Diet and Exercise for Post-COVID Syndrome

(MARVEL Trial)

Recruiting at 1 trial location

Overseen By Kristina Marcus, MS

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Must not be taking: Insulin, Anti-coagulants

Disqualifiers: Neurologic, Autoimmune, Uncontrolled diabetes, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: 12 weeks

150 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how a weight loss program, combining diet and exercise, can help manage symptoms in obese Veterans with Post-COVID Conditions (PCC). The goal is to determine if losing weight can reduce inflammation and improve physical functioning and quality of life. Participants will either follow a 12-week weight loss plan with diet and exercise or a weight stability plan with education and stretching. Veterans who had COVID-19 more than 90 days ago, have experienced ongoing symptoms for at least four weeks, and are either lean (BMI 19-25) or obese (BMI 30-50) might be a good fit for this study. As an unphased trial, this study offers Veterans a unique opportunity to contribute to understanding how lifestyle changes can improve health outcomes post-COVID.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it excludes those using anti-coagulant medications. It's best to discuss your specific medications with the trial coordinators.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that weight loss programs combining diet and exercise are generally safe and can aid individuals with long COVID. For instance, one study found that a remote weight management plan improved health for those with long COVID and extra weight. Another study demonstrated that dietary changes, such as personalized nutrition advice, enhanced physical performance in these patients.

Exercise plays a crucial role as well. A review of several studies found that both resistance exercises (like weight lifting) and aerobic exercises (like walking or cycling) improved the quality of life for people recovering from COVID-19. These findings suggest that diet and exercise plans are well-tolerated and can safely support recovery from Post-COVID Conditions. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Diet and Exercise for Post-COVID Syndrome trial because it offers a new approach to managing post-COVID symptoms through lifestyle modifications. Unlike traditional treatments that often focus on medications to manage individual symptoms, this trial emphasizes a holistic approach with structured weight loss and stability programs. The weight loss arm combines nutrition and exercise, which could improve overall health and potentially reduce post-COVID symptoms by enhancing physical fitness and resilience. Meanwhile, the weight stability arm focuses on maintaining balance and flexibility, which might help alleviate fatigue and improve quality of life for those with ongoing post-COVID issues. This integrated method could offer a sustainable and comprehensive way to manage post-COVID syndrome, making it an exciting area of exploration for researchers.

What evidence suggests that this trial's treatments could be effective for Post-COVID Syndrome?

This trial will compare a weight loss program with a weight stability program for individuals with post-COVID syndrome. Studies have shown that weight loss programs can help reduce symptoms of Long COVID. Specifically, one trial found that a remote weight management plan led to fewer Long COVID symptoms in overweight individuals. Research also highlights the importance of combining exercise and diet to aid recovery from COVID-19. Together, exercise and good nutrition can improve both breathing and muscle issues during recovery. Overall, this approach is safe and beneficial for those dealing with post-COVID conditions. ^{5 6 7 8 9}

Who Is on the Research Team?

Alice S. Ryan, PhD

Principal Investigator

Baltimore VA Medical Center VA Maryland Health Care System, Baltimore, MD

Are You a Good Fit for This Trial?

This trial is for older U.S. Veterans who are either overweight or obese, with a BMI of 19-25 or 30-40 kg/m2. It's suitable for those with no Post-COVID symptoms or at least one symptom lasting more than four weeks. Women must be postmenopausal. Participants should not have conditions affecting study assessments, significant weight change recently, use anticoagulants, uncontrolled diabetes, active diseases including inflammatory and autoimmune, nor substance abuse issues.

Inclusion Criteria

I am a woman who has gone through menopause.

I either have no Post-COVID symptoms or have had symptoms for more than 4 weeks.

U.S. Veteran

Exclusion Criteria

I am taking blood thinner medications.

I do not have active inflammation, COVID-19, autoimmune, liver, kidney, stomach issues, cancer, or severe mental health problems.

My diabetes is not under control, with HbA1c over 10% or I'm using insulin.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants will undergo a weight loss intervention including dietary modification and exercise, or a weight stability program with health education and stretching/balance classes

12 weeks

1x/week center-based nutrition or health education class, 2x/week center-based exercise or stretching/balance classes, 1x/week self-conducted session

Follow-up

Participants are monitored for changes in cardiorespiratory fitness and adipose tissue cellular senescence

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• 12-weeks of Weight Loss
• 12-weeks of Weight Stability

Trial Overview The study tests if a weight loss program involving diet changes and exercise can reduce inflammation in fat tissue and improve recovery from Post-COVID Conditions (PCC) in obese Veterans. The intervention lasts for 12 weeks focused on losing weight followed by another 12 weeks aimed at maintaining the new weight.

How Is the Trial Designed?

Group I: Weight Loss Experimental Treatment 1 Intervention

Participants will be asked to participate in a 1x/week center-based or tele-health nutrition diet class, 2x/week center-based exercise classes, and 1x/week exercise session conducted on their own for approximately 12 weeks.

Group II: Weight Stability Active Control 1 Intervention

Participants will be asked to participate in a 1x/week center-based or tele-health education class, 2x/week center-based or tele-health stretching/balance classes, and 1x/week stretching/balance session conducted on their own for approximately 12 weeks.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Baltimore VA Medical Center

Collaborator

Trials

33

Recruited

3,000+

South Texas Veterans Health Care System

Collaborator

Trials

19

Recruited

6,100+

Baltimore Veterans Affairs Medical Center

Collaborator

Trials

5

Recruited

470+

Published Research Related to This Trial

The SWiM-C intervention, designed to help adults manage weight during the COVID-19 pandemic, did not show a significant effect on weight loss compared to standard advice, with a baseline-adjusted weight change difference of -0.81 kg.

Participants in the SWiM-C group reported improvements in eating behaviors, such as reduced uncontrolled and emotional eating, as well as increased physical activity, indicating positive changes in lifestyle factors associated with weight management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention. Mueller, J., Richards, R., Jones, RA., et al.[2023]

A telemedicine-delivered very-low-carbohydrate intervention targeting nutritional ketosis resulted in significant weight loss for both pandemic and pre-pandemic cohorts, with an average weight loss of 7.5% and 7.9% respectively over one year.

The weight loss trajectory was similar for both groups, indicating that the intervention was effective regardless of the pandemic's impact on lifestyle and stress, demonstrating its robustness as a weight management strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of the COVID-19 Pandemic on the Effectiveness of a Metabolic Health Telemedicine Intervention for Weight Loss: A Propensity Score Matching Analysis. Athinarayanan, SJ., Adams, RN., VanTieghem, M., et al.[2022]

A survey of 80 recovered COVID-19 patients in Punjab, Pakistan found that factors like being male, older than 40, having poor sleep, and low physical activity were linked to longer recovery times.

The study suggests that maintaining a healthy lifestyle—such as staying active, eating a balanced diet rich in plant-based proteins, taking multivitamins, and drinking enough water—can significantly aid in faster recovery from COVID-19.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nutritional and lifestyle changes required for minimizing the recovery period in home quarantined COVID-19 patients of Punjab, Pakistan. Rabail, R., Saleem, J., Tanveer, Z., et al.[2023]

A multidisciplinary rehabilitation program for 97 patients with long COVID-19 led to significant improvements in body composition, including a reduction in abdominal fat and an increase in skeletal muscle mass after 6 weeks.

Almost 80% of participants reported improved breathing, and their physical capacity significantly increased, as shown by tests like the 6 Minute Walking Test, indicating the program effectively enhanced overall health and functionality in long COVID-19 patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Multidisciplinary Rehabilitation Program in Patients with Long COVID-19: Post-COVID-19 Rehabilitation (PCR SIRIO 8) Study. Ostrowska, M., Rzepka-Cholasińska, A., Pietrzykowski, Ł., et al.[2023]

Patients recovering from COVID-19, especially those with obesity, may benefit from a combined approach of a ketogenic diet followed by a Mediterranean diet, along with a physical activity program to alleviate post-COVID syndrome symptoms.

There is currently no established nutritional guideline for managing post-COVID syndrome, highlighting the need for further research in this area to optimize recovery strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

From the Ketogenic Diet to the Mediterranean Diet: The Potential Dietary Therapy in Patients with Obesity after CoVID-19 Infection (Post CoVID Syndrome). Barrea, L., Vetrani, C., Caprio, M., et al.[2022]

A study involving 57 patients with persistent fatigue post-COVID showed that a 4-week supervised exercise program significantly improved their maximal exercise capacity (VO2peak) compared to usual care, with no adverse events reported.

While both exercise and usual care groups experienced improvements in fatigue and quality of life over time, the exercise group engaged in significantly more physical activity during the follow-up period, suggesting that exercise is a safe option for enhancing recovery in post-COVID patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical exercise as a treatment for persisting symptoms post-COVID infection: review of ongoing studies and prospective randomized controlled training study. Kogel, A., Machatschek, M., Scharschmidt, R., et al.[2023]

A study of recently operated bariatric patients during COVID-19 quarantine revealed that 89.2% of them did not meet the recommended protein intake, indicating a significant nutritional deficiency.

Patients consumed a considerable amount of ultra-processed foods, making up about 25% of their diet, highlighting the need for improved nutritional support strategies for these individuals during periods of social distancing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nutritional Inadequacies Among Post-bariatric Patients During COVID-19 Quarantine in Sao Paulo, Brazil. Nicoletti, CF., Esteves, GP., Genario, R., et al.[2022]

Nearly half of the 92 participants recovering from COVID-19 were at risk for malnutrition, which was linked to more severe symptoms and lower calorie intake, indicating that persistent malnutrition can hinder recovery.

Most participants failed to meet dietary recommendations for fruits, vegetables, and optimal protein intake, suggesting a critical need for nutritional education and support to improve recovery outcomes after COVID-19.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition. Deer, RR., Hosein, E., Harvey, M., et al.[2022]

In a study of 185 COVID-19 survivors, those with overweight or obesity experienced significant weight loss during hospitalization, but showed a notable increase in weight and waist circumference three months after discharge, indicating rapid fluctuations in body composition.

Factors such as male sex, increased hunger levels, and initial weight loss were identified as predictors for weight gain in these patients, suggesting that monitoring these aspects could be important for managing recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Weight trajectories and abdominal adiposity in COVID-19 survivors with overweight/obesity. Di Filippo, L., De Lorenzo, R., Cinel, E., et al.[2023]

Participants in the COVID cohort (n=81) experienced greater weight loss compared to pre-COVID cohorts, losing an average of 8.5 kg by week 39, despite the challenges posed by the pandemic.

The COVID cohort reported better dietary adherence during the intervention, indicating that continued behavioral support can lead to successful weight loss even in difficult circumstances.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of the COVID-19 pandemic on weight loss in participants in a behavioral weight-loss intervention. Zaman, A., Sloggett, KJ., Caldwell, AE., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10593354/

The remote diet intervention to reduce Long COVID ... ReDIRECT uses an existing dietary weight management programme, shown to be safe, effective, and cost-effective in achieving and sustaining mean weight loss ...

2. nature.com nature.com/articles/s41591-024-03384-x

the randomized wait-list-controlled ReDIRECT trial We found that a remotely delivered weight management intervention in people with LC and excess body weight effectively reduced LC symptoms that ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12157204/

A Comprehensive Scoping Review on Diet and Nutrition in ... This scoping review synthesized global evidence on the role of diet and nutrition in managing long COVID-19 symptoms and supporting recovery.

4. frontiersin.org frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2023.1305175/full

The vital role of exercise and nutrition in COVID-19 ... Integrating exercise and nutrition therapies is crucial for addressing both the respiratory and musculoskeletal aspects of recovery. Such an ...

5. mdpi.com mdpi.com/2075-4663/13/9/329

Post-Acute COVID-19 Syndrome (PACS) and Exercise ... This review shows that an intervention protocol based on physical exercise is safe and feasible, also via telerehabilitation. The duration of the intervention ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11750722/

Remotely delivered weight management for people with long ... In a randomized trial, a remotely delivered weight management intervention for people with long COVID and excess weight improved respective long ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S2666337625001027

Impact of nutrition on long COVID Dietary interventions such as personalized nutritional counseling have been demonstrated to improve physical performance in long COVID patients.

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11311891/

Tailored Physical Activity Interventions for Long COVID A systematic review of seven studies revealed that resistance and aerobic exercise programs can improve functional capacity and quality of life in post-COVID-19 ...

9. clinicaltrials.gov clinicaltrials.gov/study/NCT05398692

NCT05398692 | Long COVID-19 Rehabilitation & ... Long COVID-19 Patients who enroll and complete a 10 week program of Physiologic and Psychological Rehabilitation will have reduced Long COVID-19 Symptoms, ...