Home-Based Exercise Tele-Rehabilitation After COVID-19

There is an urgent need to understand the lasting impact of COVID-19 on the cardiopulmonary system to improve physical function and prevent long-lasting disability. Pertinent knowledge gaps regarding the post-recovery physiology driving any impairments need to be addressed to improve the quality of life in Veterans with prior SARS-CoV-2 infection. Further, it is important to devise successful rehabilitation strategies that can be safely conducted in a Veteran's home. Hence, the investigators propose to utilize VA Video Connect to deliver a home based, supervised group exercise program to Veteran COVID-19 survivors. The objective of this exercise trial is to determine the influence of COVID-19 on cardiorespiratory fitness, pulmonary and physical function and to investigate the effect of a home-based exercise tele-rehabilitation on these outcomes. The study design includes rural and urban sites and investigators with a history of VA rehabilitation collaboration. Moreover, the investigators will explore healthcare disparities related to COVID-19 which are associated with functional decline and may affect sustainability of exercise rehabilitation strategies deployed, if necessary, under social distancing restrictions.

Inclusion criteria

• Veteran
• documented COVID-19 > 90 days ago
• diagnosis of 2 of following conditions: hypertension, diabetes, cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease OR 1 condition and BMI > 30 kg/m2

Exclusion criteria

• myocardial infarction (within 3 months)
• exertional or unstable angina (chest pain that limits activity)
• severe congestive heart failure (EF < 20% in last year or NYHA Classification III or IV)
• uncontrolled hypertension (SBP >180 &/or DBP > 110 mm Hg at screening)
• screening EKG with ischemia, complex arrhythmia, or high-grade block (per Minnesota Code)
• poorly controlled diabetes mellitus (FBS>200 mg/dl, RBS > 299 mg/dl, or HbA1C > 10)
• treatment for cancer except skin cancer (within 3 months)
• peripheral vascular disease with claudication
• severe arthritis limiting ambulation
• neurologic disease limiting ambulation (weakness requiring assist device; severe neuropathy)
• end stage liver disease (decompensated liver disease)
• End stage renal failure (dialysis)
• severe pulmonary disease (home O2, admission for dyspnea or pneumonia within 1 month)
• high fall risk (history of falls, bone fracture)
• dementia (based on Evaluation to Consent)
• signs or symptoms of any medical comorbidity that would preclude exercise testing or training
• exercises on routine basis (structured aerobic exercise > 3 time per week)