Newswise - The link between COVID-19 symptoms and physical inactivity is becoming more and more evident. A recent article Scientific Reports by researchers at the University of São Paulo in Brazil found that survivors of at least one persistent symptom of the disease, COVID-19, were 57% more likely to be inactive, and SARS-CoV-2. The presence of five or more post-acute sequelae increased the probability of physical inactivity by 138%.
"Although this is a cross-sectional study, the findings highlight the importance of discussing and encouraging physical activity at all times, including during the pandemic," said Hamilton Roschel, the study's last author and one of the USP's Applied Physiology Coordinators. Nutrition Research Group.
The study was supported by FAPESP and was one of the first to evaluate the effects of physical activity in the context of the extended COVID-19, characterized as a syndrome that usually includes symptoms that persist for at least two months after the coronavirus infection has resolved. can be explained by other health problems.
According to an editorial December 2020 in Nature Medicine, early reports showed that about three out of every four patients hospitalized for COVID-19 showed at least one persistent symptom six months after discharge.
Methods
In the study, researchers analyzed data collected by the HCFMUSP COVID-19 Working Group at the hospital complex Hospital das Clínicas , managed by the USP School of Medicine . The study included a total of 614 people with an average age of 56 who survived laboratory-confirmed COVID-19.
Patients were hospitalized between March and August 2020, and a follow-up protocol was applied from October 2020 to April 2021 . They were examined and interviewed to find out how physically active they were and to assess other lifestyle elements. They were also asked to report if they had ten symptoms associated with long-term COVID, such as fatigue, shortness of breath, severe muscle pain, loss of taste and smell, and memory impairment, among others.
Participants were classified as physically inactive if they reported doing less than 150 minutes of moderately intense exercise per week, according to World Health Organization guidelines. "Exercise in our case included sports as well as housework and walking," said Roschel.
More symptoms, more sedentary
The researchers conducted a series of statistical analyzes to investigate correlations between prolonged COVID symptoms and physical inactivity.
Sixty percent of the participants were considered physically inactive; this is higher than the rates found for most regions in a nationwide survey conducted by the Brazilian Ministry of Health in 2020.
Co-morbidities were also important: 37% were smokers, 58% had high blood pressure, 35% had diabetes, and 17% were obese. "These are risk factors for severe COVID-19. Because all participants were hospitalized, they were expected to be frequent in the study," said Roschel, adding that 55 percent needed intensive care and 37 percent were intubated.
When they adjusted the results for confounding factors , the researchers found that the presence of at least one persistent symptom was associated with a 57% higher probability of sedentaryism. "The more symptoms, the higher the likelihood of physical inactivity," said Roschel. When five or more symptoms were reported, the probability of physical activity increased by 138%.
He added that certain sequelae associated with prolonged COVID are very closely related to physical inactivity. The highest correlations in the adjusted statistical models were with shortness of breath and fatigue .
"It's reasonable to assume that people with this condition have more difficulty maintaining an active routine," he said. "However, it's also plausible that people with a sedentary lifestyle are more exposed to these long-term symptoms after recovering from an acute infection. Our study does not allow us to infer causality."
Associations and hypotheses
In the article, the authors say that physical inactivity "may be considered a persistent symptom among COVID-19 survivors." This hypothesis has also been raised by other research groups. A Dutch article cited in the article describes a study in which 239 recovering patients reported walking six months after the onset of symptoms, significantly shorter than before they contracted the disease.
Roschel also believes, based on other research, that inactivity could theoretically increase the long-term risk of COVID. A study conducted in 2021 and also led by him found that hospitalized COVID-19 patients with more muscle strength and mass tended to have less hospital stays .
In a later study, the same researchers found that patients who lost more muscle mass during hospitalization due to COVID-19 were more likely to develop persistent symptoms of the disease, also pointing to a possible correlation with higher post-acute COVID healthcare costs more for more: agencia.fapesp.br/40541).
A study conducted in the United States in 2020 analyzed the previous physical activity history of 48,440 COVID-19 patients and found that the risk of hospitalization, admission to intensive care, and was highest among those who were consistently inactive.
"Our recent study added information by describing specific associations between physical inactivity and persistent symptoms of COVID-19. Future research should explore this association to understand the underlying causes," Roschel said.
The link may be a two-way street where sedentaryness favors long COVID and people with long COVID tend to avoid exercise.
"From a practical point of view, the importance of physical activity during the pandemic becomes clear," said Roschel. He emphasized that there are situations where survivors of the disease should follow medical advice about the precautions to be taken while doing physical exercise, but an active lifestyle should be encouraged in terms of public health. A sedentary lifestyle is responsible for 9% of all-cause mortality worldwide.
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