Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation
Enya Daynes, Rachael A Evans, Neil 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 J Roberts, Charlotte E. Bolton, James D Chalmers, Trudie Chalder, Annemarie B Docherty, Omer Elneima, Ewen M Harrison, Victoria Harris, Ling‐Pei Ho, Alex Horsley, Linzy Houchen-Wolloff, Olivia C. Leavy, Michael Marks, Krishna Poinasamy, Jennifer K Quint, Betty Raman, Ruth Saunders, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Sarah Terry, Louise V. Wain, William D‐C Man, Carlos Echevarria, Ioannis Vogiatzis, Christopher E. Brightling, Sally Singh
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.