Cardiopulmonary Rehabilitation in COVID-19 Longhaulers

NCT ID: NCT04898205

Last Updated: 2021-05-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-21

Study Completion Date

2022-01-20

Brief Summary

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This study will test the efficacy of treadmill exercise combined with supplemental oxygen during exercise and recovery for the treatment of persistent post-acute COVID-19 symptoms. Participants will be pseudo-randomized (stratified by age) to one of four conditions for 8 treatment sessions: 1) treadmill exercise plus supplemental oxygen, 2) treadmill exercise plus air, 3) supplemental oxygen only, 4) air only. All participants will then cross-over and receive 16 additional sessions of treadmill exercise plus supplemental oxygen.

Detailed Description

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This study will test the efficacy of a COVID-19 specific cardiopulmonary rehabilitation protocol for treatment of persistent post-acute COVID symptoms and to study the impact of cardiopulmonary improvement on cognition, mental health, and function. Participants (N=36) with persistent post-acute COVID symptoms will undergo pre-treatment neurocognitive, orthostatic tolerance, and exercise tolerance tests before being pseudo-randomized (stratified by age and sex) to one of four conditions (all of which occur twice a week): 1) 8 sessions of treadmill exercise plus supplemental oxygen, 2) 8 sessions of treadmill exercise plus air, 3) 8 sessions of supplemental oxygen only, and 4) 8 sessions of air only. The pre-treatment testing will be repeated, after which all participants will receive 16 additional sessions of treadmill exercise plus supplemental oxygen, followed by post-treatment testing. All participants will complete baseline measures of physical and mental health, physical function, emotional wellbeing, and coping. A brief symptom measure will be collected daily and physical function, mental health, and emotional wellbeing will be assessed weekly.

Conditions

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Covid19 Viral Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

This study entails 24 treatment sessions. The first 8 sessions involve four experimental conditions: 1) exercise + oxygen (treatment), exercise + air (active control), oxygen only (active control), air only (placebo). Pre-treatment testing will then be repeated, after which all participants will crossover to 16 sessions of exercise + oxygen.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
All participants will be blind to whether they receive supplemental oxygen or air during the first 8 sessions.

Study Groups

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Treadmill Exercise with Supplemental Oxygen

Participants will receive 24 sessions (2 x week for 12 weeks) of treadmill exercise combined with 6 liters per minute of supplemental oxygen via nasal cannula during exercise and 5-minutes of recovery. The first treadmill session will last 25% longer than the exercise tolerance test, but at a lower intensity, such that 80-100% of peak exercise intensity calculated from the exercise tolerance test MET is achieved within three sessions, after which time and intensity will be increased by no more than 0.5 METS, as tolerated based on symptoms and vitals. Heart rate, rhythm, and oxygen saturation will be continuously monitored, and blood pressure readings will be obtained every three to five minutes.

Group Type EXPERIMENTAL

Treadmill Exercise

Intervention Type OTHER

The cardiopulmonary rehabilitation protocol utilizes progressive treadmill exercise with alternating increases in intensity and incline with no more than 0.5 Met increase per session.

Concentrated Oxygen

Intervention Type OTHER

Supplemental oxygen from a concentrator (6 liters per minute) will be provided via nasal cannula regardless of oxygen saturation.

Treadmill Exercise with Air

Participants will receive 8 sessions (2 x week for 4 weeks) of treadmill exercise combined with air delivered via nasal cannula during exercise and 5-minutes of recovery. They will then cross-over to 16 sessions of treadmill exercise combined with 6 liters per minute of supplemental oxygen via nasal cannula during exercise and 5-minutes of recovery. The first treadmill session will last 25% longer than the exercise tolerance test, but at a lower intensity, such that 80-100% of peak exercise intensity calculated from the exercise tolerance test MET is achieved within three sessions, after which time and intensity will be increased by no more than 0.5 METS, as tolerated based on symptoms and vitals. Heart rate, rhythm, and oxygen saturation will be continuously monitored, and blood pressure readings will be obtained every three to five minutes.

Group Type SHAM_COMPARATOR

Treadmill Exercise

Intervention Type OTHER

The cardiopulmonary rehabilitation protocol utilizes progressive treadmill exercise with alternating increases in intensity and incline with no more than 0.5 Met increase per session.

Concentrated Oxygen

Intervention Type OTHER

Supplemental oxygen from a concentrator (6 liters per minute) will be provided via nasal cannula regardless of oxygen saturation.

Concentrated Air

Intervention Type OTHER

Room air will be delivered through an concentrator provided via nasal cannula.

Supplemental Oxygen Only

Participants will receive 8 treatment sessions (2 x week for 4 weeks) of 6 liters per minute of continuous oxygen via nasal cannula for 30 minutes at rest. Heart rate, rhythm, and oxygen saturation will be continuously monitored, and blood pressure readings will be obtained every three minutes. They will then cross-over to 16 sessions of treadmill exercise combined with 6 liters per minute of supplemental oxygen via nasal cannula during exercise and 5-minutes of recovery. The first treadmill session will last 25% longer than the exercise tolerance test, but at a lower intensity, such that 80-100% of peak exercise intensity calculated from the exercise tolerance test MET is achieved within three sessions, after which time and intensity will be increased by no more than 0.5 METS, as tolerated based on symptoms and vitals. Heart rate, rhythm, and oxygen saturation will be continuously monitored, and blood pressure readings will be obtained every three to five minutes.

Group Type SHAM_COMPARATOR

Treadmill Exercise

Intervention Type OTHER

The cardiopulmonary rehabilitation protocol utilizes progressive treadmill exercise with alternating increases in intensity and incline with no more than 0.5 Met increase per session.

Concentrated Oxygen

Intervention Type OTHER

Supplemental oxygen from a concentrator (6 liters per minute) will be provided via nasal cannula regardless of oxygen saturation.

No Intervention

Participants will receive 8 treatment sessions (2 x week for 4 weeks) of air via nasal cannula for 30 minutes at rest. Heart rate, rhythm, and oxygen saturation will be continuously monitored, and blood pressure readings will be obtained every three minutes. They will then cross-over to 16 sessions of treadmill exercise combined with 6 liters per minute of supplemental oxygen via nasal cannula during exercise and 5-minutes of recovery. The first treadmill session will last 25% longer than the exercise tolerance test, but at a lower intensity, such that 80-100% of peak exercise intensity calculated from the exercise tolerance test MET is achieved within three sessions, after which time and intensity will be increased by no more than 0.5 METS, as tolerated based on symptoms and vitals. Heart rate, rhythm, and oxygen saturation will be continuously monitored, and blood pressure readings will be obtained every three to five minutes.

Group Type PLACEBO_COMPARATOR

Treadmill Exercise

Intervention Type OTHER

The cardiopulmonary rehabilitation protocol utilizes progressive treadmill exercise with alternating increases in intensity and incline with no more than 0.5 Met increase per session.

Concentrated Oxygen

Intervention Type OTHER

Supplemental oxygen from a concentrator (6 liters per minute) will be provided via nasal cannula regardless of oxygen saturation.

Concentrated Air

Intervention Type OTHER

Room air will be delivered through an concentrator provided via nasal cannula.

Interventions

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Treadmill Exercise

The cardiopulmonary rehabilitation protocol utilizes progressive treadmill exercise with alternating increases in intensity and incline with no more than 0.5 Met increase per session.

Intervention Type OTHER

Concentrated Oxygen

Supplemental oxygen from a concentrator (6 liters per minute) will be provided via nasal cannula regardless of oxygen saturation.

Intervention Type OTHER

Concentrated Air

Room air will be delivered through an concentrator provided via nasal cannula.

Intervention Type OTHER

Other Intervention Names

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Supplemental oxygen (6 liters per minute)

Eligibility Criteria

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Inclusion Criteria

* Between the ages of 18-60
* Contracted COVID-19 between February - July 2020
* Has been clinician-diagnosed with COVID-19 based on PCR/antigen testing, antibody testing, or clinical symptoms
* Is currently experiencing one or more of the following symptoms, which began only after contracting COVID-19 : dyspnea, cough, chest pain, tachycardia or other arrhythmias, hypertension, hypotension, blood pressure lability, oxygen desaturation, exercise/activity intolerance, fatigue, or dizziness.
* Has been cleared by a physician for exercise and supplemental oxygen.
* Has the capacity to provide written, informed consent
* Able to complete questionnaires in English

Exclusion Criteria

* History of any of the following per the American College of Sports Medicine exercise testing guidelines (American College of Sports Medicine et al., 2018) to be determined during a screening consultation:

1. Acute myocardial infarction within the past two days
2. Ongoing unstable angina
3. Uncontrolled cardiac arrhythmias
4. Active endocarditis
5. Symptomatic severe aortic stenosis
6. Decompensated heart failure
7. Active pulmonary embolism, pulmonary infarction, or deep venous thrombosis
8. Active myocarditis or pericarditis
9. Acute aortic dissection
10. Physical disability that precludes safe and adequate testing
* Participants who demonstrate orthostatic intolerance or oxygen desaturation (\<90%) during the exercise tolerance test will no longer be eligible for the study because it is not safe for them to exercise on a treadmill.
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Dayton

OTHER

Sponsor Role collaborator

Noah Greenspan

OTHER

Sponsor Role lead

Responsible Party

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Noah Greenspan

Founder

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Noah Greenspan, DPT

Role: PRINCIPAL_INVESTIGATOR

Pulmonary Wellness Foundation

Julie Walsh-Messinger, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

University of Dayton

Locations

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Post-COVID Rehabilitation and Recovery Clinic at H&D Physical Therapy

New York, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Noah Greenspan, DPT

Role: CONTACT

(212) 249-0904

Julie Walsh-Messinger, Ph.D.

Role: CONTACT

(937) 229-1380

Facility Contacts

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Noah Greenspan, DPT

Role: primary

212-921-0214

Julie Walsh-Messinger, PhD

Role: backup

(937) 229-1380

Related Links

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https://pulmonarywellness.org/research/

Pulmonary Wellness Foundation

https://www.hdphysicaltherapy.com/post-covid/

Pulmonary Wellness Post-COVID Rehabilitation and Recovery Clinic at H\&D Physical Therapy

https://juliewalshmessinger.weebly.com/research-studies.html

Psychopathology, Personality, and Affective Science (PPAS) Laboratory at the University of Dayton

Other Identifiers

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PLM UD 2021

Identifier Type: -

Identifier Source: org_study_id

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