Exercise + Cognitive Training for Long COVID

Overseen By Jennifer K Fairchild, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: VA Office of Research and Development

Disqualifiers: Severe psychotic disorder, Stroke, Parkinson's, Alzheimer's, others

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

Compensation: Varies

Number of Visits: 3

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if combining water-based exercise with cognitive training can improve memory and brain-related symptoms in individuals with long-COVID. Participants will engage in six months of swimming or water exercises, followed by two months of memory exercises. The trial specifically seeks veterans who have had COVID-19 and continue to experience issues like brain fog or memory problems. Participants must commit to the program for eight months and obtain their doctor's approval for water-based exercises. As an unphased trial, this study provides a unique opportunity to explore innovative treatments for long-COVID symptoms.

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 prior data suggests that this exercise + cognitive training program is safe for individuals with long-COVID?

Research has shown that combining water-based exercise with brain training (WATER+CT) is generally safe. In another study with veterans, participants engaged in similar activities and reported few side effects, suggesting the program is well-tolerated. Water exercise is gentle on the joints, which may be more comfortable for people with long-COVID. Brain training has been safely used in many groups, including those with memory problems. While more research is needed, current evidence supports the safety of this combined approach. ^{1 2 3 4 5}

Why are researchers excited about this trial?

The WATER+CT approach is unique because it combines aquatic exercise with cognitive training to tackle Long COVID symptoms. Unlike many treatments that primarily focus on pharmaceutical solutions, this method offers a dual-action strategy: first, the buoyancy of water supports low-impact physical activity, which can improve cardiovascular health and reduce fatigue. Then, cognitive training aims to enhance mental function by challenging the brain with targeted exercises. Researchers are excited because this non-drug approach might offer a holistic way to boost both physical and mental recovery, potentially improving quality of life for Long COVID patients.

What evidence suggests that this exercise and cognitive training program is effective for improving neurological symptoms of long-COVID?

Research shows that combining exercise with brain training can improve memory more effectively than either activity alone. In this trial, participants in the WATER+CT arm will undergo an 8-month intervention: 6 months of aquatic exercise followed by 2 months of cognitive training. Similar programs for individuals with memory issues have demonstrated significant improvements. Water-based exercises, like those in the trial, have helped people recover from long-COVID by easing brain-related symptoms. This approach enhances both physical and mental abilities, potentially offering comprehensive benefits for those dealing with long-COVID. Early results suggest that combining these activities holds promise for improving brain health. ^{1 2 3 4 5}

Who Is on the Research Team?

Jennifer Kaci Fairchild, PhD

Principal Investigator

VA Palo Alto Health Care System, Palo Alto, CA

Are You a Good Fit for This Trial?

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.

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.

Timeline for a Trial Participant

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

What Are the Treatments Tested in This Trial?

Interventions

• WATER+CT

Trial Overview The 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.

How Is the Trial Designed?

Group I: WATER+CT Experimental Treatment 1 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 Care Experimental Treatment 1 Intervention

This arm consists of psychoeducation regarding brain health and healthy lifestyles.

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Published Research Related to This Trial

A systematic review of 62 studies found that water-based training (WT) significantly improves strength, balance, and cardiorespiratory fitness in healthy adults when performed for at least 12 weeks, 2-3 times a week.

For adults with chronic diseases, WT led to notable health benefits, including improved quality of life and physical fitness in conditions like fibromyalgia, diabetes, and Parkinson's disease, particularly after 8-16 weeks of training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis. Faíl, LB., Marinho, DA., Marques, EA., et al.[2022]

Deep Water Running (DWR) is as effective as land-based training for improving cardiorespiratory fitness, based on a systematic review of 11 studies involving 287 participants.

DWR may offer benefits for individuals who are weak, injured, or in pain, as the aquatic environment allows for high-intensity exercise with less strain on the body, although more research is needed to confirm these advantages.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of Deep Water Running on Improving Cardiorespiratory Fitness, Physical Function and Quality of Life: A Systematic Review. Kwok, MMY., So, BCL., Heywood, S., et al.[2022]

A 6-month randomized controlled trial will assess the effects of aerobic training (AT), resistance training (RT), and their combination on cognitive function in 216 older adults (ages 65-85) with mild cognitive impairment (MCI).

The study aims to determine how different types of exercise can help prevent cognitive decline and potentially delay the onset of dementia, highlighting the importance of exercise as a therapeutic intervention for cognitive health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Barha, CK., Falck, RS., Best, JR., et al.[2022]

A study involving 67 older adults with mild cognitive impairment (MCI) showed that both water-based and land-based exercise combined with cognitive training significantly improved learning and memory outcomes over 6 months.

However, improvements in executive functioning, processing speed, language, and visuospatial abilities were only observed in the water-based exercise group, suggesting that aquatic activities may offer additional cognitive benefits for older adults with MCI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Improvement Following Physical Exercise and Cognitive Training Intervention for Older Adults With MCI. Campbell, EB., Delgadillo, M., Lazzeroni, LC., et al.[2023]

In a study of 55 healthy older adults, cognitive physical training (CPT) showed significant long-term benefits in overall cognition and verbal long-term memory compared to CPT with counseling, suggesting that combining cognitive and physical activities is effective for maintaining cognitive health.

Predictors of success in CPT included initial low performance in verbal short-term memory and fluency, as well as baseline levels of insulin-like growth factor 1 (IGF-1) and brain-derived neurotrophic factor (BDNF), indicating that individual characteristics can influence the effectiveness of cognitive training interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Kalbe, E., Roheger, M., Paluszak, K., et al.[2020]

The SmartTapestry device, tested on 53 participants (29 healthy and 24 with mild cognitive impairment), effectively combines physical activity with cognitive training, showing a strong correlation with traditional cognitive tasks.

This innovative approach suggests that cognitive-physical training tools can enhance cognitive function while being used at home, potentially improving treatment efficacy for cognitive impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can physical and cognitive training based on episodic memory be combined in a new protocol for daily training? Maselli, M., Fiorini, L., Cecchi, F., et al.[2020]

A 16-week water-based aerobic training program significantly improved functional capacity and reduced blood pressure in older women, with improvements ranging from 3-11% in functional capacity and 4-10 mmHg in blood pressure.

Cognitive function did not show any significant changes across all groups, indicating that while physical training is beneficial for functional and hemodynamic responses, it may not impact cognitive abilities in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Water-Based Training Programs Improve Functional Capacity, Cognitive and Hemodynamic Outcomes? The ACTIVE Randomized Clinical Trial. Häfele, MS., Alberton, CL., Häfele, V., et al.[2023]

Cognitive training combined with physical activity (CPT) showed stronger long-term effects on attention in older adults compared to cognitive training alone (CT), particularly noticeable at a 1-year follow-up after 6.5 weeks of training.

Both CPT and CT improved cognitive functions such as cognitive state, verbal fluency, and memory, but the specific benefits of CPT may be influenced by ongoing physical activity after the training sessions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of cognitive training with additional physical activity compared to pure cognitive training in healthy older adults. Rahe, J., Petrelli, A., Kaesberg, S., et al.[2019]

Cognitive training exercises (CTE) were found to be feasible and potentially effective for enhancing cognitive function in Egyptian adults, particularly those with mild cognitive impairment (MCI), after a 12-week program involving various cognitive tasks.

Participants who completed the CTE showed significant improvements in several cognitive assessments, including memory and executive function, indicating that CTE can help slow cognitive deterioration in individuals with subjective memory impairment and MCI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pilot feasibility study of cognitive training exercises for Egyptian adults: Proof of concept. Tawfik, HM., Tsatali, M., Hassanin, HI.[2021]

Cognitive training (CT) has a small but statistically significant effect on overall cognition in patients with traumatic brain injury (TBI) more than 12 months post-injury, based on a meta-analysis of 14 studies involving 575 patients.

CT shows a moderate effect on overall functional outcomes and is particularly effective in improving executive function and verbal memory, suggesting it should be more widely integrated into TBI rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive Training for Post-Acute Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Hallock, H., Collins, D., Lampit, A., et al.[2020]

A study involving 102 elderly individuals showed that different aquatic exercise programs significantly improved body composition, functional fitness, and cognitive function over 28 weeks.

The combined exercise program (ComG) was particularly effective for enhancing body composition and cognitive function, while the intensity (IntG) and aerobic (AerG) programs were better for improving functional fitness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Different Aquatic Exercise Programs on Body Composition, Functional Fitness and Cognitive Function of Non-Institutionalized Elderly Adults: A Randomized Controlled Trial. Farinha, C., Teixeira, AM., Serrano, J., et al.[2021]

Citations

1. reporter.nih.gov reporter.nih.gov/project-details/9028303

Water-based Activities to Enhance Recall in Veterans ... The exercise component consists of a six-month water-based exercise program followed by a four-week cognitive training program. For the first two months of the ...

2. ctv.veeva.com ctv.veeva.com/study/water-based-activity-to-enhance-recovery-in-long-covid19

Water-based Activity to Enhance Recovery in Long COVID-19 This trial will include 50 Veterans, age 18 - 89, experiencing neurological manifestations of long-COVID, with half randomized to WATER+CT and ...

3. research.va.gov research.va.gov/about/funded_research/proj-details-FY2025.cfm?pid=781439

Water-based Activity to Enhance Recovery in Long COVID Project Number: I21RX004647-01A1. Title: Water-based Activity to Enhance Recovery in Long COVID. Principal Investigator:.

4. reporter.nih.gov reporter.nih.gov/search/iReWOc7ZIUSH2_wPfYegpw/project-details/10909816

Water-based Activity to Enhance Recall in Veterans The proposed four-year randomized controlled trial will compare water-based exercise + cognitive training (WATER+CT) to a Usual Care Control Condition (UC). The ...

5. research.va.gov research.va.gov/about/funded_research/proj-details-FY2025.cfm?pid=665227

Water-based Activity to Enhance Recall in Veterans Title: Water-based Activity to Enhance Recall in Veterans: A Randomized Clinical Trial ; Principal Investigator: Jennifer Kaci Fairchild.