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

Christophe Romanet, Johan Wormser, Audrey Fels, Pauline Lucas, Camille Prudat, Emmanuelle Sacco, Cédric Bruel, Gaëtan Plantefève, Frédéric Pene, Gilles Chatellier, François Philippart, Christophe Romanet, Johan Wormser, Audrey Fels, Pauline Lucas, Camille Prudat, Emmanuelle Sacco, Cédric Bruel, Gaëtan Plantefève, Frédéric Pene, Gilles Chatellier, François Philippart

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).

Keywords: ARDS; COVID-19; Dyspnoea; HRQOL; Long COVID; Physiotherapy; Rehabilitation.

Conflict of interest statement

Declaration of Competing Interest None.

Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram illustrating recruitment and analysis in a study comparing the effect of exercise therapy rehabilitation versus standard physiotherapy on dyspnoea in people previously hospitalised with COVID-19-related acute respiratory distress syndrome (CARDS). This was an intention-to-treat trial thus participant data were analysed with their initially allocated treatment group, even though 7 patients ultimately received the other treatment. This 'imperfection' reflected the real-life effect of patient free choice. Dyspnoea was measured by the Modified Medical Research Council dyspnoea scale (mMRC).
Fig. 2
Fig. 2
Box and whisker plots comparing multidimensional dyspnoea profile (MDP) data for groups receiving exercise training rehabilitation and standard physiotherapy at baseline and 90 days. The middle horizontal line represents the median. Whisker values are the lower quartile minus 1·5 times the interquartile range, or the upper quartile plus 1·5 times the interquartile range. Means are represented by a red asterisk. X-axis categories: D0, Day 0 or baseline data; D90, data at 90 days, end of the study; MDP scores (shown on y-axis) ranged from 0 to 110 (a higher score indicated greater breathlessness).
Fig. 3
Fig. 3
Comparison of multidimensional dyspnoea profile (MDP) changes for people previously hospitalised with COVID-19-related acute respiratory distress syndrome who received exercise training rehabilitation (ETR) or standard physiotherapy (SP) for 90 days. MDP subcategories (y-axis) were breathing discomfort (Fig. 3A), sensory dimension (Fig. 3B) and emotional response (Fig. 3C). The middle horizontal line represents the median; outliers are displayed as separate black points. Whisker values are the lower quartile minus 1·5 times the interquartile range or the upper quartile plus 1·5 times the interquartile range. Means are represented by a red asterisk. X-axis categories: D0, Day 0 or baseline data; D90, data at 90 days, end of the study; MDP scores ranged from 0 to 10 (breathing discomfort), 0–50 (sensory dimension), and 0–50 (emotional response). For all MDP scores, higher values indicated greater breathlessness.

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