Hypothesis An Exercise Immune Fitness test to unravel mechanisms of post-acute sequelae of COVID-19, 2023, Deng

The Post-Acute Sequelae of COVID-19 (PASC) Syndrome is a debilitating syndrome with onset three months post COVID-19 infection, marked by the presence of fatigue, headache, cognitive dysfunction, post-exertional malaise, orthostatic intolerance, and dyspnea that is clinically relevant and is at least as severe as fatigue in several other clinical conditions, including cancer. The onset, progression, and symptom profile of PASC patients have considerable overlap with Myalgic-Encephalopathy/Chronic Fatigue Syndrome (ME/CFS). In people with ME/CFS, exercise (and other types of exertion) can cause serious setbacks and deterioration in function. Post-exertional malaise (PEM) appears to be a common and a significant challenge for the majority of this patient group.

Of the nearly 24 million adults in the U.S. who currently have long COVID, more than 80% are having some trouble carrying out daily activities. Mechanisms of PACS remain poorly understood. While multi-omic information gathered at the time of acute COVID-19 onset may help predict long COVID outcomes, we here propose to test the hypothesis that additional molecular immunological information collected during standardized exercise-testing for cardio-respiratory fitness after recovery from acute COVID-19 can be used to improve the understanding of mechanisms of PASC.

Open access, https://www.tandfonline.com/doi/full/10.1080/1744666X.2023.2214364

 

"Persons will be scheduled 3-9 months post-COVID-19 diagnosis for a clinically indicated cardiopulmonary exercise test and will have ACD, CPT, and PAX-gene tubes drawn 30 minutes before, at peak, and 1 hour after CPET testing. We expect that out of 200 COVID-19 patients, 50 patients will have 1-year PASC outcomes"

"We anticipate that the results will identify a proportion of PASC patients who are not benefitting from exercise training post-acute COVID-19. These result expectations are based on the current literature. Reviewing the effect of exercise rehabilitation on COVID‑19 outcomes [63], the majority of studies supported the beneficial effects of exercise rehabilitation in post-acute-COVID-19; however, there was seemingly a subset in whom the positive effect of exercise rehabilitation was not established."

"In survivors of COVID-19-related critical illness, ME/CFS and PEM, there currently is uncertainty about the post-ICU discharge benefit of exercise-based interventions, specifically with respect to target populations, optimum intervention dosing, best usual care protocols, and standardized outcome reporting in the most rigorous scientific manner [66] including in patients with severe respiratory illness requiring critical care"

"In summary, we propose to test the hypothesis that information collected during standardized exercise-testing for cardio-respiratory fitness after recovery from acute COVID-19 can be used to enhance our understanding of immunological mechanisms and provide improved guidance for appropriate interventions for patients suffering from the PASC Syndrome that affects – as per 2022 - nearly 24 million adults in the US alone, more than 80% of whom are having some trouble carrying out daily activities and may be considered disabled under the Americans with Disabilities Act "