Correlation between long-term COVID and physical inactivity

In a recent study reviewed in the journal Scientific Reports and published on the Research Square* preprint server, researchers assessed whether physical inactivity in survivors of the 2019 coronavirus disease (COVID-19) led to the development of post-acute consequences of COVID-19 (PASC), also known as lung COVID.

Study: Association between post-acute consequences of SARS-CoV-2 and physical inactivity: a cohort study of 614 COVID-19 survivors† Image Credit: eamesBot/Shutterstock

PASC, persistence of symptoms, such as fatigue, cough, loss of taste or smell, and impaired cognitive function, present at least four weeks after the first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is common after recovery of COVID-19.

Few studies have shown that those experiencing PASC were physically inactive after SARS-CoV-2 infection compared to the pre-infection period. Therefore, it is critical to determine how physical inactivity increases the risk of developing PASC in those who survive severe COVID-19.

About the study

The current study invited 749 eligible patients for an in-person visit six to 11 months after being admitted to a tertiary hospital in Sao Paulo, Brazil for COVID-19 between March and August 2020.

A majority of patients admitted to the hospital intensive care unit had pre-existing co-morbidities, including hypertension, type 2 diabetes, and obesity. The team classified all study participants as physically inactive according to World Health Organization (WHO) guidelines, which consider being physically active as more than 150 minutes per week of moderate to vigorous physical activity.

The researchers used standardized scales to rate ten symptoms of PASC and the International Physical Activity Questionnaire Short Form (IPAQ) to determine a patient’s physical activity over the past seven days. They then calculated the time spent on each physical activity as the number of days multiplied by self-reported hours.

The researchers stored all survey data from interviews and additional studies using web-based case report forms hosted on a Research Electronic Data Capture (REDCap) system. They presented patient characteristics as absolute (n) and relative (%) frequency. They selected confounders based on a direct acyclic graph (DAG) that identified a minimal set of covariates to remove confounding factors.

Study findings

The study included data from 614 patients, 53% of whom were male, and the median age of patients was 56±13 years. Unfortunately, only 39% of patients met recommendations for physical activity.

The modified study model took into account confounders and showed that patients with one or more PASC symptoms were more likely to be physically inactive, with an odds ratio (OR) of 1.56. The number of PASC symptoms was inversely related to physical activity. Compared to patients with no symptoms, patients with more than five PASC-specific symptoms were approximately 133% more likely to be physically inactive.

Multivariate-corrected logistic regression analysis (odds ratio [(95% CI]) of the association between presence (panel A) and number of persistent symptoms related to COVID-19 (i.e., none, 1 to 4, and ≥ 5 symptoms) (panel B) with physical inactivity (<150 min/week moderate-to-vigorous activity) . * Indicates P<0.05.

In addition, 61% of PASC patients showed a higher frequency of physical inactivity, and PASC was related to a 56% higher probability of physical inactivity. The frequency of physical inactivity in patients with zero, one, one to four, and five or more PASC symptoms was 51%, 62%, 58%, and 71%, respectively.

Only five specific symptoms, including severe muscle or joint pain, fatigue, post-trauma stress, insomnia, and shortness of breath, increased the likelihood of physical inactivity, with ORs of 1.49, 1.96, 1.53, 1.59, and 2, respectively. 22. The rest of the symptoms, such as cognitive impairment, depression, anxiety, and loss of smell and taste, were not related to physical inactivity.

conclusions

The study remarkably showed the correlation between physical inactivity – an emerging cause of morbidity and mortality in COVID-19 patients, and PASC in a group of individuals who survived after being hospitalized for COVID-19. Several patients had physical, mental and cognitive impairment after six months of acute SARS-CoV-2 infection. The observation that PASC increases the risk of physical inactivity is unique and previously unexplored. Only one other population study in Brazil estimated that 47% of age-matched individuals (such as the current study’s cohort) were physically inactive, compared to 61% in the current study.

COVID-19 and PASC can lead to persistent physical inactivity and affect patient survival. Since several organ dysfunctions enhance PASC, future research should investigate which have the greatest impact on physical inactivity related to PASC. In the future, studies should focus on developing methods to reliably identify physical inactivity in survivors of acute SARS-CoV-2 infection and the apparent role of anti-COVID-19 therapies, e.g., vaccination, in preventing from physical inactivity. Equally important would be to identify patients who could be specifically targeted by therapies adapted to promote physical activity for relieving the PASC-associated load.

*Important announcement

Research Square publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered conclusive, that should guide clinical practice/health-related behavior or be treated as established information.