Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation.
Daynes E., Evans RA., Greening NJ., Bishop NC., Yates T., Lozano-Rojas D., Ntotsis K., Richardson M., Baldwin MM., Hamrouni M., Hume E., McAuley H., Mills G., Megaritis D., Roberts M., Bolton CE., Chalmers JD., Chalder T., Docherty AB., Elneima O., Harrison EM., Harris VC., Ho LP., Horsley A., Houchen-Wolloff L., Leavy OC., Marks M., Poinasamy K., Quint JK., Raman B., Saunders RM., Shikotra A., Singapuri A., Sereno M., Terry S., Wain LV., Man WD-C., Echevarria C., Vogiatzis I., Brightling C., Singh SJ., PHOSP-COVID Study Collaborative Group None.
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.