Feasibility and preliminary efficacy of an online mindful walking intervention among COVID-19 long haulers: A mixed method study including daily diary surveys

Objective Mindful-walking (MW) intervention could be an effective strategy to address the psychosocial stressors and physical health challenges faced by COVID-19 long haulers. This study aims to test the feasibility of digitally delivering MW intervention among long haulers via social media and assess its preliminary efficacy on enhancing physical and psychosocial wellbeing. Method We recruited 23 participants via Facebook groups in March and November 2021 for a 4-week online MW intervention, consisting of mindfulness practices (2 sessions per week), delivered entirely through the Facebook group. The intervention was assessed using mixed methods. Quantitative data were collected through 28-day brief daily evening surveys over the 4 weeks intervention period, including affect, cognition, mindfulness, physical activity, and MW engagement. Qualitative data were extracted from Paradata (i.e., participants’ responses to the social media posts). Multilevel modeling was employed for statistical analysis and a pragmatic approach was used for qualitative analysis. Results The mean feasibility score was 4.93/7 ( SD= 1.88). Multilevel models showed that MW uptake on a given day was positively associated with positive affect ( β =0.89, p <0.01), perceived cognition ( β =0.52, p <0.05), and physical activity levels ( β =0.41, p <0.05), and negatively associated with negative affect ( β =-0.83, p <0.01). Total number of MW days across the study period were positively associated with mindfulness levels ( β =0.3 p <0.01). Paradata reported satisfaction in mindfulness skill enhancement, symptom management and well-being promotion. Conclusion The digital delivery of our MW intervention via Facebook showed high acceptability. Preliminary efficacy findings indicate improved mental wellbeing and physical activity among long haulers. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding statement: This study is supported by National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH) (R01AI127203-5S1). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval: The study protocol of recruitment and intervention was approved by the University of South Carolina Institutional Review Board (IRB # Pro00109358). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Statement: The data analyzed during the current study is available on request to the corresponding author.