Journal Article


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

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.

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Authors

Greenwood, Darren C.
Mansoubi, Maedeh
Bakerly, Nawar D.
Bhatia, Aishwarya
Collett, Johnny
Davies, Helen E.
Dawes, Joanna
Delaney, Brendan
Ezekiel, Leisle
Leveridge, Phaedra
Mir, Ghazala
Muhlhausen, Willie
Rayner, Clare
Read, Flo
Scott, Janet T.
Sivan, Manoj
Tucker–Bell, Ian
Vashisht, Himanshu
Tomás Ward,
O'Connor, Daryl B.
Dawes, Helen
LOCOMOTION consortium

Oxford Brookes departments

Department of Sport, Health Sciences and Social Work

Dates

Year of publication: 2024
Date of RADAR deposit: 2024-09-23


Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License


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