Home-Based Exercise Tele-Rehabilitation in High-Risk Veterans: Impact of COVID-19 Exposure and Socioeconomic Factors

2019年冠状病毒病（COVID-19）大流行在世界各地广泛传播，尽管 采取多种战略努力和预防措施，以阻止其传播。合并症，尤其是 高血压、糖尿病和慢性肺和心脏病是住院和死亡的危险因素。 退伍军人有这些条件的患病率高，并发症和贫困的风险增加 复苏制定和成功实施退伍军人康复战略， COVID-19后应该是一个高度临床研究优先事项。2019冠状病毒病的长期影响 心肺和身体功能不确定;此外，针对损伤的康复策略 必须在社交距离的限制下可行。与恢复后工作有关的知识差距 肺和心脏代谢疾病患者的生理轨迹也需要解决， 制定有效的运动康复策略。 这项运动试验的目的是调查的影响，以家庭为基础的运动远程康复 这些结果，并评估五个单独的世界卫生组织的国际分类， 为COVID-19幸存者的研究确定了功能、残疾和健康（ICF）组成部分。我们的中央 假设是，家庭锻炼与小组组成部分（COVID Tele-EX）改善心肺功能 和身体功能的变化。研究设计包括一个调查小组， VA康复合作的跟踪记录，并将允许探索与以下方面相关的医疗保健差异： COVID-19，与功能下降有关，可能影响运动康复的可持续性 在社交距离限制下部署的策略。来自巴尔的摩VAMC及周边地区的退伍军人 社区门诊（CBOCs）将在家中参与为期12周的运动干预 这将包括虚拟小组练习班在VA视频连接（VVC）。手术前后的程序 干预将包括心肺运动试验、肺功能试验、身体功能， 针对运动自我效能的问卷调查。我们对退伍军人心肺和身体功能的研究 从COVID-19中康复的患者将提供关于“长期COVID”或急性后遗症的关键和新颖信息 SARS-Co-V-2感染。 这项试验的结果将提供证据，以实施这一远程家庭小组锻炼计划， VA中心，可以延伸到COVID-19大流行之后，并对改善和创造 退伍军人康复护理的新标准

The Coronavirus Disease 2019 (COVID-19) pandemic is widespread throughout the world despite multiple strategic efforts and precautions to impede its transmission. Comorbid conditions, especially hypertension, diabetes and chronic lung and cardiac disease are risk factors for hospitalization and death. Veterans have a high prevalence of these conditions and are at increased risk for complications and poor recovery. The development and successful implementation of rehabilitative strategies for Veterans during and post COVID-19 should be a high clinical research priority. The long-term impact of COVID-19 on cardiopulmonary and physical function is uncertain; and further, rehabilitation strategies to target impairments must be feasible within constraints of social distancing. Pertinent knowledge gaps regarding the post-recovery physiologic trajectory in patients with pulmonary and cardiometabolic conditions also need to be addressed to tailor effective exercise rehabilitation strategies. The objective of this exercise trial is to investigate the effect of a home-based exercise tele-rehabilitation on these outcomes and to evaluate five individual World Health Organization’s International Classification of Functioning, Disability and Health (ICF) components identified for research in COVID-19 survivors. Our central hypothesis is that home-based exercise with a group component (COVID Tele-EX) improves cardiopulmonary and physical function in Veterans post COVID-19. The study design includes an investigative team who have a track record of VA rehabilitation collaboration and will allow the exploration of healthcare disparities related to COVID-19, which are associated with functional decline and may affect sustainability of exercise rehabilitation strategies deployed under social distancing restrictions. Veterans from the Baltimore VAMC and surrounding Community Based Outpatient Clinics (CBOCs) will participate from home in the 12-week exercise intervention which will consist of virtual group exercise classes in VA Video Connect (VVC). Procedures before and after the intervention will include cardiopulmonary exercise test, pulmonary function test, physical function, and questionnaires targeted at exercise self-efficacy. Our study of cardiopulmonary and physical function in Veterans recovered from COVID-19 will provide critical and novel information on “Long COVID” or Post-Acute Sequelae of SARS-Co-V-2 infection. Findings from this trial will provide evidence to implement this tele-home group exercise program across VA centers that can extend beyond the COVID-19 pandemic and has vital implications for improving and creating a new standard of rehabilitative care for Veterans.