Study suggests that long-COVID is associated with physical inactivity

In a recent study published in the Scientific Reports journal, researchers in Brazil assessed the association between post-acute sequelae of coronavirus disease 2019 (COVID-19) (PASC) and physical inactivity.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have wreaked havoc across the globe, resulting in critical disease outcomes and hospitalizations. Studies have highlighted the high incidence of PASC symptoms among COVID-19 survivors, which has burdened health systems worldwide. This condition is termed 'long COVID' and is described as the disease experienced by individuals having a history of suspected or confirmed COVID-19. Researchers have observed that physical inactivity is an independent risk factor associated with impaired functional status, depression and anxiety, musculoskeletal disorders, and all-cause mortality. Hence, it is essential to determine any PASC-related risk factors that COVID-19 survivors may suffer due to physical inactivity.

Study: Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors. Image Credit: Lightspring / ShutterstockStudy: Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors. Image Credit: Lightspring / Shutterstock

About the study

In the current study, researchers examined whether COVID-19 survivors' PASC was related to physical inactivity. The study is a part of a prospective and multi-disciplinary cohort study called the Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP) PASC Initiative involving COVID-19 survivors. All eligible patients were 18 years or above and hospitalized as inpatients for a minimum of 24 hours. These patients were diagnosed with SARS-CoV-2 infection between March 2020 and August 2020 and were invited for a follow-up visit from October 2020 to April 2021.

A follow-up evaluation was conducted between 6 and 11 months after hospitalization for these patients. Participants were interviewed in a semistructured manner about their sociodemographic characteristics, lifestyle habits, occupational history, and self-evaluated medical history. A battery of objective physical assessments and laboratory tests were also conducted on these patients. Physical activity was also assessed at the time of the follow-up visit via the International Physical Activity Questionnaire-Short Form (IPAQ) that determined the patient's physical activity in the previous seven days. The team also created an adjusted model that controlled for confounders, gender, admission to the intensive care unit, invasive mechanical ventilation required, length of hospital stay, hypertension, type 2 diabetes, and obesity.   

Results

The study cohort involved 749 eligible patients who attended the follow-up assessment. The cohort included 53% males aged 56±13 years and 9% patients belonging to low, 50% middle, and 40% high socioeconomic classes. Almost 37% of the patients reported smoking during baseline evaluation. Furthermore, the predominance of current hypertension was 58%, type 2 diabetes was 35%, and obesity was 17%. Additionally, 55% and 37% of the patients needed intensive care and invasive mechanical ventilation. Notably, only 40% of the study cohort satisfied the physical activity recommendations.

Among patients who displayed physical inactivity, 51% reported none, 62% reported a minimum of one, 58% had between one and four, and 71% experienced five or more PASC-related symptoms. Furthermore, among physically inactive patients, 77% had dyspnea, 69% reported fatigue, 66% had severe joint/muscle pain, 66% had insomnia, 65% reported post-traumatic stress disorder, 65% exhibited memory impairments, 65% had anxiety, 62% had depression, 65% reported loss of taste, and 63% experienced loss of smell.

Multivariate-adjusted logistic regression analyses (odds ratio [(95% CI]) of the association between persistent symptoms related to COVID-19 (Severe muscle/joint pain, fatigue, post-traumatic stress, insomnia, dyspnea, memory impairments, depression, anxiety, taste loss, and smell loss) with physical inactivity (< 150 min/week of moderate-to-vigorous activity). *Unadjusted P < 0.05; # adjusted P < 0.005 (Bonferroni correction).Multivariate-adjusted logistic regression analyses (odds ratio [(95% CI]) of the association between persistent symptoms related to COVID-19 (Severe muscle/joint pain, fatigue, post-traumatic stress, insomnia, dyspnea, memory impairments, depression, anxiety, taste loss, and smell loss) with physical inactivity (< 150 min/week of moderate-to-vigorous activity). *Unadjusted P < 0.05; # adjusted P < 0.005 (Bonferroni correction).

The adjusted model revealed that patients with one or more persistent symptoms had a higher chance of being physically inactive than those who did not suffer from any persistent symptoms. Additionally, patients with five or more persistent symptoms had a higher likelihood of being physically inactive than those with no persistent symptoms. Adjusted models also highlighted that severe joint/muscle pain, fatigue, post-traumatic stress, insomnia, and dyspnea correlated with a higher likelihood of physical inactivity. Interestingly, depression, memory impairments, anxiety, and smell and taste loss were not significantly correlated to physical activity.  

Conclusion

The study findings showed that PASC was significantly associated with physical inactivity. The novel data presented here warrant further research to confirm which organ system pathologies related to COVID-19 may contribute to the incidence of physical inactivity and facilitate the early identification of recovering SARS-CoV-2-infected patients who could benefit from therapies that treat inactivity. Considering the potential effect of physical inactivity on overall mortality and morbidity, the researchers believe that the healthcare system, medical professionals, and policymakers should focus on treating COVID-19-related physical inactivity. 

Journal reference:
Bhavana Kunkalikar

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.

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Comments

  1. connor wogen connor wogen United States says:

    Obviously someone with symptoms after the post acute infection is not going to be participating in as much physical activity as someone who does not have symptoms. The most common symptoms after the post acute infection are (intense fatigue, persistent headache, etc.). When you are in pain/have intense fatigue, it is your bodies’ way of telling you that you need to rest, and slow down so that you do not cause more damage and allow yourself time to heal. Participating in much physical activity, when you have these symptoms, is directly disobeying the commands that your body is telling you. This is like saying “someone who has a bad case of the flu, on average, participated in less physical activity than patients with a mild case of the flu. Therefore, if these patients with a bad case of the flu were just more active while sick, they would get better sooner.” The amount of confounding variables within this study that are not addressed by the medical team is laughable. The fact that these doctors spent funding/their time on researching this is insulting to the medical community. This should be given 0 publicity, as it is a completely flawed study that fails to acknowledge nearly any of the variables/factors at play. This is disgraceful to the medical community, and the fact that these doctors/this writer things that these are “legitimate findings” is not only laughable, but utterly insulting to the medical community and those suffering.

  2. connor wogen connor wogen United States says:

    The comments aren’t even posted publicly. After you post them, they vanish. So nice for that. Additionally, the findings should be “patients with long term symptoms from Covid are on average less active than patients with no symptoms after Covid.” Well, obviously. Patients with cancer are less active than patients with out cancer. Does that mean that inactivity causes cancer? No. Confounding variables doctors, you learn it in the most basic of freshman college level classes. Review your notes. Do better.

  3. Andrea Andrea United States says:

    I disagree. A majority of us were highly athletic and never hospitalized. This study is only focused on those that were hospitalized. Lame

  4. Docteur Livesey Docteur Livesey United Kingdom says:

    I know this is going to sound insane, but maybe they aren't moving because they can't breathe very well.

  5. Jeremy Crawford Jeremy Crawford United States says:

    Super active GC here got waylaid with this minths before it existed and it lasted 9 months. Thousands later have adrenal issues and hydrolase problems. You cannot run if you can't breathe or metabolize and you need to triple your salt intake due to the adrenal issue nobody could figure out. These folks have no idea what all this disease does or much less how to treat it as it hits different with each person. $585,000 later I take adrenal support, salt and cortisone and had to switch bo meds. Getting there was 11 trips to hospitals, specialists and lots of dead ends. Ended up self diagnosing and researching much of my own cure. 50 now and finally feel 46 again.

  6. Beatrice Chaney Beatrice Chaney United States says:

    The theory of GET treatment (Graded Exercise Therapy) long advocated for ME/CFS ( Myalgic Encephalomyelitis/Chronic Fatigue) a disease similar to Long Covid, has at last been debunked through extended patient advocacy after it was found to be not only ineffective but dangerous, causing the disease to be aggravated, sometimes severely. In fact, for Long Covid as for ME/CFS, the most important treatment is REST. As several posters pointed out,  many such sufferers were highly athletic before being stricken with this condition.
    This study is flawed and the article dangerous and should be pulled.
    Just Google "CFS GET" to get the full story and extensive prior research.

  7. Robert Malkis Robert Malkis United States says:

    I was running anywhere from 3 to 10 miles 4 times a week the first 6 months that I had Long Covid. Only once I read about Long Covid and then stopped working out did the constant brain fog and extreme fatigue I had had that whole time finally ease a bit. I still try to run every so often, but it alway ends up being a mistake and leaves me feeling awful for days.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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