People with chronic complex diseases like ME, Long COVID and Chronic Lyme experience many changes in their wellness over time. People with these diseases may call periods of worsened illness a ‘crash’, ‘flare’, or post-exertional malaise (PEM).

In this study, we will examine changes in your blood when you are experiencing worsened function and on days where you are feeling relatively better. We will also ask you to collect samples at regular intervals to create a baseline. In addition, we hope to use wearable devices, including Fitbits and in order to predict and help prevent crashes, flares, and PEM. In addition, we hope to better understand the mechanisms of disease fluctuations, which may lead to diagnostics and treatments.

Yes, you will receive a $25 Amazon gift card for your participation. This is a small thank-you for your effort on this study.

A flare is exacerbation of chronic illness symptoms. Post-exertional malaise, sometimes called a ‘crash’ is a
sudden and significantly worsened function and may be considered more specific to ME, ME/CFS, and Long
COVID often as a result of physical activity.

The study will be open for up to two years. Participants will be asked to gather samples over the course of three months. If you are willing and able to keep participating, you may request to continue gathering samples for up to one year by contacting our study coordinator at crashcoursestudy@stanford.edu.

1. First, participants will go through the consent process.
2. Participants who meet inclusion criteria will receive a kit by mail that contains everything they need to participate (at no additional cost to you), including microsampling kits, a Fitbit smartwatch, and a Wellysis S-patch Cardio device.
3. Participants will then download the apps to use these devices onto their Android or Apple phone. You must have access to an Android or Apple phone to participate.
4. Participants will wear a Fitbit device to keep track of their heart rate, daily step count, and other variables.
5. Participants will be asked to fill out six daily questions about their well-being; links will be sent via email each day.
6. On some days, participants will take a blood microsample:
a. Every two weeks, to develop a baseline
b. Three samples on days that feel better than average
c. Six samples on days participants are experiencing a crash, flare or post-exertional malaise
7. On collection days, participants will also wear the S-patch Cardio device all day.
8. On collection days, participants will complete a longer questionnaire about their current symptoms.
9. When participants have collected all of their samples, they will put them into the provided mailing envelope to return to us at Stanford.
10. Participants will receive an Amazon gift card in return of their first 16 samples and study kit materials,
including your Fitbit and S-patch Cardio.
11. PLEASE NOTE: If you choose to collect another 16 samples while the study is still underway, you may ask to receive a second, complete kit, and a second Amazon gift card once you return your second set of 16 samples and your study kit materials.

After you are done with the ‘first round’ (baseline samples every other week, six ‘crash’ days and three ‘good’ days), you may choose to send your first set of 16 samples and study kit materials, including your Fitbit and S-patch Cardio back to Stanford. After doing so, you may request additional sampling kits to continue your participation (for no more than 1 year) by contacting crashcoursestudy@stanford.edu.

Crashes can be induced by more than activity alone. We are interested in observing the metabolomic changes caused by crashes, flares, or PEM in general. It is okay to take samples anytime you are in a crash, no matter what may have caused it.

We recognize that people with chronic complex diseases may not have days where they ever feel truly well. Samples collected on ‘good’ days are good only relative to your average wellness. If you experience a day where your symptoms ease somewhat, consider this to be a ‘good’ day.

If you still are unable to collect samples in any of the categories, please see ‘what if I don’t collect all 16 samples’ below.

We will use data from your blood to study whether different biomarkers are produced when you are experiencing a flare, a crash, or post-exertional malaise (PEM) versus when you are feeling better. In order to do so, we are performing ‘multi-omic analysis’, meaning we will analyze over a thousand different molecules in the blood. We hope to use this data to predict whether someone is likely to have flares, crashes, or PEM, and what causes these symptoms.

All data will be stored securely on RedCap or Stanford Medicine Box. Only Stanford personnel with training in data protection and who are associated with the study will have access to your data. Data is encrypted,
firewalled, and ‘personal identifiers’ (like your name) are stored separately from any data we get from the study (like your metabolomics).

In the future, other researchers might get ‘raw’ data from this study, but they will never have access to any ‘personal identifiers’, just the data we get from performing the study.

If you have not received your survey links, please reach out to the study coordinator as soon as possible at crashcoursestudy@stanford.edu.

This data is important to capture while you collect your samples.

If you lose/do not receive your sample kit, please reach out to the study coordinator at
crashcoursestudy@stanford.edu to help you with the next best steps.

We will review the information you have provided to us to ensure your eligibility in the study. We ask for your patience and understanding, and hope to get back to you within 2 weeks of receiving your submission.

Once your complete set of 16 returned samples and your returned sample materials, including the Fitbit and
S-Patch Cardio, are received back at Stanford, you will receive your Amazon gift card for $25 within ~1 week. At that time, you may choose to ask for a second complete kit to begin the process again.

If we have reached the end of the study and have been unable to collect all 16 samples, reach out to us at crashcoursestudy@stanford.edu and let us know. We may still be able to use the samples you have collected.

Please reach out to the research team at crashcoursestudy@stanford.edu. We are happy to help answer any questions you may have, and provide you with any support you may need.