The Effects of a Multi-factorial Rehabilitation Program for Healthcare Workers Suffering From Post-COVID-19 Fatigue Syndrome

The Effects of a Multi-factorial Rehabilitation Program for Healthcare Workers Suffering From Post-COVID-19 Fatigue Syndrome

The Effects of a Multi-factorial Rehabilitation Program for Healthcare Workers Suffering From Post-COVID-19 Fatigue Syndrome

The SARS-CoV2 pandemic has kept the world in suspense for over a year now. Almost 100 million people around the world have contracted COVID-19 to date and over 2 million people have died of COVID-19 by the end of January 2021. Despite the tragedy of these deaths, it must be pointed out at this point that the number of COVID-19 survivors is significantly larger. These COVID-19 survivors are now the focus of interest in rehabilitation measures, as it has been shown that survival of the disease does not go hand in hand with a complete cure. Thirty-five percent of all COVID-19 survivors and 87% of the COVID-19 survivors who were hospitalized in the course of their illness suffer from after-effects that are currently summarized as post-COVID fatigue syndrome also known as "Long-COVID". As health care workers are at higher risk of contracting SARS CoV2 and furthermore, considering their central role in the overcoming of this pandemic, a COVID-19 rehabilitation program for healthcare workers of the Medical University of Vienna, Austria as well as the General Hospital of Vienna, Austria - together the second-largest university-clinic in the world - was developed as part of workplace health promotion. Nowadays, the fatigue syndrome is primarily known as a side effect of cancer treatment and thus from the rehabilitation of cancer patients. Cancer-related fatigue is a massive limiting side effect for patients and the currently most effective treatment strategy against cancer-associated fatigue syndrome is physical training. The idea for this current project is, that physical exercise might have similar effects on post-SARS-CoV2 fatigue as it has on cancer-related fatigue. The current study evaluates the effects of this primarily exercise-based rehabilitation program on Long-COVID fatigue.

Employees of the Medical University of Vienna, Austria and the General Hospital of Vienna, Austria who survived a SARS-CoV2 infection will be invited to take part in an eight weeks post-COVID-19 rehabilitation program which is part of a workplace health promotion measure. This program consists of eight weeks of exercising (twice per week supervised resistance training + individual, heart-rate controlled endurance training recommendations) with a sports scientist and a sports medicine specialist, complemented by one session of nutrition consultation with a nutritionist and two sessions of psychological consultation with a clinical psychologist. Parallel to this workplace health promotion program, the scientific evaluation of this intevention will be undertaken via this study.

SARS-CoV2 survivor who attends the exercise program and suffers from post-COVID-19 fatigue Syndrome according to the Post-Covid-19-Functional Scale (PCFS)

SARS-CoV2 survivor who attends the exercise program and doesn't suffer from post-COVID-19 fatigue Syndrome according to the Post-Covid-19-Functional Scale (PCFS)

Change of maximum oxygen uptake (VO2max) over time-points (baseline - 4 weeks - 8 weeks) assessed during cardio-pulmonary exercise testing (CPET)

Measurement of VO2max during an exhaustive CPET is the gold standard for objectifying cardiopulmonary performance and detecting any cardiovascular risks under stress. VO2max will be measured in ml/kg bodyweight.This examination is the gold standard for objectifying cardiopulmonary performance and detecting any cardiovascular risks under stress.

Change of walking distance during a six minutes walk test (6MWT) over time-points (baseline - 4 weeks - 8 weeks)

The 6MWT is used, among other things, to assess and control cardiovascular and pulmonary performance below the anaerobic threshold. This test is used for the clinical evaluation of the basic motor property endurance and measures the distance a patient can walk as quickly as possible on a flat, hard surface in a period of 6 minutes. It will be measured in meters.

Change of numbers over time-points (baseline - 4 weeks - 8 weeks) how often someone can stand up and sit down on a chair within 30 seconds during a 30-seconds sit-to-stand test (30secSTS)

The 30seconds Sit-to-Stand test is a well-established functional test used to estimate the strength endurance of the lower extremities and describes how often the test person can get up from a chair and sit down again in a period of 30 seconds. In patients suffering from chronic obstructive pulmonary disease (COPD), the 30seconds sit-to-stand test has proven to be a valid and reliable parameter.

Change of absolute body fat over time-points (baseline - 4 weeks - 8 weeks) via Bioelectrical Impedance Analysis (BiA)

BiA is a non-invasive method for measuring body composition and serves as a basis for assessing metabolic disease risks among others by measuring body fat in absolute (kg) numbers.

Change of body fat percentage over time-points (baseline - 4 weeks - 8 weeks) via Bioelectrical Impedance Analysis (BiA)

BiA is a non-invasive method for measuring body composition and serves as a basis for assessing metabolic disease risks among others by measuring body fat in relative (%) numbers.

Change of absolute Lean Body Mass (LBM) over time-points (baseline - 4 weeks - 8 weeks) via Bioelectrical Impedance Analysis (BiA)

BiA is a non-invasive method for measuring body composition and serves as a basis for assessing metabolic disease risks among others by measuring lean body mass in absolute (kg) numbers.

Change of realtive Lean Body Mass (LBM) over time-points (baseline - 4 weeks - 8 weeks) via Bioelectrical Impedance Analysis (BiA)

BiA is a non-invasive method for measuring body composition and serves as a basis for assessing metabolic disease risks among others by measuring lean body mass in relative (%) numbers.

Change of generalized anxiety measured over time-points (baseline - 4 weeks - 8 weeks) via Generalized Anxiety Disorder Scale-7 (GAD-7)

The GAD-7 (Generalized Anxiety Disorder 7) is a module of the health questionnaire for patients (PHQ-D), which was designed to identify patients with generalized anxiety disorder and to record the severity of symptoms of generalized anxiety (7 items). Scores range from 0 to 21 points with low scores representing low general anxiety and high scores representing high general anxiety.

Change of depression measured over time-points (baseline - 4 weeks - 8 weeks) via the Patient Health Questionnaire-9 (PHQ-9)

The questionnaire PHQ-9 corresponds to the depression module of the health questionnaire for patients (PHQ-D). It was developed as a screening instrument for the diagnosis of depression for routine use in the somatic medical field (9 items). Scores range from 0 to 27 points with low scores representing low levels of depression and high scores representing high levels of depression.

Change of mental stress measured over time-points (baseline - 4 weeks - 8 weeks) via Perceived Stress Scale (PSS-10)

The PSS-10 measures the subjective experience of stress. It records the dimensions of self-efficacy and helplessness in two scales, as well as an overall stress score (10 items). Scores range from 0 to 50 points with low scores representing low stress levels and high scores representing high stress levels.

Change of fatigue measured over time-points (baseline - 4 weeks - 8 weeks) via Brief Fatigue Inventory (BFI)

The BFI measures the severity and extent of fatigue. The questionnaire covers six dimensions: activity, mood, ability to walk, work, relationship with other people and joie de vivre (10 items). Scores range from 0 to 10 points with low scores representing low fatigue and high scores representing high fatigue.

Change of resilience measured over time-points (baseline - 4 weeks - 8 weeks) via Brief Resilience Scale (BRS)

The Brief Resilience Scale measures resilience, the ability to successfully cope with difficult, stressful situations or to recover quickly from them (6 items). Scores range from 1 to 5 points with low scores representing low resilience and high scores representing high resilience.

Change and time kinetics of handgrip strength (HGS) over time-points (baseline and before each exercise session) measured via handgrip Dynamometer.

Data on the fist force in kg (measurement of the basic motor property force), which are collected using a JAMAR® dynamometer.

Change and time kinetics of physical and functional limitations of COVID-19 survivors over time-points (baseline and before each exercise session) via Post-Covid-19-Functional Scale (PCFS)

The Post-COVID-19 Functional Scale is a questionnaire for self-assessment of physical and functional limitations after a COVID-19 infection. It ranges from 0 (no functional impairment) to 4 (severe functional impairments).

Change of work ability over time-points (baseline, 4 weeks, 8 weeks) via Work Ability Index (WAI) questionnaire.

The Work Ability Index (WAI) is a measuring instrument for recording the work ability of employees. The WAI is a questionnaire that is filled out either by the respondents themselves or by third parties, e.g. company doctors during the company medical examination. The WAI is predictive of reintegration into working life after workplace-specific rehabilitation against back pain. WAI scores range from 7-27 (poor), over 28-36 (moderate), and 37 to 43 (good) to 44-49 (very good).

TnT (0 - 14 ng/L) is a heart-specific and very sensitive marker for myocardial damage in case of elevated values

CK-MB (< 24 U/l) are elevated in cardiac muscle diseases e.g. myocardial infarction, myocarditis, ischemic conditions e.g. angina pectoris, or for the differential diagnosis of muscle diseases

CRP (< 0,5 mg/dl) is an "acute phase protein" which increases in infections (bacterial, less viral and fungi), inflammation, post-OP, malignant processes; ultra-sensitive CRP is additionally a risk assessment marker of aterosclerosis

Triglycerides (< 150 mg/dl) increased in primary hyperlipidemia as a risk faktor for cardiovascular diseases

Spare time physical activity is a key indicator for physical function and will be measured via activity tracker

Spare time physical activity is a key indicator for physical function and will be measured via activity tracker

Spare time physical activity is a key indicator for physical function and will be measured via activity tracker

A low average heart rate during activities of daily living is an indicator for a relatively low cardiovascular load

A low maximum heart rate during activities of daily living is an indicator for a relatively lower level of cardiovascular load

A high oxygen saturation is an indicator for a well functioning gas exchange in the lungs and distribution into the circulatory system

Change of Mild Cognitive Impairment over time-points (baseline, 8 weeks) via Montreal Cognitive Assessment (MoCA)

The MoCA test is a screening instrument for Mild Cognitive Impairment. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation.

Change of sleep quality over time points (baseline, 4 weeks, 8 weeks) via Insomnia Severity Index (ISI)

The Insomnia Severity Index (ISI) is a brief self-report instrument measuring the patient's perception of both nocturnal and diurnal symptoms of insomnia.

Procollagen type 1 amino-terminal propeptide (P1NP; 20-92 ng/ml) is an early marker of bone formation.

25-OH-vitamin D (75-250 nmol/l) is the precursor for calcitriol, the active form of vitamin D which is essential for calcium metabolism

Parathyroid hormone (PTH; 15-65 pg/ml) regulates the serum calcium concentration through its effects on bone, kidney, and intestine.

Inclusion Criteria: Employees of the Medical University of Vienna, Austria or the General Hospital of Vienna, Austria survived COVID-19 infection Exclusion Criteria: acute COVID-19 infection serious, uncontrolled diseases of the cardiovascular system insufficient language skills to complete the study requirements

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