Cardiopulmonary Rehabilitation in COVID-19 Longhaulers

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.

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.

Eligibility Criteria:
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.