Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study
Greenwood, Darren C Mansoubi, Maedeh Bakerly, Nawar D Bhatia, Aishwarya Collett, Johnny Davies, Helen E Dawes, Joanna Delaney, Brendan Ezekiel, Leisle Leveridge, Phaedra
Greenwood, Darren C
Mansoubi, Maedeh
Bakerly, Nawar D
Bhatia, Aishwarya
Collett, Johnny
Davies, Helen E
Dawes, Joanna
Delaney, Brendan
Ezekiel, Leisle
Leveridge, Phaedra
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Affiliation
University of Leeds; University of Exeter; Northern Care Alliance; Oxford Brookes University; Cardiff and Vale University Health Board; University Hospitals Birmingham NHS Foundation Trust; Imperial College; University of Southampton; In the Wild Research Limited; Patient Advisory Group (PAG) Representative; NHS Highlands; MRC-University of Glasgow Centre for Virus Research; Dublin City University
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Publication date
2024-09-20
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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.
Citation
Greenwood DC, Mansoubi M, Bakerly ND, Bhatia A, Collett J, Davies HE, Dawes J, Delaney B, Ezekiel L, Leveridge P, Mir G, Muhlhausen W, Rayner C, Read F, Scott JT, Sivan M, Tucker-Bell I, Vashisht H, Ward T, O'Connor DB, Dawes H; LOCOMOTION consortium. Physical, cognitive, and social triggers of symptom fluctuations in people living with long COVID: an intensive longitudinal cohort study. Lancet Reg Health Eur. 2024 Sep 20;46:101082. doi: 10.1016/j.lanepe.2024.101082.
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Article