Physiology of Long COVID-19 and the Impact of Cardiopulmonary Rehabilitation on Quality-of-Life and Functional Capacity
Study Details
Study Description
Brief Summary
The primary objectives of this study are to establish exercise training as a novel intervention to treat Long COVID and characterize the cardiorespiratory and autonomic physiology in these patients to precisely characterize mechanisms contributing to this syndrome.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Abnormalities observed among Long COVID patients are consistent with cardiac deconditioning. The Long COVID syndrome has been attributed to dysautonomia and/or postural orthostatic tachycardia syndrome (POTS) based largely on anecdotal experience and observations of positional tachycardia among affected individuals. However, it has been emphasized that data are clearly lacking to implicate dysautonomia alone as the cause of Long COVID. Alternatively, cardiac deconditioning leads to a constellation of symptoms, including exercise intolerance, brain fog/cognitive impairments, tachycardia and orthostatic intolerance, all of which are reported among reported among patients with Long COVID. Multiple studies have demonstrated that cardiac deconditioning may occur with as little as 20 hours of bedrest. Exercise training improves cardiorespiratory performance among patients suffering from cardiac deconditioning. Exercise training improves HR regulation and cardiovascular function during submaximal and peak exercise, and improves overall exercise capacity particularly among individuals with cardiac deconditioning following bedrest (e.g. Dallas bedrest studies) and among individuals with postural orthostatic tachycardia syndrome. Our preliminary data demonstrate a significant improvement/resolution in Long-COVID symptoms following a twelve-week exercise training program in a community setting. During the height of the COVID pandemic, the investigators developed an exercise protocol that has been used in the clinical setting to assist with management of patients suffering from Long COVID. This protocol involves recumbent/semi-recumbent exercise - specifically, rowing or cycling on a recumbent ergometer.
This proposal involves a clinical trial involving a two-aim initiative whereby participants with Long COVID will be randomized to a 12-week period of exercise training v. usual care ("controls") with baseline and follow-up assessments in order to: 1) Establish exercise training as a novel treatment strategy for management of Long COVID (Aim 1); and 2) Characterize cardiovascular/autonomic physiology among patients with Long COVID (Aim 2).
There will be a total of 4 visits for testing.
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Baseline Evaluation
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Visit 1: non-invasive baseline assessment. Visit length ~2 hours.
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Visit 2: invasive baseline assessment. Visit length ~3 hours.
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Visit 3: non-invasive, post-exercise assessment. Protocol identical to Visit 1
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Visit 4: invasive, follow-up assessment. Protocol identical to Visit 2.
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Following completion of Visits 1 and 2, participants will be randomized in a 1:1 ratio to either: 1) Twelve weeks of exercise training (N=15); or 2) Twelve weeks of conservative management (N=15). Thereafter, all participants will complete follow-up evaluation with noninvasive assessment (Visit 3) and invasive assessment (Visit 4), identical to the protocol for Visits 1-2.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Exercise
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Behavioral: Exercise
exercise protocol
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| No Intervention: Control
|
Outcome Measures
Primary Outcome Measures
- Characterizing the impact of exercise training (cardiac rehabilitation) on functional capacity among patients with Long COVID [12 weeks]
functional capacity as determined by VO2max
- Characterizing the impact of exercise training (cardiac rehabilitation) on HRqOL among patients with Long COVID [12 weeks]
Health-related quality of life (HRqOL) from SF-36 form; all items are scored so that a high score defines a more favorable health state. In addition, each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively.
Secondary Outcome Measures
- Characterization of abnormalities contributing to Long COVID [>12 weeks]
- Identify the mechanism by which exercise training improves functional capacity and HRqOL among patients with Long COVID [> 12 weeks]
Health-related quality of life (HRqOL) from SF-36 form; all items are scored so that a high score defines a more favorable health state. In addition, each item is scored on a 0 to 100 range so that the lowest and highest possible scores are 0 and 100, respectively.
Eligibility Criteria
Criteria
Inclusion Criteria:
- Adults ≥18 years with documented history of COVID-19 infection and symptoms consistent with Long COVID lasting >4 weeks after diagnosis.
Exclusion Criteria:
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History of cardiovascular/pulmonary disease prior to infection
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COVID-related myocardial injury such as evidence of myocarditis
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Deep vein thrombosis/pulmonary embolism following COVID-19 infection
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Exercise intolerance resulting from conditions that are not related to cardiorespiratory or autonomic factors (e.g. osteoarthritis or other musculoskeletal diseases);
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Dependency of supplemental oxygen following COVID infection due to cardiovascular and/or pulmonary complications following acute COVID infection
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body mass index > 35kg/m2
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age of greater than 65 years.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- University of Colorado, Denver
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Larsen NW, Stiles LE, Miglis MG. Preparing for the long-haul: Autonomic complications of COVID-19. Auton Neurosci. 2021 Nov;235:102841. doi: 10.1016/j.autneu.2021.102841. Epub 2021 Jul 3.
- Mancini DM, Brunjes DL, Lala A, Trivieri MG, Contreras JP, Natelson BH. Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post-Coronavirus Disease. JACC Heart Fail. 2021 Dec;9(12):927-937. doi: 10.1016/j.jchf.2021.10.002.
- Mitchell JH, Levine BD, McGuire DK. The Dallas Bed Rest and Training Study: Revisited After 50 Years. Circulation. 2019 Oct 15;140(16):1293-1295. doi: 10.1161/CIRCULATIONAHA.119.041046. Epub 2019 Oct 14. No abstract available.
- Saltin B, Blomqvist G, Mitchell JH, Johnson RL Jr, Wildenthal K, Chapman CB. Response to exercise after bed rest and after training. Circulation. 1968 Nov;38(5 Suppl):VII1-78. No abstract available.
- Writing Committee; Gluckman TJ, Bhave NM, Allen LA, Chung EH, Spatz ES, Ammirati E, Baggish AL, Bozkurt B, Cornwell WK 3rd, Harmon KG, Kim JH, Lala A, Levine BD, Martinez MW, Onuma O, Phelan D, Puntmann VO, Rajpal S, Taub PR, Verma AK. 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 May 3;79(17):1717-1756. doi: 10.1016/j.jacc.2022.02.003. Epub 2022 Mar 16. No abstract available.
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