Nature communicationsFeb 2, 2026

Using a digital activity tracker to support energy management in long COVID: a controlled trial

Long Covid Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jun 28, 2026

Abstract

Essence

A digital energy-management platform with activity tracking did not reduce post-exertional malaise in adults with long COVID versus control app support over 6 months.

Evidence

This pragmatic randomized controlled trial randomized 250 adults with long COVID, and the per-protocol analysis of 77 controls and 84 intervention participants found no time-by-group effect on DSQ-PEM (p=0.614, eta squared p=0.002).

Caveat

Interpretation is limited by the per-protocol analysis, wide inclusion criteria, and the null primary endpoint despite recovery that may have obscured any effect.

Simplified

In a 6-month pragmatic randomised controlled trial (RCT; ISRCTN16033549), we compared a just-in-time intervention to support energy management in adults with long COVID (LC) to standard care. Participants received either the 'Pace Me' app and a wearable activity tracker (intervention) or an app only with data entry screens (control). The intervention group received just-in-time messages on energy management when they reached 50%, 75%, and 100% of their daily 'activity allowance'. The primary outcome was post-exertional malaise (PEM) measured by the DePaul Symptom Questionnaire-PEM (DSQ-PEM). Of 369 participants assessed for eligibility, 250 participants were randomised 1:1, and 77 controls and 84 intervention participants were included in the final per-protocol analysis. There was no time by group interaction for the DSQ-PEM. The intervention group value was 48 (95% CI 44-53) at baseline and 46 (95% CI 41-51) post-intervention (arbitrary units). The control group value was 47 (95% CI 42-52) at baseline and 44 (95% CI 39-49) at follow-up (interaction effect p = 0.614, η²p = 0.002; trivial). No individual question exhibited an interaction effect (p > 0.05). Although the intervention had minimal effect compared to control, the substantial recovery rates previously reported in LC, coupled with our wide inclusion criteria may have masked intervention effects. Therefore, future studies should consider this energy management framework in conditions without such recovery rates, such as CFS.

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Using a digital activity tracker to support energy management in long COVID: a controlled trial

Abstract

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