@DrMark_Faghy @RebeccaOwen13_ @nik_kudiersky @PaulAnsdell @emilyhume @ruth_ashton1 @TMadenWilkinson @LindsaySkipper @mikster_derby #LongCovid #pwLC #LongCovidAwareness #research.

Conclusion: Submaximal 2-day CPET demonstrated a reduction in oxygen uptake, oxygen pulse and partial pressure of end tidal carbon dioxide, suggesting dysfunctional oxygen transport, utilisation or both may contribute to Long COVID symptoms.

Detailed investigations are required to understand the complexities of Long COVID pathophysiology including the neurological and inflammatory responses that coordinate and bring about the cardiorespiratory limitations reported.

Implications: Dysfunctional oxygen transport, utilisation or both may contribute to Long COVID symptoms. Provided that appropriate and detailed screening processes are followed, submaximal CPET offers a safe and informative option to investigate Long COVID pathophysiology🧪.

Key results:.· Early onset of anaerobic energy contribution on both test days. · A reduction in oxygen uptake, oxygen pulse and partial pressure of end tidal carbon dioxide at the first ventilatory threshold on day 2. · No differences were observed between peak measures.

Using 2-day submaximal cardiopulmonary exercise testing (CPET), submaximal measures were assessed between days at rest, first ventilatory threshold, and peak from 68 participants. Inclusion criteria and protocol were designed to minimise PEM risk & increase tolerability.

This data extends previous work which has found that exercise capacity is reduced in people with Long COVID (using a single maximal exercise test). However, only one study had investigated the utility of a 2-day approach and found just one difference in submaximal measures.

Additional steps and mitigation strategies were put in place by the study team to prevent this happening again and no further issues were reported. For more detailed information about our study please continue to read our thread🧵.

We did not include those who were at a moderate-high risk for PEM but did find a way for those with low risk PEM to carefully participate, with only one adverse event reported.

Using some carefully controlled, low level cycle exercise we showed a scientific reason for why those with Long COVID may struggle to exercise, with some data indicating issues with energy production as early as the first minute of the test and a worsening effect 24-hours later.

A new peer-reviewed publication from our @DerbyUni x @sheffhallamuni x @Northumbriauni research team has been released online which suggests problems with oxygen transport, usage or both may contribute to Long COVID symptoms. [link to publication]:

RT @DrMark_Faghy: And just like that we have completed the last patient visit in Derby for @ERASE_LC . A patient-led study with @DerbyUni….

RT @drmassimonunes: Indications that rapamycin can improve clinical symptoms in ME/CFS. I suspect that rapamycin is also treating potential….

A productive and enjoyable 5 weeks with the research team at @StellenboschUni in 2024 has culminated in the below publication. We hope this helps add to the pathophysiological understanding of #LongCovid #research.

RT @resiapretorius: Thrilled to be co-author on this preprint with @CallumThomas96 and lead @DrMark_Faghy from @DerbyUni! Callum spent ti….

@resiapretorius @DrMark_Faghy @JanPretorius98 @dbkell @drmassimonunes @LindsaySkipper @mikster_derby #LongCovid #research #microclots.

Conclusion: Exercise-induced fragmentation of fibrinaloid microclots may reduce oxygen transport and drive inflammation; providing a potential mechanism for PESE in Long COVID. We hope these findings inform safer rehabilitation approaches.

While our data support a mechanistic link between microclot fragmentation and PESE, more evidence is needed to prove causality. However, this work offers a potential biological explanation for the PESE so many patients experience.

Implications: If exercise fragments microclots but doesn’t clear them, this may worsen microvascular function. This challenges the rationale for graded exercise therapy in Long COVID & underscores the need for exercise to be carefully considered & its effects objectively measured.

Key results:.· Exercise fragmented large microclots (100–3000 µm²) into smaller ones (<30 µm²) (Figure 1). · Microclot fragmentation correlated with an increase in a variety of cytokines, some of which were associated with inflammation. · Oxygen uptake worsened post-exercise.