Safety and Physical Outcomes of a Novel Australian Multidisciplinary Long COVID Clinic That Incorporates Exercise: A Prospective Observational Study

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Background: Exercise therapy remains somewhat controversial in those with Long COVID (symptoms lasting > 3 months), due to concerns for safety and the potential for harm. Purpose: This study describes the safety and physical outcomes of an Australian multidisciplinary Long COVID Recovery Clinic that incorporates personalised exercise prescription including respiratory and peripheral muscle strengthening, carefully monitored cardiovascular training and pacing of activity. Patients and Methods: Prospective observational study of adults (≥ 18 years) engaging with a single site Long COVID Recovery Clinic (March 2022 to June 2023). Clinic eligibility required symptoms > 12 weeks which impaired activities of daily living. Safety was pre-defined as < 10% of participants experiencing a minor adverse event, and no serious disability or death as a result of participation in exercise. Physical outcomes included Modified COVID-19 Yorkshire Rehabilitation Scale, changes in exercise capacity (6-minute-walk-test), inspiratory muscle strength (maximum inspiratory pressure), Timed-Up-and-Go and ten-metre-walk-test. Data analysis included repeated measures Multivariate Analysis of Variance (MANOVA) to explore assessment and reassessment measures collectively, and repeated measures t -test. Results: Of 207 consumers referred, (62% male, median age 45, range 18– 84), 119 (57% of the total referred) enrolled to participate in the program. Of these, 72 (61%) completed the program, median participation duration 112 days (range 5– 384). There were no adverse events as a result of participation in exercise. Consumers who completed the program showed improvement in Modified COVID-19 Yorkshire Rehabilitation Scale Other Symptoms (MD − 1.5, p=0.003), Overall Health Score (MD1.3, p< 0.001), Total Score (MD − 6.5, p=0.02); maximum-inspiratory-pressure (MD 11.7 cmH 2 O, p=0.002); Timed-Up-and-Go (MD − 1.0 sec, p< 0.001); ten-metre-walk-test comfortable speed (MD 0.7 m/sec, p=0.006) and fast speed (MD 0.2 m/sec, p< 0.001); and 6-minute-walk-test distance (MD 63.0 m, p< 0.001). Conclusion: This multidisciplinary therapy program that incorporates exercise was safe and associated with improvements in physical and functional outcomes for participants who completed the program. Plain Language Summary: Few studies in Australia have investigated the impact of exercise in people with Long COVID. This observational study describes the safety and physical outcomes of 72 adults who completed an Australian multidisciplinary Long COVID clinic that incorporates supervised cardiovascular and strength training over several weeks. For those who completed the program, there were no adverse events, while multiple physical outcome measures improved relative to baseline. This study shows that exercise can be safely incorporated in a multidisciplinary clinic for people recovering from Long COVID. Keywords: exercise, COVID, rehabilitation, multidisciplinary care, physiotherapy, respiratory muscle training

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