Effect of a Personalised Pacing and Active Rest Rehabilitation Programme on Post-Exertional Symptom Exacerbation and Health Status in Long COVID (PACELOC). A Prospective Cohort Study

Background: Post-COVID Syndrome or long COVID (LC) is a novel public health crisis and, when persistent (> 2 years), is a long-term condition. Post-exertional Symptom Exacerbation (PESE) is a characteristic symptom of LC and can be improved in a structured pacing rehabilitation programme. Aims: To evaluate the effect of an 8-week structured World Health Organisation (WHO) Borg CR-10 pacing protocol on PESE episodes, LC symptoms and quality of life in a cohort of individuals with long-term LC. Methods: Participants received weekly telephone calls with a clinician to discuss their activity phase considering their PESE symptoms that week. They completed Leeds PESE questionnaire (LPQ), C19-YRS (Yorkshire Rehabilitation Scale) and EQ-5D-5L at the beginning (0 week), end of programme (8 weeks) and at final follow-up (12 weeks). Results: Thirty-one participants (duration of LC symptoms 29 months) completed the programme. The PESE episodes decreased in number each week (15% fewer each week, 95% CI: 11% to 20%, p<0.001), were of shorter duration, and of milder severity each week. The changes in C19YRS symptom severity and functional disability (0-12 weeks) were statistically significant but not clinically significant. The EQ5D-5L index score change was not statistically significant. Conclusion: A structured pacing protocol effectively reduced PESE episodes frequency, duration and severity but did not produce clinically significant changes in LC symptoms, reflecting the long-term nature of the condition in this cohort.