Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation

Enya Daynes; Rachael A Evans; Neil J Greening; Nicolette C Bishop; Thomas Yates; Daniel Lozano-Rojas; Kimon Ntotsis; Matthew Richardson; Molly M Baldwin; Malik Hamrouni; Emily Hume; Hamish McAuley; George Mills; Dimitrios Megaritis; Matthew Roberts; Charlotte E Bolton; James D Chalmers; Trudie Chalder; Annemarie B Docherty; Omer Elneima; Ewen M Harrison; Victoria C Harris; Ling P Ho; Alex Horsley; Linzy Houchen-Wolloff; Olivia C Leavy; Michael Marks; Krishna Poinasamy; Jennifer K Quint; Betty Raman; Ruth M Saunders; Aarti Shikotra; Amisha Singapuri; Marco Sereno; Sarah Terry; Louise V Wain; William D-C Man; Carlos Echevarria; Ioannis Vogiatzis; Christopher Brightling; Sally J Singh

doi:10.1183/13993003.02152-2024

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation

Enya Daynes, Rachael A Evans, Neil J Greening, Nicolette C Bishop, Thomas Yates, Daniel Lozano-Rojas, Kimon Ntotsis, Matthew Richardson, Molly M Baldwin, Malik Hamrouni, Emily Hume, Hamish McAuley, George Mills, Dimitrios Megaritis, Matthew Roberts, Charlotte E Bolton, James D Chalmers, Trudie Chalder, Annemarie B Docherty, Omer ElneimaEwen M Harrison, Victoria C Harris, Ling P Ho, Alex Horsley, Linzy Houchen-Wolloff, Olivia C Leavy, Michael Marks, Krishna Poinasamy, Jennifer K Quint, Betty Raman, Ruth M Saunders, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Sarah Terry, Louise V Wain, William D-C Man, Carlos Echevarria, Ioannis Vogiatzis, Christopher Brightling, Sally J Singh

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Abstract

Objective Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≽12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19. Design This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping. Results 181 participants (55% male, mean±SD age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19–85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1–66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8 ⁺ T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31). Conclusion Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.

Original language	English
Article number	2402152
Pages (from-to)	2402152
Number of pages	41
Journal	European Respiratory Journal
Volume	65
Issue number	5
DOIs	https://doi.org/10.1183/13993003.02152-2024
Publication status	Published - 20 Feb 2025

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10.1183/13993003.02152-2024

Eur Respir J-2025-Daynes-13993003.02152-2024 (1)Final published version, 1.36 MBLicence: Unspecified

https://publications.ersnet.org/lookup/doi/10.1183/13993003.02152-2024

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Daynes, E., Evans, R. A., Greening, N. J., Bishop, N. C., Yates, T., Lozano-Rojas, D., Ntotsis, K., Richardson, M., Baldwin, M. M., Hamrouni, M., Hume, E., McAuley, H., Mills, G., Megaritis, D., Roberts, M., Bolton, C. E., Chalmers, J. D., Chalder, T., Docherty, A. B., ... Singh, S. J. (2025). Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation. European Respiratory Journal, 65(5), 2402152. Article 2402152. https://doi.org/10.1183/13993003.02152-2024

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title = "Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation",

abstract = "Objective Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≽12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19. Design This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping. Results 181 participants (55% male, mean±SD age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19–85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1–66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in na{\"i}ve and memory CD8 + T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31). Conclusion Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.",

author = "Enya Daynes and Evans, {Rachael A} and Greening, {Neil J} and Bishop, {Nicolette C} and Thomas Yates and Daniel Lozano-Rojas and Kimon Ntotsis and Matthew Richardson and Baldwin, {Molly M} and Malik Hamrouni and Emily Hume and Hamish McAuley and George Mills and Dimitrios Megaritis and Matthew Roberts and Bolton, {Charlotte E} and Chalmers, {James D} and Trudie Chalder and Docherty, {Annemarie B} and Omer Elneima and Harrison, {Ewen M} and Harris, {Victoria C} and Ho, {Ling P} and Alex Horsley and Linzy Houchen-Wolloff and Leavy, {Olivia C} and Michael Marks and Krishna Poinasamy and Quint, {Jennifer K} and Betty Raman and Saunders, {Ruth M} and Aarti Shikotra and Amisha Singapuri and Marco Sereno and Sarah Terry and Wain, {Louise V} and Man, {William D-C} and Carlos Echevarria and Ioannis Vogiatzis and Christopher Brightling and Singh, {Sally J}",

note = "Publisher Copyright: Copyright {\textcopyright}The authors 2025.",

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doi = "10.1183/13993003.02152-2024",

language = "English",

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Daynes, E, Evans, RA, Greening, NJ, Bishop, NC, Yates, T, Lozano-Rojas, D, Ntotsis, K, Richardson, M, Baldwin, MM, Hamrouni, M, Hume, E, McAuley, H, Mills, G, Megaritis, D, Roberts, M, Bolton, CE, Chalmers, JD, Chalder, T, Docherty, AB, Elneima, O, Harrison, EM, Harris, VC, Ho, LP, Horsley, A, Houchen-Wolloff, L, Leavy, OC, Marks, M, Poinasamy, K, Quint, JK, Raman, B, Saunders, RM, Shikotra, A, Singapuri, A, Sereno, M, Terry, S, Wain, LV, Man, WD-C, Echevarria, C, Vogiatzis, I, Brightling, C & Singh, SJ 2025, 'Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation', European Respiratory Journal, vol. 65, no. 5, 2402152, pp. 2402152. https://doi.org/10.1183/13993003.02152-2024

TY - JOUR

T1 - Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation

AU - Daynes, Enya

AU - Evans, Rachael A

AU - Greening, Neil J

AU - Bishop, Nicolette C

AU - Yates, Thomas

AU - Lozano-Rojas, Daniel

AU - Ntotsis, Kimon

AU - Richardson, Matthew

AU - Baldwin, Molly M

AU - Hamrouni, Malik

AU - Hume, Emily

AU - McAuley, Hamish

AU - Mills, George

AU - Megaritis, Dimitrios

AU - Roberts, Matthew

AU - Bolton, Charlotte E

AU - Chalmers, James D

AU - Chalder, Trudie

AU - Docherty, Annemarie B

AU - Elneima, Omer

AU - Harrison, Ewen M

AU - Harris, Victoria C

AU - Ho, Ling P

AU - Horsley, Alex

AU - Houchen-Wolloff, Linzy

AU - Leavy, Olivia C

AU - Marks, Michael

AU - Poinasamy, Krishna

AU - Quint, Jennifer K

AU - Raman, Betty

AU - Saunders, Ruth M

AU - Shikotra, Aarti

AU - Singapuri, Amisha

AU - Sereno, Marco

AU - Terry, Sarah

AU - Wain, Louise V

AU - Man, William D-C

AU - Echevarria, Carlos

AU - Vogiatzis, Ioannis

AU - Brightling, Christopher

AU - Singh, Sally J

PY - 2025/2/20

Y1 - 2025/2/20

N2 - Objective Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≽12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19. Design This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping. Results 181 participants (55% male, mean±SD age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19–85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1–66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8 + T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31). Conclusion Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.

AB - Objective Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≽12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19. Design This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping. Results 181 participants (55% male, mean±SD age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19–85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1–66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8 + T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31). Conclusion Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.

UR - http://www.scopus.com/inward/record.url?scp=105007459163&partnerID=8YFLogxK

U2 - 10.1183/13993003.02152-2024

DO - 10.1183/13993003.02152-2024

M3 - Article

SN - 0903-1936

VL - 65

SP - 2402152

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 5

M1 - 2402152

ER -

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): A randomised controlled trial of exercise-based rehabilitation

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