COVID-19, Chronic Adaptation and Response to Exercise (COVID-CARE)

Study Overview
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Brief Summary
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Background: People who are recovering from COVID-19 may continue to have problems that affect their daily life. For instance, they might feel overly tired. Researchers want to learn if exercise can help people recover after COVID-19 infection. Objective: To study if participation in a rehabilitation exercise program can help people recovering from COVID-19. Eligibility: Adults ages 18-80 with a lab-confirmed SARS-CoV2 infection (the virus that causes COVID-19), and are still having some symptoms. Design: Participants will have a medical history and physical exam. They will give blood and urine samples. They will have tests to measure heart and lung function. Their blood vessels will be assessed. Participants will have a computed tomography scan of the body. They will have an ultrasound of the muscles in their arms, legs, and chest. Participants will take a 6-minute walk test. They will take other balance and movement tests. Participants will walk on a treadmill while hooked up to a monitor. Then they will be interviewed. It will be audio-recorded. Participants will complete surveys about their symptoms and daily activities. Participants will take a smell test. For this, they will identify different smells. They will also have memory, attention, and mental functioning tests. Participants will wear an activity monitor on their wrist 24 hours a day. They will exercise 3 times a week for 10 weeks by moving vigorously on a track or treadmill for 30 minutes. They will attend education classes once a week for 10 weeks. Participants will be contacted by phone or email every 3 months for 1 year after they complete the exercise part of the study. They will wear an activity monitor for up to 2 weeks.

Detailed Description
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Study Description: This randomized controlled trial will determine whether aerobic exercise training has a beneficial effect on physical function, health-related quality of life, free-living physical activity and sleep quality among survivors of COVID-19. Participants will be randomized to either an aerobic exercise training and education (AET+) group or a control education only group (CON) for 10 weeks. Assessments for physical function, self-reported health outcomes for quality of life (QOL), free-living physical activity and sleep quality will be measured at baseline and following the 10-week intervention period. Participants in the CON group will then crossover and perform AET after the 10-week follow-up visit. All participants will be monitored for one year to capture free-living physical activity, sleep quality and health-related QOL outcomes over time. It is hypothesized that following 10 weeks, physical function, health-related QOL, free-living physical activity and sleep quality will show greater improvement with AET+. Objectives: Primary Objective: To examine the effect of aerobic exercise training on physical function in participants recovering from COVID-19. Secondary Objectives: To examine the effect of aerobic exercise training on patient reported outcomes and other health-related QOL components in participants recovering from COVID-19; To examine the effect of aerobic exercise training on free-living physical activity and sleep quality in participants recovering from COVID-19. Exploratory Objectives: To explore the effect of aerobic exercise training on clinical outcomes, cardiorespiratory function, cognition, biomarkers, metabolomics, ultrasound-based muscle measurements, and vascular function in participants recovering from COVID-19; To explore the feasibility of conducting the AET program remotely in the crossover CON group of participants recovering from COVID-19; To explore follow-up physical activity, sleep quality and health-related QOL outcomes over 1 year in participants recovering from COVID-19. Endpoints: Primary Endpoints: Physical function as measured by distance walked during the 6 minute walk test after 10 weeks post randomization with AET+ and CON. Secondary Endpoints: Patient-reported outcomes and other health-related components after 10 weeks post-randomization with AET+ and CON; Freeliving physical activity and sleep quality after 10 weeks post-randomization with AET+ and CON. Exploratory Endpoints: Clinical outcomes, cardiorespiratory function, cognition, biomarkers, metabolomics, ultrasound-based muscle measurements, and vascular function after 10 weeks post-randomization with AET+ and CON; Collection of initial feasibility data to conduct exercise sessions remotely; Explore relationships between the physiological variables and post-study health outcome variables over time.

Official Title
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COVID-19, Chronic Adaptation and Response to Exercise (COVID-CARE): A Randomized Controlled Trial

Conditions
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COVID-19

Intervention / Treatment
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* Other: Aerobic Exercise Training
* Other: Education


Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Screening procedures will be performed as part of this study. In order to be eligible to participate in this study, an individual must meet all of the following criteria: Male or female, aged 18 to 80 years Previous infection with SARS-CoV2, at least 4 weeks prior to enrollment, confirmed by laboratory or a healthcare provider. Participants with a documented positive home antigen test will need confirmation of positive COVID-19 antibodies (positive anti-Nucleocapsid antibody test, OR positive anti-Spike antibody test if unvaccinated at the time of the antibody test) to be considered. Presence of physical limitations or significant fatigue since COVID-19 as demonstrated by: Total score less than or equal to 19 on the PROMIS short form for physical function or total score greater than or equal to 9 on the PROMIS short form for fatigue, AND Score greater than or equal to 1 on the Patient Global Rating of Flu Severity and Patient Global Assessment of Interference with Daily Activities Able to read, speak and understand English or Spanish Able to understand and willing to sign a written informed consent document Willing and able to complete study procedures EXCLUSION CRITERIA: An individual who meets any of the following criteria will be excluded from participation in this study: Above normal performance (i.e, greater than or equal to 100% predicted) in the 6MWT based on normative data for gender and age (86,87) History or cardiac condition as determined by NIH cardiology to be unsafe for exercise participation (e.g. ischemic heart disease, right- or left-sided heart failure, cor pulmonale or pulmonary hypertension, dilated or hypertrophic cardiomyopathy or non-idiopathic cardiomyopathy) Significant hepatic or renal dysfunction Cancer diagnosis with evidence of metastasis or a life expectancy of less than one year History of stroke resulting in impairments in functional mobility that limits safe participation Active substance abuse including EtOH Severe psychiatric disease, not responsive to treatment or medication History of diabetes and on insulin pump therapy, or uncontrolled diabetes with HbA1c > 9.0% Pregnancy Acceptance onto a lung transplant waiting list Extreme obesity with BMI > 40 kg/m^2 On medications that would influence exercise performance such as beta blockers or antiretroviral therapy Ongoing tobacco and/or nicotine product use Enrolled in another interventional clinical research trial Any other medical or health condition(s) that unduly increases the risk of exercise testing or training, affects the normal physiologic response to exercise testing or training, and/or would otherwise interfere with the ability to interpret the data as determined by the PI

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Aerobic Exercise Training and Education (AET+)<br>Participants will perform both exercise training and education for 10 weeks | Other: Aerobic Exercise Training<br>* Aerobic exercise training will consist of 10 weeks of aerobic exercise, performed 3 times/week for 30 minutes. Each session will include a warm-up and cool-down period. The intensity will be guided by heart rate and gradually increased from light-moderate to moderate-high intensity as safely tolerated by the subject. All sessions are supervised by credentialed RMD staff members.<br>Other: Education<br>* Education consisting of weekly lectures lasting approximately 1 hour for 10 weeks. Topics related to exercise programming, safety and well-being will be covered. Conducted remotely by credential RMD staff members.<br>|
| Other: Education only (CON)<br>Participants will perform only education for the first 10 weeks, then cross-over to perform exercise in the second 10 weeks | Other: Aerobic Exercise Training<br>* Aerobic exercise training will consist of 10 weeks of aerobic exercise, performed 3 times/week for 30 minutes. Each session will include a warm-up and cool-down period. The intensity will be guided by heart rate and gradually increased from light-moderate to moderate-high intensity as safely tolerated by the subject. All sessions are supervised by credentialed RMD staff members.<br>Other: Education<br>* Education consisting of weekly lectures lasting approximately 1 hour for 10 weeks. Topics related to exercise programming, safety and well-being will be covered. Conducted remotely by credential RMD staff members.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 6 minute walk test distance | The 6MWT distance has been used to reflect longitudinal changes in physical function among patients with acute lung disease and SARS. A minimal important difference (MID) has yet to be established among survivors of COVID-19. We will consider 30 meters as the MID for this study based on reported ranges of 20 to 30 meters in patients with lung disease. | Baseline, 10 weeks, 20 weeks (for cross-over group) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient reported outcomes and quality of life | Patient reported outcomes related to fatigue, sleep, post-traumatic stress disorder, depression, anxiety, general and COVID-19 specific QOL outcomes will be captured. | Baseline, 10 weeks, 20 weeks (for cross-over group), every 3 months for 1 year after exercise | 
| Free-living physical activity and sleep quality | Quantification of free-living physical activity and sleep quality and patterns using wearable accelerometer device. | Baseline, 10 weeks, 20 weeks (for cross-over group), every 3 months for 1 year after exercise | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Aerobic Exercise Training, Physical Function, Physical Activity, Convalescence, SARS-CoV-2