NHS Glos. ICS: Long COVID Recovery  

Executive Summary

Sophie Middleton, Megan Hassall & Ewan Cranwell BSc.

Background

Since the COVID-19 pandemic began in early 2020, many individuals who have received a COVID-19 diagnosis, whether they have been hospitalised or not, are suffering from a novel condition referred to as long COVID. It is estimated that ~2 million people are suffering from the impacts of long COVID (NHS, 2022), which is commonly associated with ongoing symptoms including chronic fatigue and shortness of breath. Findings from the REACT-2 studies show over a third of people who had COVID-19 reported symptoms lasting at least 12 weeks. NHS Gloucestershire ICS Commissioners felt that KiActiv^® Health could be a valuable tool to support individuals suffering with the ongoing effects of long COVID to improve self-management.

Innovation

This pilot evaluated KiActiv^® Health, a personalised and guided online service that empowers participants to optimise their everyday physical activity in the context of their condition. KiActiv^® Health provides personalised feedback in an interactive online dashboard that displays accurate physical activity data from a validated wearable and is supported remotely by phone calls with a dedicated KiActiv^® Mentor over 12 weeks. At the end of the 12 weeks, participants retain access to their personalised technology, enabling them to continue their self-management as required.

Purpose/objective

To provide an accessible service to enable participants suffering with long COVID to improve self-care through the optimisation of their everyday physical activity. 

Methodology

Eligible participants were invited to participate in KiActiv^® Health via a letter. Enrolled participants were sent a wearable activity monitor, before participating in the 12-week KiActiv^® Health programme. They were supported at key time points throughout by a trained KiActiv^® Mentor. Data was analysed from a range of sources: the KiActiv^® Health platform, KiActiv^® Mentor calls, and a self-administered online questionnaire.  

Key Findings

• Demographics: 109 participants started KiActiv^® Health, average age category of 44 years, average body mass index (BMI) = 24.1kg/m².
• Completion: 59 participants (33 females, 26 males) have completed the 12-week programme to date. 42 participants are within the 12-week programme.
• Engagement: The use of the technology was excellent and included 96% of days being classed as having complete data sets.
• PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv^® Health.
  • An increase of 1.2 in the combined WHOQoL score, which is greater than the minimum clinically important difference for that domain (0.876).
  • An increase of 2.4 in the physical health domain score, which is greater than the minimum clinically important difference for that domain (1.545).
  • An increase of 2.0 in the Short Warwick-Edinburgh Mental Wellbeing Scale, which is statistically important (>1.0).
  • 78.1% of participants increased their self-efficacy levels
  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise.
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
    • Improved pulmonary symptoms (i.e., reduced breathlessness, improved lung capacity).
    • Benefits to other aspects of lifestyle such as improved sleep, feeling fitter, stronger and more energised.
    • The ability to set realistic goals, self-manage, and improve daily physical activities.
    • A sense of control around how everyday physical activities affect their health and wellbeing, which has led to an improvement in physical and mental health, as well as overall quality of life.

• Physical Activity Data: Physical Activity Data: Increasing physical activity is not always the primary goal for people recovering from hospitalisation due to COVID-19 or for those living with long COVID. However, 54 of 59 patients (91.5%) who have completed their 12-week programme to date have expressed a desire to increase their physical activity levels, yet many wanted to be cautious and not risk doing too much.
  • 100% of participants improved their physical activity in 3+ dimensions.
  • 98% of participants improved their physical activity in 4+ dimensions.
  • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
    • Non-Sedentary Time: +40hrs 31mins (+13%)
    • Moderate Activity: +18hrs 57mins (+21%)
    • Moderate Bouts: +17hr 10mins (+400%)
    • Calorie Burn: +7,047kcals (+4%)

A recent systematic review and meta-analysis of physical activity monitor based interventions showed increases of 6.9 minutes per day of moderate to vigorous physical activity and a 9.9 minutes per day increase per day in non-sedentary time (Larsen et al., 2022). In comparison, those who completed KiActiv^® Health increased their moderate to vigorous physical activity by 17.0 minutes per day and increased their non-sedentary time by 36.3 minutes per day, equating to 2.5-fold and 3.5-fold improvements, respectively.

Conclusion

KiActiv^® Health proved effective amongst this cohort in part due to the accessibility of everyday physical activity, shifting the narrative away from structured exercise, instead adopting a more personalised approach to everyday physical activity, where the individual is able to self-manage their physical activity to determine what works best for them. This is important within this group, physical activity is often avoided by individuals with long COVID, given the effect of physical exertion on cognitive and physical fatigue (Rudrofff et al., 2020). Despite such perceptions, maintaining and improving physical activity is extremely important as it has been shown to reduce breathlessness, as well as increase muscle strength and exercise capacity (Lan et al., 2013; Torres-Sánchez et al., 2017).

KiActiv^® Health also provided participants with the tools to optimise physical activity to better manage fatigue levels. This is important given that long COVID recovery must be tailored to the individual, accounting for their personal experiences of fatigue symptoms and post-exertional malaise (Nijs et al., 2004; Larun and Malterud, 2011; Humphreys et al., 2021).

These results should also be reviewed in the context of our recently published pilot for participants with CFS/ME undertaken on behalf of the NHS, which included enrolments during the pandemic and highlight valuable comparisons.

June 2022