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Introduction Many adults hospitalised with COVID-19 have persistent symptoms such as fatigue, breathlessness and brain fog that limit day-to-day activities. These symptoms can last over 2 years. Whilst there is limited controlled studies on interventions that can support those with ongoing symptoms, there has been some promise in rehabilitation interventions in improving function and symptoms either using face-to-face or digital methods, but evidence remains limited and these studies often lack a control group. Methods and analysis This is a nested single-blind, parallel group, randomised control trial with embedded qualitative evaluation comparing rehabilitation (face-to-face or digital) to usual care and conducted within the PHOSP-COVID study. The aim of this study is to determine the effectiveness of rehabilitation interventions on exercise capacity, quality of life and symptoms such as breathlessness and fatigue. The primary outcome is the Incremental Shuttle Walking Test following the eight week intervention phase. Secondary outcomes include measures of function, strength and subjective assessment of symptoms. Blood inflammatory markers and muscle biopsies are an exploratory outcome. The interventions last eight weeks and combine symptom-titrated exercise therapy, symptom management and education delivered either in a face-to-face setting or through a digital platform (www.yourcovidrecovery.nhs.uk). The proposed sample size is 159 participants, and data will be intention-to-treat analyses comparing rehabilitation (face-to-face or digital) to usual care. Ethics and dissemination Ethical approval was gained as part of the PHOSP-COVID study by Yorkshire and the Humber Leeds West Research NHS Ethics Committee, and the study was prospectively registered on the ISRCTN trial registry (ISRCTN13293865). Results will be disseminated to stakeholders, including patients and members of the public, and published in appropriate journals. Article summary Strengths and limitations of this study • This protocol utilises two interventions to support those with ongoing symptoms of COVID-19 • This is a two-centre parallel-group randomised controlled trial • The protocol has been supported by patient and public involvement groups who identified treatments of symptoms and activity limitation as a top priority

This study adopted a descriptive correlational design to identify organ transplant athletes' motivational behaviour and level of physical activity enjoyment during the 2019 World Transplant Games. The causal relationship between motivational behaviour and enjoyment was also determined. Data was collected through questionnaires during the event that tapped participants' demographic information and responses to the Task and Ego Orientation Questionnaire, Sport Motivation Scale-2 and Physical Activity Enjoyment Scale. Descriptive statistics revealed that transplant athletes (n = 119; Mage = 52.92 years, SD = 13.51) find sport mostly enjoyable whilst holding a strong task-oriented approach towards sport participation with high approximations of intrinsic, integrated and identified motivation. Male and female athletes also shared a relatively similar motivational profile with male athletes reporting significantly higher levels of sport enjoyment compared to their female counterparts. Inferential statistics further revealed significant associations between most dimensions of motivation and level of enjoyment, of which gender and certain aspects of motivation were exposed as significant predictors of athletes' reported enjoyment in sport. It is advised that autonomous regulatory behaviours be garnered in transplant recipients looking to start/continue sport participation as it proved to be prime correlates and determinants of enjoyment in sport.

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Background: Supporting organ transplant recipients’ quality of life after surgery continues to be of topical interest to health researchers and applied practitioners. However, literature and guidance on the factors linked to quality of life in transplant recipient athletes remains largely unreported and unconfirmed. Aim: Therefore, in this study we sought to identify significant predictors of quality of life in an international sample of organ transplant recipient athletes (N = 99, Mage = 53.12, SD = 13.70). Method: Adopting a cross-sectional design, we collected the study data during the 2019 World Transplant Games using online and pen-and-paper surveys that consisted of demographic items, health, and physical activity-related measures (i.e., Task and Ego Orientation in Sport Questionnaire, Fatigue Severity Scale, Assessment of Physical Activity Questionnaire, Physical Activity Enjoyment Scale). Predictor variables in the study were broadly summarised into three categories namely demographic factors, sport-related factors, and levels of fatigue with physical and mental quality of life functioning as the outcome variables. Results: Hierarchical regression analyses exposed fatigue to exert a significant negative influence on both mental and physical quality of life perceptions explaining 49% and 64% of the variance in these variables respectively. Conclusion: It is recommended that transplant athletes’ level of fatigue should be routinely measured and closely monitored in sport settings as it has a negative bearing on quality of life that may act as a potential barrier to sport participation and enjoyment.