Exercise + Cognitive Training for Long COVID
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: VA Office of Research and Development
Disqualifiers: Severe psychotic disorder, Stroke, Parkinson's, Alzheimer's, others
No Placebo Group
Trial Summary
What is the purpose of this trial?
This two-year study will evaluate the feasibility and safety of an exercise + cognitive training program to improve neurological symptoms of long-COVID. This is a two-phased trial: 1) an exercise phase and 2) a cognitive training phase. The exercise phase will be an aquatic based exercise program. A combination exercise + memory training programs designed for persons with cognitive impairment have significantly improved memory more than other single intervention groups (exercise only, cognitive training only) and given the success of combination training programs with healthy adults, it is important to adapt these programs for persons with neurological symptoms of long-COVID.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment WATER+CT for Long COVID?
Research suggests that combining cognitive training with physical activity can improve cognitive function, as seen in studies with older adults and those with traumatic brain injury. This indicates that the WATER+CT treatment, which combines aquatic exercise with cognitive training, may help improve cognitive issues in Long COVID patients.12345
Is aquatic exercise safe for humans?
Aquatic exercise programs have been shown to be safe and beneficial for improving physical fitness and health in both healthy adults and those with chronic diseases. Studies indicate that these programs can enhance strength, balance, and cardiorespiratory fitness without significant safety concerns.678910
How does the Exercise + Cognitive Training treatment for Long COVID differ from other treatments?
This treatment is unique because it combines physical exercise with cognitive training, which has shown potential benefits for cognitive function in older adults and those with degenerative diseases. Unlike standard treatments that may focus solely on physical or cognitive aspects, this approach aims to enhance both physical and mental recovery, potentially offering a more comprehensive benefit for Long COVID patients.124511
Eligibility Criteria
This trial is for veterans aged 18-89 with long COVID neurological symptoms like 'brain fog', who can undergo neuropsychological testing and water-based exercise. They must have had COVID-19 at least 6 months prior, with ongoing symptoms for over 8 weeks. Those with severe pre-existing conditions or current severe cardiac disease cannot participate.Inclusion Criteria
You had COVID-19 more than 6 months ago, and it was confirmed by a doctor.
I have had 'brain fog' or trouble thinking clearly for at least 8 weeks since getting COVID-19.
I can see and hear well enough to take psychological tests.
See 3 more
Exclusion Criteria
I had a neurological or neurodegenerative condition, or a serious illness affecting my brain function before getting COVID-19.
I do not have severe heart problems or recent serious blood clots.
You cannot do an exercise stress test.
See 2 more
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Exercise Training
Participants undergo a six-month long individualized water-based exercise program with thrice-weekly group sessions
6 months
3 visits per week (in-person)
Cognitive Training
Participants engage in classroom-based cognitive training focusing on pre-training and mnemonic training
2 months
Regular classroom sessions (in-person)
Follow-up
Participants are monitored for safety and effectiveness after treatment
4 weeks
Treatment Details
Interventions
- WATER+CT (Behavioural Intervention)
Trial OverviewThe study tests a two-phase program combining aquatic exercises and cognitive training to improve long-COVID neurological issues. Participants will first engage in water-based exercises followed by memory training, assessing the combined effect on recovery.
Participant Groups
2Treatment groups
Experimental Treatment
Group I: WATER+CTExperimental Treatment1 Intervention
This is 8-month long two phase intervention consisting of: 1) 6 months of aquatic exercise followed by 2) 2 months of cognitive training.
Group II: Usual CareExperimental Treatment1 Intervention
This arm consists of psychoeducation regarding brain health and healthy lifestyles.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
VA Palo Alto Health Care System, Palo Alto, CAPalo Alto, CA
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Who Is Running the Clinical Trial?
VA Office of Research and DevelopmentLead Sponsor
References
Effects of a Cognitive Training With and Without Additional Physical Activity in Healthy Older Adults: A Follow-Up 1 Year After a Randomized Controlled Trial. [2020]Background: Combining cognitive training (CT) with physical activity (CPT) has been suggested to be most effective in maintaining cognition in healthy older adults, but data are scarce and inconsistent regarding long-term effects (follow-up; FU) and predictors of success. Objective: To investigate the 1-year FU effects of CPT versus CT and CPT plus counseling (CPT+C), and to identify predictors for CPT success at FU. Setting and Participants: We included 55 healthy older participants in the data analyses; 18 participants (CPT group) were used for the predictor analysis. Interventions: In a randomized controlled trial, participants conducted a CT, CPT, or CPT+C for 7 weeks. Outcome Measures: Overall cognition, verbal, figural, and working memory, verbal fluency, attention, planning, and visuo-construction. Results: While within-group comparisons showed cognitive improvements for all types of training, only one significant interaction Group × Time favoring CPT in comparison to CPT+C was found for overall cognition and verbal long-term memory. The most consistent predictor for CPT success (in verbal short-term memory, verbal fluency, attention) was an initial low baseline performance. Lower education predicted working memory gains. Higher levels of insulin-like growth factor 1 (IGF-1) and lower levels of brain-derived neurotrophic factor at baseline (BDNF) predicted alternating letter verbal fluency gains. Discussion: Within-group comparisons indicate that all used training types are helpful to maintain cognition. The fact that cognitive and sociodemographic data as well as nerve growth factors predict long-term benefits of CPT contributes to the understanding of the mechanisms underlying training success and may ultimately help to adapt training to individual profiles. Clinical Trial Registration: WHO ICTRP (http://apps.who.int/trialsearch/), identifier DRKS00005194.
Pilot feasibility study of cognitive training exercises for Egyptian adults: Proof of concept. [2021]Cognitive training exercises (CTE) are promising and effective interventions to enhance cognitive reserve and slowdown cognitive deterioration in people with subjective memory impairment (SCI) and mild cognitive impairment (MCI). In this pilot study, we aimed to assess the feasibility of CTE among Egyptian adults.
Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis. [2020]Objective: To quantitatively aggregate effects of cognitive training (CT) on cognitive and functional outcome measures in patients with traumatic brain injury (TBI) more than 12-months post-injury. Design: We systematically searched six databases for non-randomized and randomized controlled trials of CT in TBI patients at least 12-months post-injury reporting cognitive and/or functional outcomes. Main Measures: Efficacy was measured as standardized mean difference (Hedges' g) of post-training change. We investigated heterogeneity across studies using subgroup analyses and meta-regressions. Results: Fourteen studies encompassing 575 patients were included. The effect of CT on overall cognition was small and statistically significant (g = 0.22, 95%CI 0.05 to 0.38; p = 0.01), with low heterogeneity (I2 = 11.71%) and no evidence of publication bias. A moderate effect size was found for overall functional outcomes (g = 0.32, 95%CI 0.08 to 0.57, p = 0.01) with low heterogeneity (I2 = 14.27%) and possible publication bias. Statistically significant effects were also found only for executive function (g = 0.20, 95%CI 0.02 to 0.39, p = 0.03) and verbal memory (g = 0.32, 95%CI 0.14 to 0.50, p < 0.01). Conclusion: Despite limited studies in this field, this meta-analysis indicates that CT is modestly effective in improving cognitive and functional outcomes in patients with post-acute TBI and should therefore play a more significant role in TBI rehabilitation.
Reshaping the path of mild cognitive impairment by refining exercise prescription: a study protocol of a randomized controlled trial to understand the "what," "for whom," and "how" of exercise to promote cognitive function. [2022]Targeted exercise training is a promising strategy for promoting cognitive function and preventing dementia in older age. Despite the utility of exercise as an intervention, variation still exists in exercise-induced cognitive gains and questions remain regarding the type of training (i.e., what), as well as moderators (i.e., for whom) and mechanisms (i.e., how) of benefit. Both aerobic training (AT) and resistance training (RT) enhance cognitive function in older adults without cognitive impairment; however, the vast majority of trials have focused exclusively on AT. Thus, more research is needed on RT, as well as on the combination of AT and RT, in older adults with mild cognitive impairment (MCI), a prodromal stage of dementia. Therefore, we aim to conduct a 6-month, 2 × 2 factorial randomized controlled trial in older adults with MCI to assess the individual effects of AT and RT, and the combined effect of AT and RT on cognitive function and to determine the possible underlying biological mechanisms.
Effects of cognitive training with additional physical activity compared to pure cognitive training in healthy older adults. [2019]Cognitive training (CT) has been reported to improve cognition in older adults. Its combination with protective factors such as physical activity (CPT) has rarely been studied, but it has been suggested that CPT might show stronger effects than pure CT.
Water-Based Training Programs Improve Functional Capacity, Cognitive and Hemodynamic Outcomes? The ACTIVE Randomized Clinical Trial. [2023]Purpose: To compare the effects of 16 weeks of aerobic training (AT) to 8 weeks of AT followed by 8 weeks of combined training (CT), as well as to a control group (CG), on the functional, cognitive and hemodynamic responses of older women exercising in the aquatic environment. Materials and Methods: The study is a three-armed parallel randomized controlled clinical trial. For this, 52 older women were first randomized in an aerobic training (AT; n = 35) or control group (CG; n = 17). After 8 weeks of intervention, participants from AT group were again randomized into another 8-week period of either AT (n = 17) or combined training (CT; n = 18). AT was performed at the percentage of the heart rate corresponding to the anaerobic threshold, resistance training was performed with sets at maximal effort and the control group performed low-intensity therapeutic exercises in water. All outcomes were assessed before (week 0) and after the intervention (week 17). In addition, some outcomes were also investigated in the middle timepoint (week 9). Generalized Estimating Equations (GEE) and Bonferroni post-hoc tests (α = 0.05) were used to compare timepoints and groups. Results: All groups similarly improved functional capacity (3-11%) and blood pressure (-4 to -10%), whereas cognitive function was not modified for any group. Conclusion: Water-based training programs and therapeutic exercises (i.e., CG) improve functional capacity and blood pressure responses in older women. Clinical Trials NCT03892278.
Effectiveness of Deep Water Running on Improving Cardiorespiratory Fitness, Physical Function and Quality of Life: A Systematic Review. [2022]Deep Water Running (DWR) is a form of aquatic aerobic exercise simulating the running patterns adopted on dry land. Little is known on the effectiveness of DWR despite gaining popularity. The objective of this study is to systematically review the effects of DWR on cardiorespiratory fitness, physical function, and quality of life in healthy and clinical populations. A systematic search was completed using six databases, including SPORTDiscus, MEDLINE, CINAHL, AMED, Embase, and The Cochrane Library, up to February 2022. Eleven studies evaluating the effectiveness of DWR on cardiorespiratory fitness (CRF), physical function, or quality of life (QoL), compared with no interventions (or standard treatment) or land-based trainings were identified. Data relevant to the review questions were extracted by two independent reviewers when means and standard deviations were reported, and standardized mean differences were calculated. A quality assessment was conducted using selected items from the Downs and Black checklist. A total of 11 clinical trials (7 randomized controlled trials) with a total of 287 participants were included. Meta-analyses were not completed due to the high level of clinical and statistical heterogeneity between studies. Compared with land-based training, DWR showed similar effects on CRF with limited studies reporting outcomes of physical function and QoL compared with the no-exercise control group. DWR appears to be comparable to land-based training for improving CRF. The aquatic environment may provide some advantages for off-loaded exercise at high intensity in populations that are weak, injured or in pain, but more studies are required.
Impact of Different Aquatic Exercise Programs on Body Composition, Functional Fitness and Cognitive Function of Non-Institutionalized Elderly Adults: A Randomized Controlled Trial. [2021]Aquatic physical exercise programs have become progressively more popular among elderly people. Some of the major physical exercise program disadvantages on land are minimized due to the specific properties of the aquatic environment. The purpose of the present randomized controlled study is to verify the effects of different aquatic physical exercise programs on body composition, functional fitness and cognitive function in non-institutionalized elderly people. For this study, 102 elderly individuals were randomly allocated into four different groups: AerG (n = 25, 71.44 ± 4.84 years); IntG (n = 28, 72.64 ± 5.22 years); ComG (n = 29, 71.90 ± 5.67 years) and CG (n = 20, 73.60 ± 5.25 years). Individuals from the groups AerG, IntG and ComG participated in three different aquatic physical exercise programs for a period of 28 weeks. The CG participants kept to their usual routines. All participants were evaluated for body composition, functional fitness and cognitive function at two time moments, i.e., pre- (M1) and post-intervention (M2). Significant differences for body composition were found between M1 and M2 for FM (p < 0.001), LBM (p < 0.001) and WCir (p < 0.01) in the AerG, for BMI (p < 0.05), FM (p < 0.05), LBM (p < 0.001) and LCir-R (p < 0.05) in the IntG, and for WGT (p < 0.01), FM (p < 0.05), LBM (p < 0.01), LCir-R (p < 0.05) and LCir-L (p < 0.01) in the ComG groups. For functional fitness, differences were found between M1 and M2 for 2m-ST (p < 0.000), 30s-CS (p < 0.000), 30s-AC (p < 0.05), HG-T-R (p < 0.000) and HG-T-L (p < 0.000) in the AerG, for 2m-ST (p < 0.05), BS-R (p < 0.05), 30s-CS (p < 0.000), 30s-AC(p < 0.01), HG-T-R (p < 0.000) and HG-T-L (p < 0.000) in the IntG, and for 30s-CS (p < 0.000), HG-T-R (p < 0.000) and HG-T-L (p < 0.000) in the ComG groups. The present study evidenced the beneficial effects of physical exercise in an aquatic environment on body composition, functional fitness and cognitive function in non-institutionalized elderly adults. The ComG water-based exercise program showed more beneficial effects in the improvement of body composition and cognitive function variables, while the IntG and AerG programs were more effective in the improvement of functional fitness.
Cognitive Improvement Following Physical Exercise and Cognitive Training Intervention for Older Adults With MCI. [2023]The diagnosis of mild cognitive impairment (MCI) presents a critical period for intervention. Although exercise and cognitive training (CT) interventions have reported independent success in improving cognition, some meta-analyses have suggested that combined interventions provide maximal benefits. Much previous research has studied land-based as opposed to water-based exercise, which places potential barriers on older adults. The purpose of the current study was to examine the impact of combined exercise (water- or land-based) and CT treatment on cognition for older adults with MCI.
Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis. [2022]Aquatic exercise is being increasingly recommended for healthy individuals as well as people with some special health conditions. A systematic review with meta-analysis was performed to synthesize and analyze data on the effects of water-based training (WT) programs on health status and physical fitness of healthy adults and adults with diseases to develop useful recommendations for health and sports professionals. We searched three databases (PubMed, Web of Science, and Scopus) up to June 2021 for randomized trials that examined WT in adults. A total of 62 studies were included, of which 26 involved only healthy individuals and 36 focused on adults with chronic diseases. In the healthy group, the effects of WT on strength, balance, and cardiorespiratory fitness were beneficial, indicating the usefulness of performing WT for at least 12 weeks (2-3x/week, 46-65 min/session). Among adults with diseases, improvements were observed in patients with fibromyalgia (in balance and cardiorespiratory fitness), bone diseases (pain, balance, flexibility, and strength), coronary artery disease (strength and anthropometry), hypertension (quality of life), stroke (quality of life), diabetes (balance and quality of life), multiple sclerosis (quality of life and balance), and Parkinson's disease (pain, gait, cardiorespiratory fitness, and quality of life). Research is required to determine the effects of WT on patients with heart disease, especially coronary artery disease. In adults with chronic disease, benefits in physical fitness and/or other health-related measures were mainly observed after 8-16 weeks of training. WT is an effective physical activity when the intention is to enhance health and physical fitness in healthy adults and adults with chronic diseases.
Can physical and cognitive training based on episodic memory be combined in a new protocol for daily training? [2020]Cognitive training (CT) is defined as guided practice on a set of standard tasks designed to stimulate particular cognitive functions. Recent studies have shown that physical exercise is beneficial for cognitive activity in older adults and patients with degenerative diseases.