Home-Based Exercise Tele-Rehabilitation After COVID-19

Study Overview
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Brief Summary
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The Coronavirus Disease 2019 (COVID-19) pandemic has resulted in catastrophic infections and fatalities across the nation. Many older Veterans with comorbidities are especially vulnerable to complications and poor recovery. This award will investigate the effect of a novel, home-based, supervised, group exercise tele-rehabilitation in Veterans recovered from COVID-19 on cardiopulmonary and physical function.

Detailed Description
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There is an urgent need to understand the lasting impact of COVID-19 on the cardiopulmonary system to improve physical function and prevent long-lasting disability. Pertinent knowledge gaps regarding the post-recovery physiology driving any impairments need to be addressed to improve the quality of life in Veterans with prior SARS-CoV-2 infection. Further, it is important to devise successful rehabilitation strategies that can be safely conducted in a Veteran's home. Hence, the investigators propose to utilize VA Video Connect to deliver a home based, supervised group exercise program to Veteran COVID-19 survivors. The objective of this exercise trial is to determine the influence of COVID-19 on cardiorespiratory fitness, pulmonary and physical function and to investigate the effect of a home-based exercise tele-rehabilitation on these outcomes. The study design includes rural and urban sites and investigators with a history of VA rehabilitation collaboration. Moreover, the investigators will explore healthcare disparities related to COVID-19 which are associated with functional decline and may affect sustainability of exercise rehabilitation strategies deployed, if necessary, under social distancing restrictions.

Official Title
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Home-Based Exercise Tele-Rehabilitation in High-Risk Veterans: Impact of COVID-19 Exposure and Socioeconomic Factors

Conditions
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Post SARS-CoV2 (COVID-19)

Intervention / Treatment
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* Other: Tele-exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veteran documented COVID-19 > 90 days ago diagnosis of 2 of following conditions: hypertension, diabetes, cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease OR 1 condition and BMI > 30 kg/m2 Exclusion Criteria: myocardial infarction (within 3 months) exertional or unstable angina (chest pain that limits activity) severe congestive heart failure (EF < 20% in last year or NYHA Classification III or IV) uncontrolled hypertension (SBP >180 &/or DBP > 110 mm Hg at screening) screening EKG with ischemia, complex arrhythmia, or high-grade block (per Minnesota Code) poorly controlled diabetes mellitus (FBS>200 mg/dl, RBS > 299 mg/dl, or HbA1C > 10) treatment for cancer except skin cancer (within 3 months) peripheral vascular disease with claudication severe arthritis limiting ambulation neurologic disease limiting ambulation (weakness requiring assist device; severe neuropathy) end stage liver disease (decompensated liver disease) End stage renal failure (dialysis) severe pulmonary disease (home O2, admission for dyspnea or pneumonia within 1 month) high fall risk (history of falls, bone fracture) dementia (based on Evaluation to Consent) signs or symptoms of any medical comorbidity that would preclude exercise testing or training exercises on routine basis (structured aerobic exercise > 3 time per week)

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Exercise tele-rehabilitation
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tele-exercise<br>Exercise training 2x/week at home. Sessions include circuit exercises of aerobic and resistive training stations which are led remotely. | Other: Tele-exercise<br>* Exercise training 2x/week at home. Sessions include circuit exercises of aerobic and resistive training stations which are led remotely.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in VO2peak | physical fitness, units are ml/kg/min | Baseline and after 12 weeks tele-exercise | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in 2-minute step test | physical function, units are number of times | Baseline and after 12 weeks tele-exercise | 
| chair stands | muscular strength, units are number of times | Baseline and after 12 weeks tele-exercise | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise, COVID-19, Cardiopulmonary