Effectiveness of exercise training on the dyspnoea of individuals with long COVID: A randomised controlled multicentre trial 2023 Romanet et al

Highlights

• After COVID-19 infection, symptoms such as dyspnoea may persist.
  
  
• In respiratory diseases, dyspnoea reduces health-related quality of life.
  
  
• Physiotherapy and rehabilitation are both currently recommended in this context.
  
  
• A 3-month course of exercise training rehabilitation (ETR) decreased dyspnoea.
  
  
• Standard physiotherapy was not found to reduce dyspnoea or improve quality of life.

Abstract

Background
COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition.

Objectives
To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS.

Methods
In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores.

Results
Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10−4).

Conclusion
People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).

Open access, https://www.sciencedirect.com/science/article/pii/S1877065723000362

 

No mention of PEM/PESE that I could find.

 

A great shame that there doesn’t seem to be consideration of the likely heterogeneity of Long Covid.

For those whose breathlessness is the result of one off impairment arising during the acute infection the right form of exercise may be expected to help, but for those whose initial infection triggered an ongoing disease process including those that present with PEM, so presumably also have ME/CFS, surely the most rational solution is to address that ongoing condition.

This is what the paper says about subject selection:

Though it may be that this approach may have had the effect of selecting those whose issues where primarily the result of one off impact during the acute infection, as @Andy points out, they do not mention PEM leaving us with no idea whether any people meeting the diagnostic criteria for ME/CFS were included or not.

 

They were all ICU admissions, with significant COVID-induced ARDS, exclusions were <48 hours of invasive mechanical ventilation, so they had severe lung injury.

I would expect they would correlate with the breathless/non-fatigue sub-group as outlined in Monocyte migration profiles define disease severity in acute COVID-19 and unique features of long COVID (2023).

 

This is an unblinded study with subjective outcome measures, meaning we're unlikely to learn anything from it.