# Remotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM HIIT-Covid19)

> **NIH NIH R01** · DUKE UNIVERSITY · 2022 · $799,093

## Abstract

Severe disease from COVID-19 requires hospitalization in 20% of adults, with a third of those patients requiring
intensive care unit (ICU) treatment. While a growing number of patients are surviving COVID-19 critical illness,
like other ICU survivors, the majority will experience significant post-hospital disabilities in physical function and
exercise capacity, new-onset disability, muscle wasting/weakness, and new cognitive deficits. These difficulties,
which can persist for months to years post-ICU, are collectively known as post-intensive care syndrome (PICS)
and may be more severe in COVID-19 survivors. Despite literature demonstrating the benefit of physical
rehabilitation in COVID-19 and other ICU survivors, there are limited available options and data to support an
optimal post-hospital physical rehabilitation strategy. Combined with the difficulties of delivering rehabilitation in-
person after hospitalization during a pandemic, addressing this “rehabilitation pandemic” from COVID-19
represents an enormous public health challenge. Previous studies of home-based physical rehabilitation in ICU
survivors have utilized unsupervised exercise training without a personalized exercise prescription, and none
have done so while actively monitoring and targeting exercise via physiologic data such as heart rate or included
strength and balance training. In debilitated older patients, high intensity interval training (HIIT) is safe and
associated with significant improvements (in as little as two weeks) in cardiorespiratory fitness (CRF) that also
correlates with self-reported physical function and disability. We have evaluated this approach in a successful
NIH-funded phase 1 pilot study demonstrating safety and feasibility of HIIT in debilitated older adults with cancer.
Adherence to exercise was 117% (meaning patients exercised more than recommended 3 sessions/week),
compliance with heart rate goals was 98% (meaning patients were actually doing HIIT vs. less-intensive
exercise), and on average patients improved CRF, as measured by VO2peak on cardiopulmonary exercise
testing by 25%. The key to our approach is our mHealth platform, in which patients are given Apple Watches
and iPhones preloaded with our software allowing us to remotely download data after each exercise session to
provide personalized up-coaching via videoconferencing in home setting. As critical illness survivors, including
COVID-19 ICU survivors, have impaired CRF (similar to patients in pilot study) and other manifestations of PICS,
a similar monitored, personalized, structured, and progressive multi-domain physical rehabilitation intervention
has significant potential for improving recovery, but has not yet been studied in COVID-19 survivors. To address
this gap in knowledge, we will randomize 140 COVID-19 ICU survivors being discharged home to our REmotely
Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM-HIIT-Covid-
19) stud...

## Key facts

- **NIH application ID:** 10490892
- **Project number:** 5R01HD107103-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Amy M Pastva
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $799,093
- **Award type:** 5
- **Project period:** 2021-09-17 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10490892

## Citation

> US National Institutes of Health, RePORTER application 10490892, Remotely Monitored, Mobile health-supported High Intensity Interval Training after COVID-19 Critical Illness (REMM HIIT-Covid19) (5R01HD107103-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10490892. Licensed CC0.

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