TY - JOUR
T1 - Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID
T2 - an intensive longitudinal cohort study
AU - the LOCOMOTION consortium
AU - Greenwood, Darren C.
AU - Mansoubi, Maedeh
AU - Bakerly, Nawar D.
AU - Bhatia, Aishwarya
AU - Collett, Johnny
AU - Davies, Helen E.
AU - Dawes, Joanna
AU - Delaney, Brendan
AU - Ezekiel, Leisle
AU - Leveridge, Phaedra
AU - Mir, Ghazala
AU - Muhlhausen, Willie
AU - Rayner, Clare
AU - Read, Flo
AU - Scott, Janet T.
AU - Sivan, Manoj
AU - Tucker–Bell, Ian
AU - Vashisht, Himanshu
AU - Ward, Tomás
AU - O'Connor, Daryl B.
AU - Dawes, Helen
AU - Balasundaram, Kumaran
AU - Ball, Megan
AU - Barahona, Mauricio
AU - Casson, Alexander
AU - Clarke, Jonathan
AU - Cook, Karen
AU - Cooper, Rowena
AU - Curcin, Vasa
AU - Darbyshire, Julie
AU - de Lusignan, Simon
AU - Echevarria, Carlos
AU - Elkin, Sarah
AU - Espinosa Gonzalez, Ana Belen
AU - Evans, Rachael
AU - Evans, Sophie
AU - Falope, Zacchaeus
AU - Glampson, Ben
AU - Goodwin, Madeline
AU - Greenhalgh, Trish
AU - Halpin, Stephen
AU - Harris, Juliet
AU - Hinton, Will
AU - Horton, Mike
AU - Jones, Samantha
AU - Kwon, Joseph
AU - Lee, Cassie
AU - Lovett, Ashliegh
AU - Mansoubi, Mae
AU - Masey, Victoria
AU - Master, Harsha
AU - Mayer, Erik
AU - Meza-Torres, Bernardo
AU - Milne, Ruairidh
AU - Morris, Jacqui
AU - Mosley, Adam
AU - Mullard, Jordan
AU - O'Connor, Rory
AU - Osborne, Thomas
AU - Parkin, Amy
AU - Petrou, Stavros
AU - Pick, Anton
AU - Prociuk, Denys
AU - Rebane, Amy
AU - Rogers, Natalie
AU - Smith, Adam B.
AU - Smith, Nikki
AU - Tucker, Emma
AU - Tucker–Bell, Ian
AU - Williams, Paul
AU - Winch, Darren
AU - Wood, Conor
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/11
Y1 - 2024/11
N2 - Background: Symptom fluctuations within and between individuals with long COVID are widely reported, but the extent to which severity varies following different types of activity and levels of exertion, and the timing of symptoms and recovery, have not previously been quantified. We aimed to characterise timing, severity, and nature of symptom fluctuations in response to effortful physical, social and cognitive activities, using Ecological Momentary Assessments.Methods: We recorded activity, effort, and severity of 8 core symptoms every 3 h for up to 24 days, in cohorts from both clinic and community settings. Symptom severities were jointly modelled using autoregressive and moving average processes. Findings: Consent was received from 376 participants providing ≥1 week's measurements (273 clinic-based, 103 community-based). Severity of all symptoms was elevated 30 min after all categories of activity. Increased effort was associated with increased symptom severity. Fatigue severity scores increased by 1.8/10 (95% CI: 1.6–1.9) following the highest physical exertions and by 1.5 (1.4–1.7) following cognitive efforts. There was evidence of only mild delayed fatigue 3 h (0.3, 0.2–0.5) or one day later (0.2, 0.0– 0.5). Fatigue severity increased as the day progressed (1.4, 1.0–1.7), and cognitive dysfunction was 0.2 lower at weekends (0.1–0.3). Interpretation: Cognitive, social, self-care and physical activities all triggered increased severity across every symptom, consistent with associated common pathways as potential therapeutic targets. Clear patterns of symptom fluctuations emerged that support more targeted self-management. Funding: National Institute for Health and Care Research.
AB - Background: Symptom fluctuations within and between individuals with long COVID are widely reported, but the extent to which severity varies following different types of activity and levels of exertion, and the timing of symptoms and recovery, have not previously been quantified. We aimed to characterise timing, severity, and nature of symptom fluctuations in response to effortful physical, social and cognitive activities, using Ecological Momentary Assessments.Methods: We recorded activity, effort, and severity of 8 core symptoms every 3 h for up to 24 days, in cohorts from both clinic and community settings. Symptom severities were jointly modelled using autoregressive and moving average processes. Findings: Consent was received from 376 participants providing ≥1 week's measurements (273 clinic-based, 103 community-based). Severity of all symptoms was elevated 30 min after all categories of activity. Increased effort was associated with increased symptom severity. Fatigue severity scores increased by 1.8/10 (95% CI: 1.6–1.9) following the highest physical exertions and by 1.5 (1.4–1.7) following cognitive efforts. There was evidence of only mild delayed fatigue 3 h (0.3, 0.2–0.5) or one day later (0.2, 0.0– 0.5). Fatigue severity increased as the day progressed (1.4, 1.0–1.7), and cognitive dysfunction was 0.2 lower at weekends (0.1–0.3). Interpretation: Cognitive, social, self-care and physical activities all triggered increased severity across every symptom, consistent with associated common pathways as potential therapeutic targets. Clear patterns of symptom fluctuations emerged that support more targeted self-management. Funding: National Institute for Health and Care Research.
KW - Ecological momentary analysis
KW - Intensive longitudinal methods
KW - Long COVID
KW - Mental exertion
KW - Physical exertion
KW - Post-acute COVID-19 syndrome
KW - Symptoms
UR - http://www.scopus.com/inward/record.url?scp=85204349589&partnerID=8YFLogxK
U2 - 10.1016/j.lanepe.2024.101082
DO - 10.1016/j.lanepe.2024.101082
M3 - Article
C2 - 39381546
AN - SCOPUS:85204349589
SN - 2666-7762
VL - 46
JO - The Lancet Regional Health - Europe
JF - The Lancet Regional Health - Europe
M1 - 101082
ER -