. 2024 Sep 20:46:101082.

doi: 10.1016/j.lanepe.2024.101082. eCollection 2024 Nov.

Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study

Darren C Greenwood^{1

2}, Maedeh Mansoubi^{3

4

5}, Nawar D Bakerly⁶, Aishwarya Bhatia⁴, Johnny Collett⁷, Helen E Davies⁸, Joanna Dawes^{4

9}, Brendan Delaney¹⁰, Leisle Ezekiel¹¹, Phaedra Leveridge⁵, Ghazala Mir¹², Willie Muhlhausen¹³, Clare Rayner¹⁴, Flo Read¹⁵, Janet T Scott^{16

17}, Manoj Sivan¹⁸, Ian Tucker-Bell¹⁴, Himanshu Vashisht¹³, Tomás Ward¹⁹, Daryl B O'Connor²⁰, Helen Dawes^{3

4

5}; LOCOMOTION consortium

Collaborators, Affiliations

Collaborators

LOCOMOTION consortium:
Nawar D Bakerly, Kumaran Balasundaram, Megan Ball, Mauricio Barahona, Alexander Casson, Jonathan Clarke, Karen Cook, Rowena Cooper, Vasa Curcin, Julie Darbyshire, Helen E Davies, Helen Dawes, Simon de Lusignan, Brendan Delaney, Carlos Echevarria, Sarah Elkin, Ana Belen Espinosa Gonzalez, Rachael Evans, Sophie Evans, Zacchaeus Falope, Ben Glampson, Madeline Goodwin, Trish Greenhalgh, Darren C Greenwood, Stephen Halpin, Juliet Harris, Will Hinton, Mike Horton, Samantha Jones, Joseph Kwon, Cassie Lee, Ashliegh Lovett, Mae Mansoubi, Victoria Masey, Harsha Master, Erik Mayer, Bernardo Meza-Torres, Ruairidh Milne, Ghazala Mir, Jacqui Morris, Adam Mosley, Jordan Mullard, Daryl O'Connor, Rory O'Connor, Thomas Osborne, Amy Parkin, Stavros Petrou, Anton Pick, Denys Prociuk, Clare Rayner, Amy Rebane, Natalie Rogers, Janet T Scott, Manoj Sivan, Adam B Smith, Nikki Smith, Emma Tucker, Ian Tucker-Bell, Paul Williams, Darren Winch, Conor Wood

Affiliations

¹ School of Medicine, University of Leeds, Leeds, UK.
² Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
³ NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK.
⁴ Medical School, University of Exeter, Exeter, UK.
⁵ Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK.
⁶ Northern Care Alliance, Salford, UK.
⁷ Department of Sport, Health and Social Work, Oxford Brookes University, Oxford, UK.
⁸ Cardiff and Vale University Health Board, Cardiff, UK.
⁹ University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁰ Faculty of Medicine, Department of Surgery & Cancer, Imperial College, London, UK.
¹¹ School of Health Sciences, University of Southampton, Southampton, UK.
¹² Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
¹³ In the Wild Research Limited, Dublin, Ireland.
¹⁴ Patient Advisory Group (PAG) Representative, UK.
¹⁵ Department of Health and Community Sciences, University of Exeter, Exeter, UK.
¹⁶ COVID Recovery Service, NHS Highlands, Raigmore Hospital, Inverness, UK.
¹⁷ MRC-University of Glasgow Centre for Virus Research, Glasgow, UK.
¹⁸ Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK.
¹⁹ Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland.
²⁰ School of Psychology, University of Leeds, Leeds, UK.

PMID: 39381546
PMCID: PMC11458954
DOI: 10.1016/j.lanepe.2024.101082

Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study

Darren C Greenwood et al. Lancet Reg Health Eur. 2024.

. 2024 Sep 20:46:101082.

doi: 10.1016/j.lanepe.2024.101082. eCollection 2024 Nov.

Authors

Collaborators

LOCOMOTION consortium:
Nawar D Bakerly, Kumaran Balasundaram, Megan Ball, Mauricio Barahona, Alexander Casson, Jonathan Clarke, Karen Cook, Rowena Cooper, Vasa Curcin, Julie Darbyshire, Helen E Davies, Helen Dawes, Simon de Lusignan, Brendan Delaney, Carlos Echevarria, Sarah Elkin, Ana Belen Espinosa Gonzalez, Rachael Evans, Sophie Evans, Zacchaeus Falope, Ben Glampson, Madeline Goodwin, Trish Greenhalgh, Darren C Greenwood, Stephen Halpin, Juliet Harris, Will Hinton, Mike Horton, Samantha Jones, Joseph Kwon, Cassie Lee, Ashliegh Lovett, Mae Mansoubi, Victoria Masey, Harsha Master, Erik Mayer, Bernardo Meza-Torres, Ruairidh Milne, Ghazala Mir, Jacqui Morris, Adam Mosley, Jordan Mullard, Daryl O'Connor, Rory O'Connor, Thomas Osborne, Amy Parkin, Stavros Petrou, Anton Pick, Denys Prociuk, Clare Rayner, Amy Rebane, Natalie Rogers, Janet T Scott, Manoj Sivan, Adam B Smith, Nikki Smith, Emma Tucker, Ian Tucker-Bell, Paul Williams, Darren Winch, Conor Wood

Affiliations

¹ School of Medicine, University of Leeds, Leeds, UK.
² Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
³ NIHR Exeter Biomedical Research Centre, University of Exeter, Exeter, UK.
⁴ Medical School, University of Exeter, Exeter, UK.
⁵ Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK.
⁶ Northern Care Alliance, Salford, UK.
⁷ Department of Sport, Health and Social Work, Oxford Brookes University, Oxford, UK.
⁸ Cardiff and Vale University Health Board, Cardiff, UK.
⁹ University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
¹⁰ Faculty of Medicine, Department of Surgery & Cancer, Imperial College, London, UK.
¹¹ School of Health Sciences, University of Southampton, Southampton, UK.
¹² Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
¹³ In the Wild Research Limited, Dublin, Ireland.
¹⁴ Patient Advisory Group (PAG) Representative, UK.
¹⁵ Department of Health and Community Sciences, University of Exeter, Exeter, UK.
¹⁶ COVID Recovery Service, NHS Highlands, Raigmore Hospital, Inverness, UK.
¹⁷ MRC-University of Glasgow Centre for Virus Research, Glasgow, UK.
¹⁸ Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK.
¹⁹ Insight SFI Research Centre for Data Analytics, Dublin City University, Dublin, Ireland.
²⁰ School of Psychology, University of Leeds, Leeds, UK.

PMID: 39381546
PMCID: PMC11458954
DOI: 10.1016/j.lanepe.2024.101082

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.

Keywords: Ecological momentary analysis; Intensive longitudinal methods; Long COVID; Mental exertion; Physical exertion; Post-acute COVID-19 syndrome; Symptoms.

PubMed Disclaimer

Conflict of interest statement

This work is independent research funded by the National Institute for Health and Care Research (NIHR) (Long COVID grant, Ref: COV-LT2-0016). The views expressed in this publication are those of the authors and not necessarily those of NIHR or The Department of Health and Social Care. All authors were supported by funding from this source (DCG, MM, NDB, AB, JC, HED, JD, BD, LE, PL, GM, WM, CR, FR, JTS, MS, IT, HV, TW, DBO’C, HD). DCG was additionally supported by funding from NHS England, NHS Improvement and NHS National Services Scotland. MM and HD are supported by the National Institute for Health and Care Research Exeter Biomedical Research Centre. JC is funded by the National Institute for Health and Care Research Oxford Health Biomedical Research Centre. BD is a member of the BioNTech Long COVID and vaccination review advisory board. MS was supported by funding from Research England Policy Support Fund and the Engineering and Physical Sciences Research Council, holds roles with the Oxford Handbook of Rehabilitation Medicine, Advances in Rehabilitation Science and Practice, Frontiers in Pain Research and the British Society of Physical and Rehabilitation Medicine. This work was undertaken on ARC4, part of the High Performance Computing facilities at the University of Leeds, UK.

Figures

**Fig. 1**
**Change in mean symptom severity scores associated with physical activity effort (0–10), by length of time-lag, with 95% credible intervals**. Activity effort is truncated at the 99th centile for presentation.

**Fig. 2**
**Change in mean symptom severity scores associated with cognitive activity effort (0–10), by length of time-lag, with 95% credible intervals**. Activity effort is truncated at the 99th centile for presentation.

See this image and copyright information in PMC

References

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1. Hastie C.E., Lowe D.J., McAuley A., et al. True prevalence of long-COVID in a nationwide, population cohort study. Nat Commun. 2023;14(1):7892. - PMC - PubMed
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Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study

Collaborators

Affiliations

Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

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