# Water-based Activity to Enhance Recovery in Long COVID

> **NIH VA I21** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2024 · —

## Abstract

The primary research question of the proposed study is this: Is a water-based exercise + cognitive training
(WATER+CT) intervention for Veterans with neurological manifestations of long-COVID feasible? We
address the need to enhance recovery in this vulnerable population through an innovative multi-component
training program that has successfully been used in other cognitively impaired populations. The aims of the
proposed research include: 1) demonstrate feasibility as shown by good recruitment and retention rates and
stakeholder ratings; 2) evaluate appropriateness of suggested inclusion and exclusion criteria; 3) evaluate
acceptability of water-based physical exercise + cognitive training interventions; 4) assess ability of selected
outcome measurement techniques to determine the efficacy of water-based physical exercise + cognitive
training; and 5) examine outcome “moderator” and “mediator” measurement techniques.
These aims will be tested in a single-blind randomized controlled pilot trial that will establish the feasibility of
WATER+CT. This trial will include 50 Veterans, age 18 – 89, experiencing neurological manifestations of
long-COVID, with half randomized to WATER+CT and half to usual care. WATER+CT consists of two-
phases: 1) an exercise training phase and 2) a cognitive training phase. The exercise training (i.e., WATER)
consists of a six-month long individualized exercise program of water-based exercises. During this phase,
Veterans will come to thrice-weekly group sessions at Aquatic Therapy Center at VA Palo Alto Health Care
System (VAPAHCS). After completion of the exercise program, Veterans will begin classroom-based
cognitive training at VAPAHCS for up to two months. The CT is based on an efficacious training program
that is structured around two components, pre-training, and mnemonic training, both of which have been
used successfully in persons with cognitive impairment. Veterans randomized to the UC control condition
will receive educational materials about brain health in addition to their usual care, which is the care they
would typically receive in the VA. Assessments of adherence will be administered throughout treatment and
measures of feasibility will be completed post-treatment.
Participants will complete a variety of neuropsychological measures taping into areas of cognition such as
attention, executive functioning, and memory. Participants will also undergo physical fitness assessments
including a 6-minute walk test and an exercise treadmill test. To study possible predictors of response to
treatment, we will also collect physiological (VO2 max), biological (inflammatory markers and BDNF plasma
levels), and genetic data (APOE and BDNF genotypes) from these participants. We hope to provide initial
evidence of the feasibility of a water-based exercise training + cognitive training program and provide
foundational support for a future VA Merit application targeting enhanced recovery in Veterans with
neurological manif...

## Key facts

- **NIH application ID:** 10803731
- **Project number:** 1I21RX004647-01A1
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Jennifer Kaci Fairchild
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-01-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10803731

## Citation

> US National Institutes of Health, RePORTER application 10803731, Water-based Activity to Enhance Recovery in Long COVID (1I21RX004647-01A1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10803731. Licensed CC0.

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