Greenwood, D.C. orcid.org/0000-0001-7035-3096, Mansoubi, M., Bakerly, N.D. et al. (18 more authors) (2024) Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study. The Lancet Regional Health - Europe, 46. 101082. ISSN 2666-7762
Abstract
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Keywords: | Long COVID; Post-acute COVID-19 syndrome; Physical exertion; Mental exertion; Symptoms; Ecological momentary analysis; Intensive longitudinal methods |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research COV-LT2-0016 |
Depositing User: | Symplectic Publications |
Date Deposited: | 12 Sep 2024 15:42 |
Last Modified: | 10 Oct 2024 14:28 |
Published Version: | https://www.thelancet.com/journals/lanepe/article/... |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.lanepe.2024.101082 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:217105 |
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