Aimee Layton is director of the Pediatric Cardiopulmonary Exercise Laboratory at Columbia University Irving Medical Center / NewYork-Presbyterian, where she performs exercise testing and counseling for patients with lung disease or heart disease. Her research focuses on impacting kids' behavior and relationship with exercise.
After recovering from the initial infection, many adults develop long COVID and report persistent problems with fatigue, "brain fog," mood, and other symptoms that can last for months.
Much remains to be learned, but in kids, long COVID even less understood. The percentage of children who develop long COVID, what lies behind the symptoms, and who's most at risk are still unknown.
To help uncover the long-term effects of COVID on children, a team of Columbia researchers was selected by the NIH's RECOVER program to develop an exercise study for the thousands of children who have enrolled in the nationwide study.
We spoke to Aimee Layton, PhD, assistant professor of applied physiology in the Department of Pediatrics and director of the Pediatric Cardiology Cardiopulmonary Exercise Laboratory, who's leading the effort, about the study's goals.
Why is quantifying children's ability to exercise important in understanding long COVID?
Exercise often enhances any issues the body may be having in tolerating and responding to stress.
Exercise is kind of like putting the body under a magnifying glass. I often tell patients that exercise allows us to pick up on changes in their health much sooner than if they weren't exercising. For instance, if you exercise every day and you notice that you are becoming short of breath at a lower intensity, you will probably go to the doctor and get things checked out. The same underlying problem may not produce any symptoms if you're sitting or just casually walking around.
How will the data help us understand long COVID in children?
The data will eventually help doctors better identify children with long COVID, how they're different from kids who don't have long COVID, and what people with long COVID can expect long term.
"Exercise is kind of like putting the body under a magnifying glass."
The data should also help us design treatments for those who are struggling to recover from the illness.
Potentially that could include exercise. If we can better understand how COVID impacts the physiology of the muscle, than we can potentially use different types of exercise to help the muscle rebuild and heal. And we can help patients avoid exercises that may worsen the problem.
How was your team selected to create the exercise protocol?
The pediatric exercise lab at Columbia-which includes pediatric cardiologists Michael Fremed and Leonardo Liberman, study coordinator Ruskin Del Mundo, and exercise physiologist Erin McCown, in addition to myself-has been a part of several multicenter NIH studies in which exercise was a primary outcome. So, we're known in the space. In addition, I published work during COVID investigating how we can use a home exercise program to help patients recover from COVID.
It was a long application process, and in the final interview I answered questions from experts from the NIH and other top pediatric cardiology programs in the country. A big concern of theirs was how I was going to control for poor fitness seen by many children during the pandemic.
The way we solve for such issues is with control groups. Kids without long COVID also experienced the pandemic and change in their environment. If we see significant difference between certain variables for a given exercise effort, we can better isolate the impact of the COVID virus.
We were chosen, so we've designed the protocol based on prior research in kids with other diseases and research in adults recovering from COVID. We're now making an instructional presentation for how other clinical centers in RECOVER should carry out the protocol.
