Randomized Controlled Trial

. 2025 May 22;65(5):2402152.

doi: 10.1183/13993003.02152-2024. Print 2025 May.

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation

Enya Daynes^{1

2}, Rachael A Evans^{3

2}, Neil J Greening^{3

2}, Nicolette C Bishop⁴, Thomas Yates^{5

6}, Daniel Lozano-Rojas^{3

2}, Kimon Ntotsis^{3

2}, Matthew Richardson^{3

2}, Molly M Baldwin^{3

2}, Malik Hamrouni⁶, Emily Hume⁷, Hamish McAuley^{3

2}, George Mills^{3

2}, Dimitrios Megaritis⁷, Matthew Roberts⁶, Charlotte E Bolton^{8

9}, James D Chalmers¹⁰, Trudie Chalder¹¹, Annemarie B Docherty¹², Omer Elneima^{3

2}, Ewen M Harrison¹³, Victoria C Harris³, Ling P Ho^{13

14}, Alex Horsley¹⁵, Linzy Houchen-Wolloff^{3

2}, Olivia C Leavy^{3

16}, Michael Marks^{17

18}, Krishna Poinasamy¹⁹, Jennifer K Quint²⁰, Betty Raman^{21

22}, Ruth M Saunders³, Aarti Shikotra³, Amisha Singapuri³, Marco Sereno³, Sarah Terry³, Louise V Wain^{3

16}, William D-C Man^{23

24

25}, Carlos Echevarria²⁶, Ioannis Vogiatzis⁷, Christopher Brightling^{3

2}, Sally J Singh^{3

2}; PHOSP-COVID Study Collaborative Group

Affiliations

¹ The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK enya.daynes@uhl-tr.nhs.uk.
² Department of Respiratory Sciences, University of Leicester, Leicester, UK.
³ The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.
⁴ National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁵ NIHR Leicester Biomedical Research Centre - Diabetes, Leicester, UK.
⁶ Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
⁷ Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
⁸ Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
⁹ NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
¹⁰ University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
¹¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹² Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK.
¹³ MRC Human Immunology Unit, University of Oxford, Oxford, UK.
¹⁴ NIHR Oxford Biomedical Research Centre, Oxford, UK.
¹⁵ Manchester University NHS Foundation Trust, Manchester, UK.
¹⁶ Department of Population Health Sciences, University of Leicester, Leicester, UK.
¹⁷ Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
¹⁸ Hospital for Tropical Diseases, University College London Hospital, London, UK.
¹⁹ Asthma and Lung UK, London, UK.
²⁰ School of Public Health, Imperial College London, London, UK.
²¹ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
²² Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
²³ Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁴ National Heart and Lung Institute, Imperial College, London, UK.
²⁵ King's Centre for Lung Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
²⁶ The Newcastle upon Tyne Hospitals NHS Foundation Trust, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.

PMID: 39978856
PMCID: PMC12095904
DOI: 10.1183/13993003.02152-2024

Randomized Controlled Trial

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation

Enya Daynes et al. Eur Respir J. 2025.

. 2025 May 22;65(5):2402152.

doi: 10.1183/13993003.02152-2024. Print 2025 May.

Authors

Affiliations

¹ The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK enya.daynes@uhl-tr.nhs.uk.
² Department of Respiratory Sciences, University of Leicester, Leicester, UK.
³ The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester, Leicester, UK.
⁴ National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁵ NIHR Leicester Biomedical Research Centre - Diabetes, Leicester, UK.
⁶ Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
⁷ Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
⁸ Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
⁹ NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
¹⁰ University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
¹¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹² Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK.
¹³ MRC Human Immunology Unit, University of Oxford, Oxford, UK.
¹⁴ NIHR Oxford Biomedical Research Centre, Oxford, UK.
¹⁵ Manchester University NHS Foundation Trust, Manchester, UK.
¹⁶ Department of Population Health Sciences, University of Leicester, Leicester, UK.
¹⁷ Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
¹⁸ Hospital for Tropical Diseases, University College London Hospital, London, UK.
¹⁹ Asthma and Lung UK, London, UK.
²⁰ School of Public Health, Imperial College London, London, UK.
²¹ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
²² Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
²³ Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
²⁴ National Heart and Lung Institute, Imperial College, London, UK.
²⁵ King's Centre for Lung Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
²⁶ The Newcastle upon Tyne Hospitals NHS Foundation Trust, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.

PMID: 39978856
PMCID: PMC12095904
DOI: 10.1183/13993003.02152-2024

Abstract

Objective: Post-COVID syndrome involves prolonged symptoms with multisystem and functional impairment lasting ≥12 weeks after acute coronavirus disease 2019 (COVID-19). We aimed to determine the efficacy of exercise-based rehabilitation interventions, either face-to-face or remote, compared to usual care in individuals experiencing post-COVID syndrome following a hospitalisation with acute COVID-19.

Design: This single-blind randomised controlled trial compared two exercise-based rehabilitation interventions (face-to-face or remote) to usual care in participants with post-COVID syndrome following a hospitalisation. The interventions were either a face-to-face or remote 8-week programme of individually prescribed exercise and education. The primary outcome was the change in Incremental Shuttle Walking Test (ISWT) following 8 weeks of intervention (either face-to-face or remote) compared to usual care. Other secondary outcomes were measured including health-related quality of life (HRQoL), and exploratory outcomes included lymphocyte immunotyping.

Results: 181 participants (55% male, mean±sd age 59±12 years, length of hospital stay 12±19 days) were randomised. There was an improvement in the ISWT distance following face-to-face rehabilitation (mean 52 m, 95% CI 19-85 m; p=0.002) and remote rehabilitation (mean 34 m, 95% CI 1-66 m; p=0.047) compared to usual care alone. There were no differences between groups for HRQoL self-reported symptoms. Analysis of immune markers revealed significant increases in naïve and memory CD8⁺ T-cells following face-to-face rehabilitation versus usual care alone (p<0.001, n=31).

Conclusion: Exercise-based rehabilitation improved short-term exercise capacity in post-COVID syndrome following an acute hospitalisation and showed potential for beneficial immunomodulatory effects.

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Conflict of interest statement

Conflict of interest: E. Daynes reports consulting fees from NMHI, honoraria from ClinicalPhysio, Neuroscience and Mental Health Institute (funding committee 2023), and leadership roles with the BTS as chair of the Pulmonary Rehabilitation Specialist Advisory Group (unpaid) and The Royal College of Physicians (paid). R.A. Evans reports funding from UKRI/MRC/NIHR, grants from Wolfson Foundation and Genentech/Roche, consulting fees for AstraZeneca/Evidera for long COVID, speaker fees for Boehringer and Moderna on the topic of long COVID, support for attending meetings from Chiesi, and leadership roles as Chair of ERS Group 01.02 Pulmonary Rehabilitation and Chronic Care, and Chair of ATS Pulmonary Rehabilitation Assembly. N.J. Greening reports consultancy fees for Genetech/Roche, honoraria from Chiesa, GSK, AstraZeneca and Pulmonx, and support for attending meetings from Chiesi and GSK. N.C. Bishop reports support for the present manuscript from NIHR-Leicester Biomedical Research Centre. M. Hamrouni reports support for the present manuscript from NIHR-Leicester Biomedical Research Centre. M. Roberts reports support for the present manuscript from NIHR. C.E. Bolton reports grants from NIHR, UKRI, Nottingham Hospitals Charity, UoN charitable gifts and Nottingham University Hospitals Trust. J.D. Chalmers reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis and Insmed, personal fees from Chiesi, Zambon, Janssen and Grifols, and grants from Gilead Sciences, outside the submitted work. T. Chalder is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, and reports grants from Guy's and St Thomas’ Charity, NIHR and UKRI, is on the Expert Advisory Panel for Covid-19 Rapid Guidelines and the Scientific committee of BABCP, has received ad hoc payments for workshops carried out on long-term conditions, support for attending meetings from BABCP and EABCT, and is the author of several self-help books on chronic fatigue for which she has received royalties. A.B. Docherty reports funding from Wellcome in an unrelated fellowship (216606/Z/19/Z). L.P. Ho reports support from Roche/Genentech. A. Horsley reports support for the present manuscript from UKRI (MR/V027859/1), NIHR (COV0319) and NIHR Manchester BRC, and is Chair of NIHR Translational Research Collaboration (unpaid). J.K. Quint reports consulting fees for Evidera for advice on COVID-19 studies. B. Raman reports support for the present manuscript from Wellcome Trust (Wellcome Trust Career Development Award (302210/Z/23/Z)) and NIHR Oxford BRC. A. Singapuri reports support for the present manuscript from UKRI and NIHR (MR/V027859/1 and COV0319). L.V. Wain reports support for the present manuscript from UKRI, GSK/Asthma and Lung UK, and NIHR, grants from Orion Pharma, GSK, Genetech and AstraZeneca, consulting fees from Galapagos and Boehringer Ingelheim, support for attending meetings from Genentech, advisory board membership with Galapagos, and a leadership role as associate editor for the European Respiratory Journal. W.D-C. Man reports grants from NIHR and Small Business Research Initiative, and a leadership role as Honorary President of the Association for Respiratory Technology and Physiology. C. Brightling reports support for the present manuscript from PHOSP-COVID NIHR UKRI and NIHR Leicester BRC, and has received grants and consultancy fees from 4D Pharma, Areteia, AstraZeneca, Chiesi, Genentech, GlaxoSmithKline, Mologic, Novartis, Regeneron Pharmaceuticals, Roche and Sanofi. The remaining authors have no potential conflicts of interest to disclose.

Figures

None — In this study individuals with post-COVID syndrome improved exercise capacity following face-to-face rehabilitation or digital rehabilitation compared to usual care alone.

**FIGURE 1**
Consort diagram for PHOSP-R study. Randomisation procedure indicated as 1) following a 1:1:1 ratio, 2) following a 2:1 ratio in favour of face-to-face rehabilitation and 3) following a 2:1 ratio in favour of digital rehabilitation. PEM: post-exertional malaise.

**FIGURE 2**
Mean (95% confidence interval) change from baseline for face-to-face, usual-care and remote groups. Comparisons are made between face-to-face and usual care, and remote and usual care. ISWT: Incremental Shuttle Walking Test; MCID: minimal clinically important difference.

See this image and copyright information in PMC

Comment in

Rehabilitation for persons with long COVID beyond the recovery phase of SARS-CoV-2 infection.
Puhan MA, Dalla Lana K. Puhan MA, et al. Eur Respir J. 2025 May 22;65(5):2500239. doi: 10.1183/13993003.00239-2025. Print 2025 May. Eur Respir J. 2025. PMID: 40404198 No abstract available.

References

1. NHS England . Post-COVID syndrome (long COVID). Date last accessed: 20 April 2024. www.england.nhs.uk/coronavirus/post-covid-syndrome-long-covid/
1. Ely EW, Brown LM, Fineberg HV, et al. . Long Covid defined. N Engl J Med 2024; 391: 1746–1753. doi: 10.1056/NEJMsb2408466 - DOI - PMC - PubMed
1. World Health Organization (WHO) . Post COVID-19 condition (long COVID). Date last accessed: 20 April 2024. Date last updated: 7 December 2022. www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition#:∼...
1. Evans RA, McAuley H, Harrison EM, et al. . Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. Lancet Respir Med 2021; 9: 1275–1287. doi:10.1016/S2213-2600(21)00383-0 - DOI - PMC - PubMed
1. Hanson S W, Abbafati C, Aerts JG, et al. . Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA 2022; 328: 1604–1615. doi:10.1001/jama.2022.18931 - DOI - PMC - PubMed

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Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation

Affiliations

Post-Hospitalisation COVID-19 Rehabilitation (PHOSP-R): a randomised controlled trial of exercise-based rehabilitation

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

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Grants and funding

LinkOut - more resources

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Medical

Research Materials