Long COVID
Conditions
Keywords
Telerehabilitation, Long COVID, cardiorespiratory fitness, quality of life, long COVID symptoms
Brief summary
Patients with long coronavirus disease (COVID-19) experience multisystem symptoms and reduced quality of life (QOL). Proactive interventions are needed to enhance health outcomes.To investigate the effects of a 12-week tele-exercise training program on long COVID symptoms, cardiorespiratory fitness, and QOL.
Detailed description
Long COVID is a multi-organ condition with persistent or delayed symptoms lasting weeks after infection, affecting physical and psychological function and reducing quality of life. It can occur regardless of age or initial disease severity, with prevalence ranging from 30% to 87.4%. Common symptoms include fatigue, cardiopulmonary issues, and neurological problems, collectively impairing daily functioning and mental health. Exercise-based rehabilitation, including tele-exercise training, has emerged as a practical management strategy and may improve symptoms, cardiorespiratory fitness, and quality of life. However, current evidence remains limited due to small sample sizes and inconsistent protocols. Therefore, this study evaluated the effects of a 12-week tele-exercise program on symptoms, fitness, and quality of life in Taiwanese patients with long COVID compared with usual care.
Interventions
DEVICETelehealth exercise training program
Each participant received an individual exercise counselling session lasting 10-15 minutes, based on the guidelines of the American College of Sports Medicine. Participants in the home-based telehealth exercise group were provided with a mobile exercise application integrated with heart rate-monitoring clothing. The app delivers real-time heart rate feedback during each session and includes an alert system to ensure participants maintain their prescribed target heart rate based on individualized exercise prescriptions. Upon completion of each session, exercise duration and heart rate data are automatically uploaded to the medical center's cloud system via the monitoring device. An experienced nurse regularly reviewed the cloud-based data to monitor adherence. Additionally, communication between participants and researchers was facilitated through the LINE platform, enabling timely interaction and support.
BEHAVIORALEducation and self-exercise
Each participant received an individual exercise counselling session lasting 10-15 minutes, based on the guidelines of the American College of Sports Medicine. Participants received usual outpatient care for long COVID, which included general guidance on physical activity, physician-led management of persistent symptoms (e.g., fatigue, dyspnea, and reduced exercise tolerance), and routine follow-up visits as clinically indicated.
Sponsors
Tri-Service General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Aged 20-80 years * Diagnosed with long COVID based on the criteria of the World Health Organization * Able to speak and understand Mandarin * Able to ambulate independently * Owns a mobile phone with Internet access * Willing to participate and undergo randomization
Exclusion criteria
* History of arrhythmia * History of mental illness * Pregnancy * Acute or unstable chronic diseases (e.g., recent stroke, ongoing cancer treatment, end-stage renal disease requiring dialysis, or major surgery within the previous 3 months) Comorbid neurological or musculoskeletal conditions (e.g., stroke, Parkinson's disease, or dementia) resulting in moderate-to-severe physical disability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Long COVID Symptoms | 12 weeks | Common long COVID symptoms, based on the participants' subjective reports, include fatigue, shortness of breath, cough, chest pain, palpitations, brain fog, headaches, sleep disturbances, dizziness, changes in taste or smell, and depression or anxiety; these were assessed by a physician using a checklist with a binary response (present or absent). |
| Cardiorespiratory Fitness - Peak Oxygen Uptake (VO₂peak) | 12 weeks | Participants will undergo cardiopulmonary exercise testing using a motorized cycle ergometer with an incremental ramp protocol (10 W/min). The test will continue until participants report physical exhaustion or reach maximal exercise capacity, defined by respiratory exchange ratio criteria. Peak oxygen uptake (VO₂peak, mL/kg/min) will be estimated from maximal cardiac output and oxygen utilization and identified when oxygen consumption plateaus despite increasing exercise intensity. Unit of Measure: mL/kg/min |
| Cardiorespiratory Fitness - Peak Workload | 12 weeks | During cardiopulmonary exercise testing, peak workload (watts) will be recorded as the highest workload achieved on the cycle ergometer. This reflects participants' ability to tolerate increasing exercise intensity. Unit of Measure: watts |
| Cardiorespiratory Fitness - Anaerobic Threshold | 12 weeks | Anaerobic threshold (AT, mL/kg/min) will be determined during cardiopulmonary exercise testing as the point at which energy production begins to shift from aerobic to anaerobic metabolism. Unit of Measure: mL/kg/min |
| Health-Related Quality of Life | 12 weeks | The brief World Health Organization Quality of Life questionnaire includes 26 standardized items covering four domains: physical, psychological, social, and environmental. It also contains two general items assessing overall quality of life and general health. The Taiwanese version adds two culturally specific items related to social respect/acceptance and eating/food. All items are rated on a 5-point Likert scale, where higher scores reflect better quality of life. Scores for each domain are calculated by averaging the item scores within that domain and then multiplying by 4, yielding a final score range from 4 to 20. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Safety and adverse events | 12 weeks | Adverse events were monitored throughout the 12-week intervention. They were defined as any unfavorable or unintended signs, symptoms, or medical conditions occurring during the study that were considered related or possibly related to the intervention and required medical attention, discontinuation of exercise, or modification of the intervention. Mild and transient exercise-related responses, such as expected fatigue or delayed-onset muscle soreness that resolved without medical intervention, were not classified as adverse events, in accordance with standard exercise guidelines. |
Countries
Taiwan
Contacts
PRINCIPAL_INVESTIGATORShang-Lin Chiang, PhD
Tri-Service General Hospital
Outcome results
None listed