Long COVID quality of life and healthcare experiences in the UK: a mixed method online survey.

PURPOSE: The complexity of long COVID and its diverse symptom profile contributes to unprecedented challenges for patients, clinicians, and healthcare services. The threat of long COVID remains ignored by Governments, the media and public health messaging, and patients' experiences must be heard through understanding of the lived experience. This study aimed to understand the lived experience of those living with long COVID. METHODS: An online web-based survey was designed using Patient and Public Involvement and Engagement (PPIE) to increase understanding of the lived experiences of long COVID, and was distributed through PPIE groups, social media, and word of mouth. The survey used closed and open questions relating to demographics, pre- and post-COVID-19 health quality of life, daily activities and long COVID experiences. RESULTS: Within our sample of 132 people living with long COVID, the findings highlight that individuals are being severely impacted by their symptoms and are unable to or limited in participating in their daily activities, reducing quality of life. Long COVID places strain on relationships, the ability to live life fully and is detrimental to mental health. Varying health care experiences are described by participants, with reports of medical gaslighting and inadequate support received. CONCLUSIONS: Long COVID has a severe impact on the ability to live life fully, and strains mental health. The appropriate mechanisms and support services are needed to support those living with long COVID and manage symptoms.

Causal systems mapping to promote healthy living for pandemic preparedness: a call to action for global public health.

COVID-19 has severely impacted population health and well-being globally. Acknowledging that COVID-19 will not be the world's last pandemic, improving healthy living factors (i.e., physical activity, healthful nutrition, healthy weight), which are important in mitigating negative outcomes of future infectious disease pandemics, should be prioritized. Although well-documented, promoting healthy living factors remains challenged by a lack of scalability and sustainability due, in part, to a mismatch between intervention focus on individual behavior change as opposed to recognizing complex and multifactorial causes that prevent people from living healthy lifestyles and maintaining them long-term (such as political will, economic benefits, urban planning, etc.). To recognize this complexity in promoting healthy living, we propose the application of systems science methods for the creation of a comprehensive causal systems map of healthy living factors in the context of COVID-19 to inform future pandemic preparedness. Generating such a map would benefit researchers, practitioners, and policy makers in multi-sector collaborative efforts to improve public health preparedness in the context of future pandemics in a scalable, sustainable, and equitable manner. This effort should be facilitated by a trusted and widely respected governing body with global reach.

A flow resistive inspiratory muscle training mask worn during high-intensity interval training does not improve 5 km running time-trial performance.

PURPOSE: There is little evidence of the ergogenic effect of flow-resistive masks worn during exercise. We compared a flow-resistive face mask (MASK) worn during high-intensity interval training (HIIT) against pressure threshold loading inspiratory muscle training (IMT). METHODS: 23 participants (13 males) completed a 5 km time trial and six weeks of HIIT (3 sessions weekly). HIIT (n = 8) consisted of repeated work (2 min) at the speed equivalent to 95% [Formula: see text]O2 peak with equal rest. Repetitions were incremental (six in weeks 1, 2 and 6, eight in weeks 3 and 4 and ten in week 5). Participants were allocated to one of three training groups. MASK (n = 8) wore a flow-resistive mask during all sessions. The IMT group (n = 8) completed 2 × 30 breaths daily at 50% maximum inspiratory pressure (PImax). A control group (CON, n = 7) completed HIIT only. Following HIIT, participants completed two 5 km time trials, the first matched identically to pre-intervention trial (ISO time), and a self-paced effort. RESULTS: Time trial performance was improved in all groups (MASK 3.1 ± 1.7%, IMT, 5.7 ± 1.5% and CON 2.6 ± 1.0%, p < 0.05). IMT improved greater than MASK and CON (p = 0.004). Post intervention, PImax and diaphragm thickness were improved in IMT only (32% and 9.5%, respectively, p = 0.003 and 0.024). CONCLUSION: A flow-resistive mask worn during HIIT provides no benefit to 5 km performance when compared to HIIT only. Supplementing HIIT with IMT improves respiratory muscle strength, morphology and performance greater than HIIT alone.

A critical review of citrulline malate supplementation and exercise performance.

As a nitric oxide (NO) enhancer, citrulline malate (CM) has recently been touted as a potential ergogenic aid to both resistance and high-intensity exercise performance, as well as the recovery of muscular performance. The mechanism has been associated with enhanced blood flow to active musculature, however, it might be more far-reaching as either ammonia homeostasis could be improved, or ATP production could be increased via greater availability of malate. Moreover, CM might improve muscle recovery via increased nutrient delivery and/or removal of waste products. To date, a single acute 8 g dose of CM on either resistance exercise performance or cycling has been the most common approach, which has produced equivocal results. This makes the effectiveness of CM to improve exercise performance difficult to determine. Reasons for the disparity in conclusions seem to be due to methodological discrepancies such as the testing protocols and the associated test-retest reliability, dosing strategy (i.e., amount and timing), and the recent discovery of quality control issues with some manufacturers stated (i.e., citrulline:malate ratios). Further exploration of the optimal dose is therefore required including quantification of the bioavailability of NO, citrulline, and malate following ingestion of a range of CM doses. Similarly, further well-controlled studies using highly repeatable exercise protocols with a large aerobic component are required to assess the mechanisms associated with this supplement appropriately. Until such studies are completed, the efficacy of CM supplementation to improve exercise performance remains ambiguous.

Cross-validation of Actigraph derived accelerometer cut-points for assessment of sedentary behaviour and physical activity in children aged 8-11 years.

AIM: To cross-validate previously calibrated Actigraph cut-points in children. METHODS: Twenty-eight children (50% boys) aged between 8 and 11 years of age (9.4 ± 1.4 years) performed a series of 5 minute bouts of activity reflective of different levels of PA from sedentary behaviour (SB) to moderate to vigorous physical activity (MVPA); V˙ O2 was assessed using breath-by-breath indirect calorimetry, and activity was assessed using Actigraph accelerometers worn on the hip and non-dominant wrist. The V˙ O2 values were then converted into age-specific METs (measured METs) and coded as SB, light PA and MVPA. Accelerometer data were analysed using previously calibrated cut-points at different epochs, that is 5, 15, 30 and 60 seconds. RESULTS: Receiver operating characteristic (ROC) curve analysis indicated that there was excellent discrimination of SB using the Evenson et al (15 seconds), Romanzini (15 seconds), Treuth et al (30 seconds), Freedson et al (60 seconds), Treuth et al (60 seconds) and Troiano et al (60 seconds) cut-points. ROC analysis indicated poor discrimination for LPA irrespective of the cut-points used. Good discrimination of MVPA was evident for all existing cut-points using a 60-second epoch. CONCLUSION: There is considerable variation in the performance of existing cut-points for assessment of SB, LPA and MPA in children.

Calibration and Cross-Validation of Accelerometery for Estimating Movement Skills in Children Aged 8-12 Years.

(1) Background: This study sought to calibrate triaxial accelerometery, worn on both wrists, waist and both ankles, during children's physical activity (PA), with particular attention to object control motor skills performed at a fast and slow cadence, and to cross-validate the accelerometer cut-points derived from the calibration using an independent dataset. (2) Methods: Twenty boys (10.1 ±1.5 years) undertook seven, five-minute bouts of activity lying supine, standing, running (4.5kmph-1) instep passing a football (fast and slow cadence), dribbling a football (fast and slow cadence), whilst wearing five GENEActiv accelerometers on their non-dominant and dominant wrists and ankles and waist. VO2 was assessed concurrently using indirect calorimetry. ROC curve analysis was used to generate cut-points representing sedentary, light and moderate PA. The cut-points were then cross-validated using independent data from 30 children (9.4 ± 1.4 years), who had undertaken similar activities whilst wearing accelerometers and being assessed for VO2. (3) Results: GENEActiv monitors were able to discriminate sedentary activity to an excellent level irrespective of wear location. For moderate PA, discrimination of activity was considered good for monitors placed on the dominant wrist, waist, non-dominant and dominant ankles but fair for the non-dominant wrist. Applying the cut-points to the cross-validation sample indicated that cut-points validated in the calibration were able to successfully discriminate sedentary behaviour and moderate PA to an excellent standard and light PA to a fair standard. (4) Conclusions: Cut-points derived from this calibration demonstrate an excellent ability to discriminate children's sedentary behaviour and moderate intensity PA comprising motor skill activity.

Functional training of the inspiratory muscles improves load carriage performance.

Inspiratory Muscle Training (IMT) whilst adopting body positions that mimic exercise (functional IMT; IMTF) improves running performance above traditional IMT methods in unloaded exercise. We investigated the effect of IMTF during load carriage tasks. Seventeen males completed 60 min walking at 6.5 km·h-1 followed by a 2.4 km load carriage time-trial (LCTT) whilst wearing a 25 kg backpack. Trials were completed at baseline; post 4 weeks IMT (consisting of 30 breaths twice daily at 50% of maximum inspiratory pressure) and again following either 4 weeks IMTF (comprising four inspiratory loaded core exercises) or maintenance IMT (IMTCON). Baseline LCTT was 15.93 ± 2.30 min and was reduced to 14.73 ± 2.40 min (mean reduction 1.19 ± 0.83 min, p < 0.01) after IMT. Following phase two, LCTT increased in IMTF only (13.59 ± 2.33 min, p < 0.05) and was unchanged in post-IMTCON. Performance was increased following IMTF, providing an additional ergogenic effect beyond IMT alone. Practitioner Summary: We confirmed the ergogenic benefit of Inspiratory Muscle Training (IMT) upon load carriage performance. Furthermore, we demonstrate that functional IMT methods provide a greater performance benefit during exercise with thoracic loads. Abbreviations: [Lac-]B: blood lactate; FEV1: forced expiratory volume in one second; FEV1/FVC: forced expiratory volume in one second/forced vital capacity ratio; FVC: forced vital capacity; HR: heart rate; IMT: inspiratory muscle training; IMTCON: inspiratory muscle training maintenance; IMTF: functional inspiratory muscle training; LC: load carriage; LCTT: load carriage time trial; Pdi: transdiaphragmatic pressure; PEF: peak expiratory flow; PEmax: maximum expiratory mouth pressure; PImax: maximum inspiratory mouth pressure; RPE: rating of perceived exertion; RPEbreating: rating of perceived exertion for the breathing; RPEleg: rating of perceived exertion for the legs; SEPT: sport-specific endurance plank test; V̇ O2: oxygen consumption; V̇ O2peak: peak oxygen consumption.

Thoracic load carriage-induced respiratory muscle fatigue.

PURPOSE: We investigated the effect of carrying a 25 kg backpack upon exercise-induced respiratory muscle fatigue, pulmonary function and physiological and perceptual responses to exercise. METHODS: Nineteen healthy males performed 60 min walking at 6.5 km h(-1) and 0 % gradient with a 25 kg backpack (load carriage; LC). Following 15 min recovery participants then completed a 2.4 km time trial with the load (LCTT) and on a different day, repeated the trials without the load [control trial (CON) and control time trial (CONTT), respectively]. Respiratory muscle fatigue was determined by the transient change in maximal inspiratory (P Imax) and expiratory (P Emax) pressure prior to and immediately following exercise. RESULTS: P Imax and P Emax were reduced from baseline by 11 and 13 % (P < 0.05), respectively, post-LC but remained unchanged post-CON. Following the time trial P Imax and P Emax were reduced 16 and 19 %, respectively, post-LCTT (P < 0.05) and by 6 and 10 %, respectively (P < 0.05), post-CONTT compared to baseline. Both forced vital capacity and forced expiratory volume in 1 s were reduced by 4 ± 13 and 1 ± 9 %, respectively, during LC when compared to CON. Relative to CON all physiological and perceptual responses were greater in LC, both post-LC and -LCTT (P < 0.01). Time trial performance was faster during CONTT (11.08 ± 1.62 min) relative to LCTT (15.93 ± 1.91 min; P < 0.05). CONCLUSION: This study provides novel evidence that constant speed walking and time trial exercise with 25 kg thoracic load carriage induces significant inspiratory and expiratory muscle fatigue and may have important performance implications in some recreational and occupational settings.

Preloaded time trial to assess load carriage performance.

The relevance and importance of load carriage in recreational and occupational tasks has stimulated a large body of research. Exercise protocols have been criticized for a lack of relevance to occupational activities; accordingly, the aim of this study was to assess the reliability of a preloaded time-trial protocol for load carriage assessment. After full familiarization, 8 healthy males performed 2 trials separated by 1 week. Each trial comprised 60-minute walking at 6.5 km·h and 0% gradient (LC), 15 minutes seated recovery followed by a 2.4-km time-trial (LCTT). All trials were performed wearing a 25-kg backpack. Performance time was 16.71 ± 1.82 minutes and 16.37 ± 1.78 minutes for LCTT 1 and 2, respectively with a mean difference of -0.34 ± 0.89 minutes. Using log ratio limits of agreement, the mean bias was 1.02 and random error component of the agreement ratio was 1.11. The intraclass correlation was 0.85, coefficient of variation was 10.5%, and Cohen's d was 0.35. The protocol demonstrated a very good level of reliability. We present a novel and reliable preloaded time-trial protocol that more closely reflects operational activities and can be used to quantify load carriage performance. This protocol provides greater ecologically validity regarding physical demands of load carriage activities than those adopted previously and provides an excellent tool for the strength and conditioning practitioner to assess individual load carriage performance.

Using cardiorespiratory fitness assessment to identify pathophysiology in long COVID - Best practice approaches.

Cardio-respiratory fitness (CRF) is well-established in the clinical domains as an integrative measure of the body's physiological capability and capacity to transport and utilise oxygen during controlled bouts of physical exertion. Long COVID is associated with >200 different symptoms and is estimated to affect ∼150 million people worldwide. The most widely reported impact is reduced quality of life and functional status due to highly sensitive and cyclical symptoms that manifest and are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli, more commonly known as post-exertional symptom exacerbation (PESE) which prevents millions from engaging in routine daily activities. The use of cardiopulmonary exercise testing (CPET) is commonplace in the assessment of integrated physiology; CPET will undoubtedly play an integral role in furthering the pathophysiology and mechanistic knowledge that will inform bespoke Long COVID treatment and management strategies. An inherent risk of previous attempts to utilise CPET protocols in patients with chronic disease is that these are compounded by PESE and have induced a worsening of symptoms for patients that can last for days or weeks. To do this effectively and to meet the global need, the complex multi-system pathophysiology of Long COVID must be considered to ensure the design and implementation of research that is both safe for participants and capable of advancing mechanistic understanding.

The physiologic benefits of optimizing cardiorespiratory fitness and physical activity - From the cell to systems level in a post-pandemic world.

Cardiovascular (CV) disease (CVD) is a leading cause of premature death and hospitalization which places a significant strain on health services and economies around the World. Evidence from decades of empirical and observational research demonstrates clear associations between physical activity (PA) and cardiorespiratory fitness (CRF) which can offset the risk of mortality and increase life expectancy and the quality of life in patients. Whilst well documented, the narrative of increased CRF remained pertinent during the coronavirus disease 2019 (COVID-19) pandemic, where individuals with lower levels of CRF had more than double the risk of dying from COVID-19 compared to those with a moderate or high CRF. The need to better understand the mechanisms associated with COVID-19 and those that continue to be affected with persistent symptoms following infection (Long COVID), and CV health is key if we are to be able to effectively target the use of CRF and PA to improve the lives of those suffering its afflictions. Whilst there is a long way to go to optimise PA and CRF for improved health at a population level, particularly in a post-pandemic world, increasing the understanding using a cellular-to-systems approach, we hope to provide further insight into the benefits of engaging in PA.

Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment.

The Post Covid-19 Condition (commonly known as Long Covid) has been defined by the World Health Organisation as occurring in individuals with a history of probable or confirmed SARS CoV 2 infection, usually within 3 months from the onset of acute Covid-19 infection with symptoms that last for at least two months which cannot be explained by an alternative diagnosis. Long Covid is associated with over two hundred recognised symptoms and affects tens of millions of people worldwide. Widely reported reductions in quality of life(QoL) and functional status are caused by extremely sensitive and cyclical symptom profiles that are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli. This manifestation prevents millions of people from engaging in routine activities of daily living (ADLs) and has important health and well-being, social and economic impacts. Post-exertional symptom exacerbation (PESE) (also known as post-exertional malaise) is an exacerbation in the severity of fatigue and other symptoms following physical, emotional, orthostatic and cognitive tasks. Typically, this will occur 24-72 h after "over-exertion" and can persist for several days and even weeks. It is a hallmark symptom of Long Covid with a reported prevalence of 86%. The debilitating nature of PESE prevents patients from engaging in physical activity which impacts functional status and QoL. In this review, the authors present an update to the literature relating to PESE in Long Covid and make the case for evidence-based guidelines that support the design and implementation of safe rehabilitation approaches for people with Long Covid. This review also considers the role of objective monitoring to quantify a patient's response to external stimuli which can be used to support the safe management of Long Covid and inform decisions relating to engagement with any stimuli that could prompt an exacerbation of symptoms.

Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters.

PURPOSE: Resistance training activates the ventilatory muscles providing a stimulus similar to ventilatory muscle training. We examined the effects of elite powerlifting training upon ventilatory muscle strength, pulmonary function and diaphragm thickness in world-class powerlifters (POWER) and a control group (CON) with no history of endurance or resistance training, matched for age, height and body mass. METHODS: Body composition was assessed using single-frequency bioelectrical impedance. Maximal static volitional inspiratory (P(I,max)) and expiratory (P(E,max)) mouth pressures, diaphragm thickness (T(di)) derived from ultrasound measurements and pulmonary function from maximal flow volume loops were measured. RESULTS: There were no differences in physical characteristics or pulmonary function between groups. P(I,max) (22 %, P < 0.05, effect size d = 1.13), P(E,max) (16 %, P = 0.07, effect size d = 0.86) and T(di) (27 %, P < 0.01, effect size d = 1.59) were greater in POWER than CON. Correlations were observed between both T(di) and P(I,max) (r = 0.518, P < 0.05), T(di) and P(E,max) (r = 0.671, P < 0.01) and T(di) and body mass (r = 0.502, P < 0.05). CONCLUSIONS: We conclude that manoeuvres performed by world-class powerlifters improve ventilatory muscle strength and increases diaphragm size. Whole-body resistance training may be an appropriate training mode to attenuate the effects of ventilatory muscle weakness experienced with ageing and some disease states.

Improving Fundamental Movement Skills during Early Childhood: An Intervention Mapping Approach.

The earlier in life that a child can begin mastering fundamental movement skills (FMS), the more positive their physical activity (PA) trajectories and health outcomes are. To achieve sufficient development in FMS, children must be guided with tuition and practice opportunities. Schools and educators provide an opportunity for interventions that improve health behaviours and outcomes for children. The aim of this study was to use intervention mapping (IM) to design a programme of school-based intervention to improve FMS for children aged 4-5 years old. Following the six steps of IM, with each step comprising three to five tasks that require the input of a planning group formed by key stakeholders, a programme of intervention was planned. Prior knowledge and primary and secondary evidence was used to support the development of the programme. A logic model of the problem as well as logic models of change, programme design, production, implementation, and evaluation were proposed or completed within the study. The results can be used to begin to implement an FMS-focussed intervention within school settings within England and propose a sustainable and realistic approach for helping children to develop FMS with the support of well-informed educators who are confident to deliver better FMS practice and PA opportunities.

Systems science approaches to cardiovascular disease prevention and management in the era of COVID-19: A Humpty-Dumpty dilemma?

The coronavirus disease 2019 (COVID-19) pandemic necessitated the implementation and prioritizing of strict public health strategies to mitigate COVID-19 transmission and infection over all else. As we enter a 'recovery' phase in which the impact of the virus recedes (but does not relent), we ask, "How do we develop a game plan that considers prevention over management of public health threats of a more chronic nature, including cardiovascular disease?" We frame this choice point as a "Humpty-Dumpty" moment for public health with enduring and potentially irreversible consequences. Citing clear examples of other public health successes and failures, we outline in detail how sustaining cardiovascular population health under complex post-pandemic conditions will necessitate decision-making to be informed with a systems science approach, in which interventions, goals, outcomes and features of complex systems are carefully aligned.

The Impact of COVID-19 on the Social Determinants of Cardiovascular Health.

Cardiovascular disease is the leading noncommunicable disease and cause of premature mortality globally. Despite well established evidence of a cause-effect relationship between modifiable lifestyle behaviours and the onset of risk of chronic disease, preventive approaches to curtail increasing prevalence have been ineffective. This has undoubtedly been exacerbated by the response to COVID-19, which saw widespread national lockdowns implemented to reduce transmission and alleviate pressure on strained health care systems. A consequence of these approaches was a well documented negative impact on population health in the context of both physical and mental well-being. Although the true extent of the impact of the COVID-19 response on global health has yet to be fully realised or understood, it seems prudent to review effective preventative and management strategies that have yielded positive outcomes across the spectrum (ie, from individual to society). There is also a clear need to heed lessons learned from the COVID-19 experience in the power of collaboration and how this can be used in the design, development, and implementation of future approaches to address the longstanding burden of cardiovascular disease.

A united approach to promoting healthy living behaviours and associated health outcomes: a global call for policymakers and decisionmakers.

Chronic disease pandemics have challenged societies and public health throughout history and remain ever-present. Despite increased knowledge, awareness and advancements in medicine, technology, and global initiatives the state of global health is declining. The coronavirus disease 2019 (COVID-19) pandemic has compounded the current perilous state of global health, and the long-term impact is yet to be realised. A coordinated global infrastructure could add substantial benefits to public health and yield prominent and consistent policy resulting in impactful change. To achieve global impact, research priorities that address multi-disciplinary social, environmental, and clinical must be supported by unified approaches that maximise public health. We present a call to action for established public health organisations and governments globally to consider the lessons from the COVID-19 pandemic and unite with true collaborative efforts to address current, longstanding, and growing challenges to public health.

Acute COVID-19, the Lived Experience, and Lessons to Learn for Future Pandemics.

OBJECTIVES: The study aimed to increase the understanding of the lived experience of patients during the acute phase of a coronavirus disease 2019 (COVID-19) infection. METHOD: A Web-based survey was distributed through established patient and public engagement and involvement groups and networks, social media, and by means of word of mouth. The survey covered questions relating to patient demographics, COVID-19 diagnosis, symptom profile, and patient experience during acute COVID-19. RESULTS: The findings demonstrate the varying symptom profiles experienced by people in the acute stage of COVID-19 infection, with participants sharing how they managed care at home, and/or accessed medical advice. Findings also highlight themes that people were concerned with being unable to receive care and believed they needed to rely heavily on family, with extreme thoughts of death. CONCLUSIONS: Although the urgent threat to public health has been negated by efficacious vaccines and enhanced treatment strategies, there are key lessons from the lived experience of COVID-19 that should be used to prepare for future pandemics and public health emergencies.

Forming a consensus opinion to inform long COVID support mechanisms and interventions: a modified Delphi approach.

Background: Current approaches to support patients living with post-COVID condition, also known as Long COVID, are highly disparate with limited success in managing or resolving a well-documented and long-standing symptom burden. With approximately 2.1 million people living with the condition in the UK alone and millions more worldwide, there is a desperate need to devise support strategies and interventions for patients. Methods: A three-round Delphi consensus methodology was distributed internationally using an online survey and was completed by healthcare professionals (including clinicians, physiotherapists, and general practitioners), people with long COVID, and long COVID academic researchers (round 1 n = 273, round 2 n = 186, round 3 n = 138). Across the three rounds, respondents were located predominantly in the United Kingdom (UK), with 17.3-15.2% (round 1, n = 47; round 2 n = 32, round 2 n = 21) of respondents located elsewhere (United States of America (USA), Austria, Malta, United Arab Emirates (UAE), Finland, Norway, Malta, Netherlands, Iceland, Canada, Tunisie, Brazil, Hungary, Greece, France, Austrailia, South Africa, Serbia, and India). Respondents were given ∼5 weeks to complete the survey following enrolment, with round one taking place from 02/15/2022 to 03/28/22, round two; 05/09/2022 to 06/26/2022, and round 3; 07/14/2022 to 08/09/2022. A 5-point Likert scale of agreement was used and the opportunity to include free text responses was provided in the first round. Findings: Fifty-five statements reached consensus (defined as >80% agree and strongly agree), across the domains of i) long COVID as a condition, ii) current support and care available for long COVID, iii) clinical assessments for long COVID, and iv) support mechanisms and rehabilitation interventions for long COVID, further sub-categorised by consideration, inclusion, and focus. Consensus reached proposes that long COVID requires specialised, comprehensive support mechanisms and that interventions should form a personalised care plan guided by the needs of the patients. Supportive approaches should focus on individual symptoms, including but not limited to fatigue, cognitive dysfunction, and dyspnoea, utilising pacing, fatigue management, and support returning to daily activities. The mental impact of living with long COVID, tolerance to physical activity, emotional distress and well-being, and research of pre-existing conditions with similar symptoms, such as myalgic encephalomyelitis, should also be considered when supporting people with long COVID. Interpretation: We provide an outline that achieved consensus with stakeholders that could be used to inform the design and implementation of bespoke long COVID support mechanisms. Funding: None.