acupressure and qigong in chronic fatigue post covid-19.

Conditions: COVID-19; Post-COVID-19 Syndrome

Summary: international observational studies confirm the high incidence of post-infectious residual syndrome after infection with severe acute respiratory syndrome corona virus 2 (sars-cov2), which can occur in 10-15% of all infected persons, regardless of the severity of the acute infection. post corona virus disease 19 (postcovid-19) patients suffer mostly from symptoms such as fatigue, muscle pain, problems to focus, depression and sleep disturbances. so far, there are no results of interventional studies for the treatment of chronic fatigue post covid-19, but there are indicators that post covid-19 syndrome is a chronic subclinical inflammation, similar to chronic fatigue syndrome / myalgic encephalomyelitis csf/me, which also often develops from a postviral syndrome. previously tested and effective strategies for the treatment of chronic fatigue syndrome / myalgic encephalomyelitis (cfs/me) will be tested in the treatment of chronic fatigue postcovid-19, in this randomized controlled trial a combination of acupressure and qigong. the aim of this project is to evaluate an acupressure treatment plus a qigong exercise series specifically tailored for chronic fatigue postcovid-19 , used daily by the patients themselves and regularly supervised, in comparison to the advice literature on the treatment of postcovid-19 syndrome alone.

prospective two-arm (parallel groups) randomised controlled confirmatory intervention study with mixed methods approach in 2x 100 patients (n=200). intervention: self-applied acupressure and online qigong course over 8 weeks and follow up at week 16. group 1: acupressure + qigong: massage of the points daily for 3 minutes per point with the finger or an acupuncture pen (some points can be massaged bilaterally, therefore total approx. 20 min). in addition, twice a week an online guided qigong course with a duration of 30-45 min. the patients should practise qigong at least 3 times a week (including the course date). in addition, all patients will receive the guidebook literature for the treatment of complaints after sars-cov2 infection. group 2: patients will receive advice literature on the treatment of chronic fatigue after sars-cov2 infection. after the end of this study the patients of this group will receive written information and video material regarding the acupressure and qigong exercises.

Eligibility criteria:
inclusion criteria: 1. diagnosis of chronic fatigue (after sars-cov2 infection) 2. with at least 3 of 7 criteria at time of study inclusion: sleeping disorder, headaches, joint pain/muscle pain, anxiety/depression, memory impairment/ concentration problems, anosmia, exercise intolerance. 3. acute sars-cov2 infection at least 12 weeks ago 4. age 18-60 years 5. visual analogue scale (0-100 mm) physical resilience of maximum 60 mm 6. sf-36 physical function of maximum 65 7. technically equipped to participate in the online intervention and willing to follow the study procedure, acupressure and qigong to perform the exercise series at home 8. written informed consent available. exclusion criteria: 1. fatigue already present before the sars-cov2 infection 2. other underlying diseases leading to symptoms of chronic fatigue, such as major depression, oncological diseases, multiple sclerosis, fibromyalgia and drug abuse 3. other serious underlying diseases, such as severe pulmonary, cardiac, psychiatric or infectious diseases, which could interfere with study participation or affect the results 4. ongoing opioid therapy or opioid therapy in the week prior to study entry 5. chronic use of cannabinoids before or during the study. 6. start of psychotherapy or interruption of ongoing therapy during study participation 7. female participants: pregnancy or breastfeeding 8. participation in another clinical intervention study during study participation 9. ongoing pension procedure or planned claiming of a pension procedure due to disability 10. planned inpatient rehabilitation measures during study participation due to postcovid-19 -

Keywords: post covid-19, sequelae, chronic fatigue