Uninterrupted and Interrupted Sitting in Long COVID-19

Design:

The present study will be a laboratory study. The intervention group being persons suffering from Long COVID, and the control group being a healthy aged match group. Both the experimental and control groups will be randomised into either performing uninterrupted or interrupted sitting first to reduce the risk of order and learning effects associated with the trials. All individuals who are identified from general practitioner (GP) practices (e.g. Park and St Francis Surgery, Chandlers Ford near Winchester or associated surgeries and clinics) or long COVID clinics (e.g. Gloucestershire Health and Care NHS (National Health Service) Foundation Trust, Post Covid Syndrome Service and Southampton and Isle of Wight Long Covid Clinic, Solent NHS Trust, Southern Health NHS Trust and Isle of Wight NHS Trust), who meet the inclusion criteria will be provided with equal opportunity to engage with the study provided they are able to travel to either the University of Winchester or University of Gloucestershire for assessment. Healthy participants who will form the control group will also have equal opportunity to engage with the study providing they meet the inclusion criteria and are able to travel to either the University of Winchester or University of Gloucestershire for assessment.

The purpose and design of this study has been discussed with all members of the study team, and at a Patient and Public Involvement (PPI) meeting, with people currently suffering from Long COVID.

Recruitment:

Potential participants will initially be identified by the healthcare team at Park and St Francis Surgery, the Gloucestershire Health and Care NHS Foundation Trust, Post Covid Syndrome Service, Southampton and Isle of Wight Long Covid Clinic, Solent NHS Trust, Southern Health NHS Trust and Isle of Wight NHS Trust or associated surgeries and clinics according to study inclusion/exclusion criteria. The clinical team will gain documented verbal consent from potential participants for their contact details to be provided to the research team at the University of Winchester (Prof. James Faulkner, Dr Helen Ryan-Stewart and Mr Nick Hudson) and University of Gloucestershire (Dr Simon Fryer, Dr Keeron Stone and Mr Callum Thomas) who will then contact patients directly to discuss their potential participation.

As described above (Design), the research team will make every effort to provide all participants a fair and equal opportunity to engage with the study provided they are able to travel to the University sites for study participation.

Informed Consent:

Participants will be provided with a study information sheet which outlines their possible involvement and will have opportunities to discuss the study with the research team prior to deciding as to whether to participate or not. Each participant will have had sufficient time (>24-hours) to read the information sheet and will be able to ask questions to the research team both by phone prior to attending their first assessment visit and upon arrival to the Exercise Physiology Laboratory at the University of Winchester or University of Gloucestershire before providing voluntary written consent for participation in this study. Participants will be reminded that they can withdraw from the study at any time and without repercussion of any kind.

Procedures:

All participants will complete an adapted health history questionnaire and the EQ-5D-5L quality of life questionnaire during familiarisation. Participants will be fitted with an activity monitor for seven days following familiarisation to attain measures of physical activity/sedentary behaviour during a typical week. Participants with long COVID will be asked to complete a series of questionnaires which measure the type and severity of their symptoms as well as their functional status (COVID-19 Yorkshire Rehabilitation tool, COVID-19 symptom score, Post COVID-19 Functional Status Scale). Central and peripheral blood pressure, pulse wave velocity, cognitive function and cerebral perfusion will be measured in a supine and seated position at baseline and following 120 minutes of interrupted or uninterrupted sitting. Central and peripheral blood pressure, pulse wave velocity and cerebral perfusion will be measured while seated during the sitting period. Following visiting the laboratory, long COVID participants will complete the DePaul Symptom Questionnaire Post-Exertional Malaise (DSQ-PEM) and receive a telephone call from the research team within 72 hours of their visit. Should participants present symptoms of PEM, their participation in future visits to the laboratory will be delayed. Should symptoms of PEM persist for 30 days they will be withdrawn from the study and their GP will be contacted.

Confidentiality:

Participants will be assured of the confidentiality of the research process. All data will be anonymised using alpha- numeric code which will be stored on a password protected network, accessible by only the named researchers involved with the study. Hard copies of data will be locked in a filing cabinet in the office of Prof. James Faulkner in Centre for Sport of the University of Winchester's King Alfred campus and in Dr Simon Fryer's locked office at the Oxstalls campus at the University of Gloucestershire. Physical copies of data will not be removed from these offices. Due to collaboration, data will need to be shared between institutions. Data will be uploaded to a secure, password protected folder on Microsoft OneDrive. All data will be presented as group means and standard deviations. All data will be kept for 7 years, with Prof. Faulkner and Dr Fryer responsible for its security during this time and its appropriate disposal once this period has elapsed.

Risks/Burdens:

Potential risks to participants could be caused by over exertion during a physical activity intervention within the experimental condition. To minimise this risk, the type and intensity of physical activity chosen is low and comfortable to complete for participants with low levels of mobility and who experience fatigue after minimal activity. Participants will have up to 30 days between visits to further minimise any risks. In addition, participants will undertake the Covid 19 Yorkshire Rehab Screen (C19-YRS). This will allow the researchers to gain prior knowledge of participants level of fatigue, mobility, and cognitive function prior to involvement in the study and participant selection.