The purpose of this study is to determine the benefits and feasibility of physiotherapyin the recovery of ongoing symptoms after COVID-19 illness. Long COVID Syndrome (LongCOVID) is defined by persistent symptoms (including breathlessness, chest pain andfatigue) after COVID-19 illness that continue for more than 12 weeks and cannot beexplained by another diagnosis. The goal of this project is to explore physiotherapy astreatment for patients suffering from Long COVID.
The global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 [COVID-19]
has resulted in catastrophic loss of life and significant morbidity in survivors. It is
now recognized that a significant number of patients have symptoms lasting for weeks to
months after initial infection, a clinical entity termed "Long COVID". For many patients,
this has led to an unexpectedly long recovery and has negatively impacted health-related
quality of life (QOL). Persisting breathlessness, fatigue and exercise limitation were
among the most common patient-reported symptoms after COVID-19 infection, affecting
approximately 50% of individuals. Given the heterogeneity in the causes of breathlessness
post-COVID, there are no specific medications that can be broadly recommended to
alleviate dyspnea among these patients. Breathing retraining, combined with supervised
exercise, improves QOL and exercise capacity among patients with various chronic lung
diseases and is an important potential strategy that could reduce dyspnea and regain
physical function among those with Long COVID. The benefits of physiotherapy are
recognized in hospitalized, and critically ill patients, and physiotherapy interventions
have been studied among hospitalized patients with acute COVID-19 pneumonia.
Physiotherapy may also play an instrumental role in the recovery of ambulatory patients
with Long COVID, but few data currently exist.
Behavioral: Physiotherapy
Interventions will include:
1. Education and self-management strategies, including the use of wearable activity and
real-time heart rate monitors, to safely guide pacing and activity.
2. Breathing pattern education and retraining (including diaphragmatic, relaxed, and
paced breathing exercises).
3. Return-to-activity exercise programming (e.g., postural, aerobic, and whole-body
strengthening exercises).
Inclusion Criteria:
1. Participant has English language fluency (approximately grade 8-10 reading level)
and is able to provide informed consent.
2. Participant is an adult (aged ≥ 18 years).
3. Confirmed diagnosis of COVID-19 via a positive nasopharyngeal or throat swab within
the past 12 months.
4. Persistent symptoms lasting ≥12 weeks since the first positive test, including
dyspnea (new or increased from baseline as measured by modified Medical Research
Council (mMRC) score ≥1).
5. Normal oxygen saturation (greater than 90%) by pulse oximetry at rest on room air.
6. Participant owns a smart phone, tablet, or computer, and has or is willing to create
an email address (for links to REDCap and Zoom).
Exclusion Criteria:
1. Abnormal pulmonary function testing (FEV1/FVC ratio <70, total lung capacity <80%
predicted, or diffusing capacity <70% predicted).
2. Pre-existing diagnosis chronic lung disease (Interstitial lung disease, COPD,
bronchiectasis, or moderate to severe asthma).
3. Pulmonary embolism.
4. Parenchymal abnormalities on chest radiograph, deemed clinically significant by the
pulmonologist.
5. Acute or chronic cardiac disease by medical history (myocardial infarction,
myocarditis, cardiomyopathy, arrhythmia, moderate or severe valve disease,
ventricular dysfunction).
6. Syncope at rest or exertion (which could indicate clinically significant cardiac
disease).
7. Pre-existing diagnosis of a post-viral fatigue syndrome, myalgic
encephalomyelitis/chronic fatigue syndrome (ME/CFS) or fibromyalgia.
Peter Lougheed Centre (PLC), University of Calgary
Calgary, Alberta, Canada
Rockyview General Hospital, University of Calgary
Calgary, Alberta, Canada
Jason Weatherald, MD, MSc, Principal Investigator
University of Calgary