for HRQoL of 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.
Original languageEnglish
Article number2402152
Number of pages14
JournalEuropean Respiratory Journal
Volume65
Issue number5
Early online date20 Feb 2025
DOIs
Publication statusPublished - May 2025

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