Trial Report Functional Limitations and Exercise Intolerance in Patients With Post-COVID Condition A Randomized Crossover Clinical Trial, 2024, Tryfonos et al

[Kalliope]

Professor Karl Lauterbach, the German Minister of Health comments the study on X:

Neue Studie aus Stockholm zu Exercise mit Post-COVID Symptomen ist sehr relevant. Eine Studie kann Frage der gezielten Belastung #Post-COVID nicht beantworten. Trotzdem ein wichtiger Hoffnungsschimmer. Werden wir mit Experten ⁦@BMG_Bund besprechen

Auto translation:
New study from Stockholm on exercise with post-COVID symptoms is very relevant. A study cannot answer the question of targeted exercise #Post -COVID. Nevertheless, an important glimmer of hope. We will discuss it with experts ⁦@BMG_Bund



⁩

Karl Lauterbach has replied to a tweet from Eric Topol about the study:

Eric Topol:
With tens of millions of people suffering from #LongCovid around the world, I don't see how recommendations for exercise can be based on a trial of 62 participants (half were controls)

Karl Lauterbach (auto translated):
I agree @EricTopol, I certainly see it that way too. A single study that goes against the existing evidence needs to be discussed. But it doesn't change any guidelines. We do that with our experts, like Ms. @C_Scheibenbogen, who has already expressed her criticism.

https://twitter.com/user/status/1776888815229055187

 

[SNT Gatchaman]

16% (5/31) of PCC dropped out of the study after the initial CPET (1), first (3) or second (1) exercise sessions.

This study had again been posted on BlueSky so I had occasion to look at the study flowchart (fig 1) again. The drop-out figures are actually worse than this because they recorded drop-outs at two time points following physiological characterisation (either side of "included in the study").

After initial inclusion/exclusion criteria were met 70 participants underwent physiological characterisation. 34 were PCC, 36 where HCs.

Spoiler: Physiological characterisation included: CPET, HUTT, 6MWT, handgrip, leg extensions. Summarising:

All participants underwent standard spirometry and echocardiography according to clinical guidelines. Cardiopulmonary exercise testing was performed on a cycle ergometer (increments of 10-25 W/min) with a continuous gas analyzer to determine aerobic capacity as peak volume of oxygen consumption (VO2) and ventilatory threshold (VT) using the V-slope method. Lactate concentration was measured at the earlobe before and every 2 minutes during CPET; the onset of blood lactate accumulation at 4 mmol/L was assessed.

Orthostatic tolerance was assessed by the head-up tilt test (HUTT) with continuous hemodynamic monitoring according to guidelines. Clinical outcomes, including postural orthostatic tachycardia syndrome (POTS), were determined based on consensus criteria.

Arterial stiffness was assessed by aortic pulse wave velocity using arteriography. The 6-minute walk test assessed physical function, whereas upper- and lower-body muscle strength were measured using handgrip dynamometry and isokinetic dynamometry, respectively.

Following the physiological characterisation, which is itself a series of exertion challenges / exercise tests, 3 PCC dropped out, 2 prior to being "included in the study" and 1 after that point. (1 PCC who was initially deemed eligible was also excluded due to unspecified "abnormal findings" at physiological characterisation). Then 3 PCC dropped out after randomised exercise session #1 and 1 PCC dropped out after randomised exercise session #2. That left 26 PCC that completed the three randomised exercise sessions.

So, of the 34 PCCs that did the exercise challenges of initial physiological characterisation, 7 dropped out (+1 other with abnormal findings). 7/34 is 20.6%.

Of the 36 HCs that underwent physiological characterisation, 4 (11.1%) dropped out. 3 had abnormal findings, so were in fact not HCs but otherwise we might assume that the 4 that did drop out were actually healthy and did so for non-relevant / non-biological / personal circumstance reasons.

It would be good to know why the 20.6% vs 11.1% drop-out rate occurred and in particular why each of the PCCs discontinued their participation.

 

[Kalliope]

Jama Researchers See Hope in Symptom-Guided Exercise for Long COVID With Postexertional Malaise

Quotes:

The World Health Organization defines PESE, more commonly known as postexertional malaise, as the “worsening of symptoms that can follow minimal cognitive, physical, emotional, or social activity, or activity that could previously be tolerated.” The condition has some symptoms overlapping those of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). However, the appropriate exercise protocols for patients with long COVID who experience PESE remain largely unstudied.

Some researchers think it’s time to better understand exercise tolerance and acceptability as part of rehabilitation to help these individuals get back to daily life.

...

“We are not saying that the exercise can treat post-COVID,” Tryfonos said. “But we know that not only in post-COVID, in any other disease, if you stop doing exercise in the long run, it’ll affect your body, it’ll affect your heart, it’ll affect your vessels. It’ll affect pretty much everything.”

Ladlow considers strategies to increase physical function and prevent secondary health conditions in patients with long COVID a global priority.


...

Cynthia Adinig, a patient advocate based in Virginia, said that in addition to long COVID, she has also been diagnosed with ME/CFS and postural tachycardia syndrome, among other health issues. Navigating symptoms daily, she likens experiencing an ME/CFS symptom flare to “feeling like my cells are filled with lead.”

In an interview, Adinig voiced concerns about broadly applying the new study’s findings. She worries about the potential for the exercise approaches to induce debilitating symptom flares.

“I don’t think they understand how much the uncertainty of the timeline of a flare really devastates a patient,” she said.

 

[rvallee]

So, the exact same thing, but with different words. Good grief. This is why the subject can't even be broached, that we basically have to categorically shut the door to it because even when it recognizes what's always been denied, PEM/PESE, they just want to do the same thing for the same reason anyway, and they'll lie to our faces for it if they have to, which they generally do. Even though it's a complete contradiction. Let's treat radiation poisoning with more radiation, because that's how radiation poisoning has long been treated. Gah!

And people are always calling for more research, but it always ends up with "acceptability as part of rehabilitation to help these individuals get back to daily life". Which just means the same old nonsense looping around for more years. They're not saying that it treats it, but this is exactly how it's handled anyway, nuance is not possible here, misinterpretation is the only possible option. The very framing that it brings 'hope', which makes no sense at all here, says everything.

We're already literally several years into "it's not a cure, it just may be of help to some". And nothing matters. This is brain-dead ideology.

if you stop doing exercise in the long run, it’ll affect your body, it’ll affect your heart, it’ll affect your vessels. It’ll affect pretty much everything.

Then treat the damn illness! The illness, PEM, is the only reason why people aren't active. This is not hard, a freaking dog can understand this.

 

[SNT Gatchaman]

There's a follow-on paper, but given the problems with the cohort as outlined in this thread I'm not sure it's worth posting separately. I'll record it here.

Non-Hospitalized Patients With Post-COVID Condition and Myopathic Electromyography Findings Show no Difference in Symptom Severity and Clinical Manifestations Compared to Those Without Myopathic Findings (2024)
Atif Sepic; Andrea Tryfonos; Helene Rundqvist; Tommy R. Lundberg; Thomas Gustafsson; Kaveh Pourhamidi

INTRODUCTION
The COVID-19 pandemic has resulted in a post-infectious syndrome designated as long-COVID or post-COVID condition (PCC) that presents with numerous symptoms including fatigue and myalgias. This study evaluated myopathic electromyography (EMG) findings in non-hospitalized PCC patients in relation to symptom severity, quality of life (QoL), and physical function.

METHODS
Twenty-nine PCC patients with persistent symptoms ≥ 3 months after laboratory-confirmed SARS-CoV-2 infection, without hospitalization or comorbidities, were included. EMG, nerve conduction studies (NCS), and quantitative sensory testing (QST) were performed. Symptom severity was measured with visual analog scales, QoL with validated questionnaires, and physical function with the 6-min walk test, cardiopulmonary exercise testing, handgrip strength, and isokinetic dynamometry.

RESULTS
Myopathic findings on EMG were present in 62% of PCC patients (n = 18). Symptom severity (muscle pain and fatigue) and QoL (physical function and fatigue) were similar between patients with and without myopathic EMG findings. The 6-min walk test (457 ± 81 vs. 459 ± 86 m) and peak VO2 (29 ± 9 vs. 28 ± 6 mL/kg/min) were similar between patients with and without myopathic EMG findings. Handgrip strength (32 [29–43] vs. 33 [29–50] kg) and quadriceps muscle strength (136 [111–191] vs. 136 [114–184] Nm) were comparable between the groups. NCS and QST results were normal in all patients.

DISCUSSION
Myopathic findings on EMG are common in PCC patients, but no significant differences in symptom severity, QoL, or physical function were found between those with and without myopathic EMG findings. Myopathic EMG changes in PCC patients should be interpreted with caution, considering the overall clinical context.

Link | PDF (Muscle & Nerve) [Open Access]