Table 2. Main findings from pre-pilot study testing REGAIN intervention delivery.

Component	Finding(s)	Implications for REGAIN Intervention
IT/online issues	Participants not placing device in adequate position for practitioner to view during exercises. Some older participants had difficulty navigating Zoom/MS Teams, enabling microphone/camera, and accessing link to session. Some participants accessed the session through their Smartphone which limited functionality (couldn’t see the rest of group). One person held smartphone throughout, so very jerky & too close; it was not possible for the practitioner to safely monitor exertion levels or technique.	During 1:1 consultation there is a need to go through set up - test the device and where the camera will be set up. etc. Log in to zoom and do test session. Practitioners and ‘co-pilot’ to log in early to group sessions as considerable time needed to let everyone into session. Amend workbook/telephone screening calls to indicate that a smartphone not good enough unless it can be ‘cast’ to a TV. Laptops & tablets preferred.
Progression	Participants found the progression more acceptable once they had gained confidence in the sessions and felt included in short ’debrief’ post exercise with rest of group.	Class templates amended so that Practitioners could alter the duration of exercises and recovery periods to suit each group. Participants to be asked how they felt the day after each session, as well as post session, to guard against post exertional fatigue.
Safety	Participants would frequently talk or make noise throughout, inadvertently interrupting practitioners’ instructions. Occasionally participants would disappear from view- going to toilet/answering door- practitioners were unsure if the patient was unwell.	All participants should be instructed to mute during exercise. Hand signals required to indicate whether easy, ok, too hard and another to say I am unwell/need to stop/etc. Set ground rules and instructions at start of each class requesting participants to signal before they leave the screen.
Very debilitated participants	One participant was chair bound in the same session as another with a relatively high level of fitness. Practitioners needed assistance from ‘co- pilots’ (via chat function) to adequately monitor all participants.	Need alternative chair-based option for all exercises in the session templates. Priority should be given to enjoyment while participants gain confidence. Frequent water breaks should be provided and the emphasis placed on the participant to take responsibility for their own exertion level
One to one consultation	Several participants were identified as having case level mental health disorder on anxiety/depression questionnaire. More discussion during the consultations revealed a higher level of emotional support needed than initially planned. Some participants spent longer overcoming IT issues than they did talking about their long- COVID.	Consultations should be at least an hour in order to introduce website and sign-up process, triage participant for exercise classes, and go through IT accessibility/optimal camera position etc. Regular meetings with psychologist planned throughout trial for ongoing advice/support for practitioners during trial.
Behavioural education	Participants required more support coping with anxiety/avoidance around social interaction and not just physical activity. Goal setting session was difficult as most participants experienced frequent setbacks and had unknown timescale of recovery. Some participants dominated the support sessions and others barely spoke. Practitioners were unsure how long to ‘let it go’ before interrupting. Practitioners were also unsure about PTSD issues that some participants may be facing, and giving advice outside of their competences.	Additional material included in the participant workbook relating to negative thought patterns. Practitioners should approach long COVID differently to traditional rehabilitation for long term conditions with no expectation of linear improvement each week Health psychologists to do additional training with practitioners regarding managing groups.