Mats Hallgren

Background: Post COVID-19 condition (or long COVID) is a newly recognized health condition that lasts for at least two months and cannot be explained by an alternative diagnosis (WHO, 2022). Common symptoms include fatigue, breathlessness, and impaired cognition (‘brain fog’). Pain is frequently reported, and sleep quality is often reduced. Over time, these symptoms have a detrimental effect on quality of life and mental health. Sweden and India have experienced major COVID-19 epidemics. In both countries, middle-aged and older adults have been disproportionately affected. Recent estimates suggest that ~25,000 Swedish adults have subsequently been diagnosed with post COVID. Physical activity (PA) levels are reduced in most people affected by post COVID, which increases the risk of multimorbidity. Conventional exercise (e.g., running) is not suitable for many of those affected. Yoga is shown to have positive effects on many of the symptoms associated with post COVID and could help those affected to regain PA levels and improve quality of life. Aim: To improve long-term health-related quality of life (HR-QoL) and promote healthy ageing in middle-aged and older adults (aged 50–75 years) with post COVID using yoga-based exercise.  Methods: We will conduct a randomized controlled trial (n=115) to compare the effects of a 12-week yoga intervention to a health promotion intervention for post COVID. Both interventions will be offered as adjuncts to usual care administered by a physician. The primary outcome is HR-QoL (SF-36). Secondary outcomes include self-reported fatigue, breathing difficulty, anxiety and depressive symptoms and cognition. Changes will be assessed on three occasions: baseline, post-intervention (12-weeks), and 6-month follow-up. A comparable intervention will be implemented in India and the results compared. A cost-effectiveness study is planned.Our Indian collaborators are experts in the design and assessment of yoga interventions

knowledge that will be transferred to Sweden during the project. India will benefit from collaborative ties with Karolinska Institutet, and from methodological expertise. Our team includes experts in rehabilitation medicine, physical activity, neuropsychology, and international health. The PI in Sweden has a track record evaluating the health effects of yoga interventions in middle aged and older adults, including his recent Sweden-India collaboration, FitForAge (2017-20)