Exercise Intolerance in Post-COVID Patients (EXILE)

mango · Jun 11, 2023

Exercise Intolerance in Post-COVID Patients (EXILE)
https://clinicaltrials.gov/ct2/show/NCT05445830?term=tryfonos&draw=2&rank=1

Official study title:
Physiological Characterization of Functional Limitations and Exercise Intolerance in Post-COVID Patients

Thomas Gustafsson, Helene Rundqvist, Tommy Lundberg, Kaveh Pourhamidi, Andrea Tryfonos

Karolinska Institutet, Karolinska University Hospital, Sweden

"Brief Summary:

The post-COVID syndrome poses an unprecedented challenge to modern society, affecting millions of people worldwide. Persistent fatigue and exercise intolerance are among the most common complaints of these subjects. The mechanisms of exercise intolerance in post-COVID subjects are remained yet unknown, which make the rehabilitation efforts complex and challenging.

The overall goals of this project are to:
1) improve physiological understanding of symptoms in this clinical condition,
2) elucidate plausible mechanisms to explain exercise intolerance/symptom exacerbation, and finally
3) provide knowledge that can be directly applied in the clinical setting to improve diagnosis, care, and individualized rehabilitation of subjects with post-COVID syndrome.

Post-COVID subjects and age/sex matched healthy controls will undertake a comprehensive set of physiological and functional assessments, followed by 3 experimental visits (in a randomized order), where acute exercise responses will be assessed in either continuous moderate intensity aerobic exercise, high intensity interval exercise, or strength training.

The same set of physiological assessments will also be performed after 1 year in both post-COVID subjects and healthy-matched controls to better understand the time course of the syndrome.

It is hypothesized that the mechanism responsible for exercise intolerance is linked to specific symptoms and will vary across subjects. However, it is expected that most post-COVID subjects will respond well to at least one type of exercise."

mango · Jun 11, 2023

Article i one of Sweden's biggest newspapers:

Trotsade postcovid-råd – Sanna, 41, springer igen
https://www.svd.se/a/bgWL63/postcovidsjuka-sanna-springer-igen-trots-traningsintolerans

Auto-translate said:

Defied post-covid advice - Sanna, 41, runs again
[...] Sanna had heard about the similarity between poscovid and the disease myalgic encephaloyelitis (ME), which is characterised by fatigue, severe complicated tiredness and PEM, post-exertional malaise. Her symptoms were similar to those of ME.

- 'I had a strong feeling that this will never go away,' says Sanna.

'I felt more sick and tired after activity, but over time the feeling decreased'

It's hard to be sure what was happening. Sanna knows several people who have recovered spontaneously from post-covid. But she doesn't think it was spontaneous for her, because she has had to fight hard.

It all started when she read an article about a person with fatigue. In this case, the person had ME and had recovered with behavioural therapy.

- 'Reading that story filled me with such hope, because I realised that I too could get better, maybe healthy. That day I got up," she says.

Two weeks later, Sanna started working again
Click to expand...

Auto-translate said:

It is known that many people with post-covid experience PEM, post-exertional malaise, but today it is unclear why. Andrea Tryfonos is a researcher in clinical physiology at Karolinska Institutet and is currently conducting a large exercise study to understand this. The hope is that the studies will lead to a rehabilitation programme.

- Many people are afraid to exercise because they experience worse symptoms, such as more brain fatigue, several days after exercising. But it is not bad to exercise. Avoiding exercise, on the other hand, will affect the organs negatively," she says.

In the study, more than 30 people with postcovid - and the same number without - will complete three different exercise programmes: a high-intensity cycling session, a low-intensity session and a strength session, while wearing equipment that measures how the body reacts.

- We want to understand what makes the symptoms worse. We intend to test all proposed hypotheses," says Andrea Tryfonos. [...]

- 'The 30 participants with post-covid that we have tested so far said they didn't feel so bad two days afterwards,' she says. [...]

- 'My view is that patients need to know which organ or organs are failing. But it may be that we cannot link the exercise intolerance to any of the examined organs, in which case that is also good knowledge, at least we know what it is not due to. In such cases, we need to look at the brain," she says.
Click to expand...

Auto-translate said:

Physiotherapist Malin Nygren Bonnier was one of the initiators of the post-covid clinic that Sanna visited. According to her, it is a misinterpretation that you have found a reasonable level of activity if you work 25 per cent and lie in bed for large parts of the day. Getting that message, as Sanna did, doesn't sound right to her.

- "We've become sharper here. Even though it can be difficult for patients, they need to get started with physical activity in order to move forward," she says.

Malin Nygren Bonnier noticed early on that the post-covid patients were exercise intolerant.

- "We physiotherapists began to understand quite quickly that the activity needs to have the right intensity and be increased in small doses." [...]

As a researcher in physiotherapy at Karolinska Institutet, she is also conducting studies to find out the best method of physical training for POTS, which involves pulse surges when standing up.

- 'I've had many discussions with cardiologists and there is nothing dangerous that can happen, although it is unpleasant for the patients. But it is important that they receive individualised professional rehabilitation and are allowed to increase the dosage in small steps," she says.
Click to expand...

mango · Jun 11, 2023

A previous study Tryfonos has been involved in:

Post-exercise endothelial function is not associated with extracellular vesicle release in healthy young males
https://cdnsciencepub.com/doi/abs/10.1139/apnm-2022-0278

mango · Jun 11, 2023

Info about the POTS study mentioned by the physiotherapist Malin Nygren-Bonnier in the news article linked above.

Physical Training in Patients With POTS After Covid-19 (POTS-ReCOV)
https://clinicaltrials.gov/ct2/show/NCT05094622?term=malin+nygren+bonnier&draw=2&rank=3

...and some other studies she is currently involved in:

ReCOV - Recovery and rehabilitation after COVID-19
https://ki.se/nvs/recov-recovery-and-rehabilitation-after-covid-19

Effects of Individual Tailored Physical Exercise in Patients With POTS After COVID-19 - a Randomized Controlled Study (RCT-POTS-ReCov)
https://clinicaltrials.gov/ct2/show/NCT05877534?term=malin+nygren+bonnier&draw=2&rank=2

Effects of Inspiratory Muscle Training After Covid-19 (ReCOV) (IMT-ReCov)
https://clinicaltrials.gov/ct2/show/NCT05024474?term=malin+nygren+bonnier&draw=2&rank=1

Sean · Jun 12, 2023

"We've become sharper here. Even though it can be difficult for patients, they need to get started with physical activity in order to move forward," she says.

Malin Nygren Bonnier noticed early on that the post-covid patients were exercise intolerant.

- "We physiotherapists began to understand quite quickly that the activity needs to have the right intensity and be increased in small doses." [...]
Click to expand...

They have understood nothing.

RedFox · Jun 12, 2023

They're enrolling a decent number of participants and measuring a lot of things. We have a decent chance to learn a little about PEM from this.

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Exercise Intolerance in Post-COVID Patients (EXILE)

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