COVID-19 and the Impact of Physical Activity on Persistent Symptoms

Lauren E Opielinski ^1* Toni D Uhrich ^1,2,3 Michael H Haischer ^1,2 Rachel N Beilfuss ³ Lindsey M Mirkes Clark ^1,4 Kamryn M Kroner ¹ Rachel E Bollaert ¹ Michael J Danduran ¹ Linda B Piacentine ^2,4 Marie Hoeger Bement ³ Paula E Papanek ¹ Sandra K Hunter ⁵

• ¹ Exercise Science Program, Marquette University, Milwaukee, United States
• ² Athletic and Human Performance Research Center, Marquette University, Milwaukee, United States
• ³ Department of Physical Therapy, Marquette University, Milwaukee, United States
• ⁴ College of Nursing, Marquette University, Milwaukee, United States
• ⁵ Movement Science Program, School of Kinesiology, University of Michigan, Ann Arbor, United States

Introduction: Physical activity is protective against chronic disease but whether activity is associated with persistent symptoms in non-hospitalized COVID-19 survivors is unknown. The purpose of the study was to determine the impact of the COVID-19 pandemic on physical activity levels and the influence of physical activity on acute and long COVID symptoms in non-hospitalized COVID-19 survivors. Methods: 64 non-hospitalized COVID-19 survivors (45 females, 40 ± 18 yr) were assessed for activity levels, body composition and symptoms of COVID-19 8.5 ± 4.7 months post infection and categorized into two groups 1) persistent symptoms 2) no symptoms at the time of testing. 43 of the 64 participants (28 females, 46 ± 18 yr) completed a follow-up questionnaire online 51.0 ± 39.7 months (4.25 years) post infection. A subset of 22 COVID-19 survivors (16 females, 35 ± 16 yr) were matched for age, sex, and BMI with healthy controls. Physical activity was quantified using 1) self-reported questionnaire (International Physical Activity Questionnaire; IPAQ-SF) at three time periods; prior to COVID-19 infection, at the time of laboratory testing (8.5 ± 4.7 months after infection), and an online follow-up (51.0 ± 39.7 months i.e., 4.25 years after infection); and 2) 7-day ActiGraph accelerometer worn following laboratory testing. Results: Physical activity (IPAQ-SF) declined in COVID-19 survivors from pre COVID infection to 8.5 ± 4.7 months after infection (3656 vs 2656 MET min/wk, 27% decrease, p<0.001, n=64) and rebounded to levels similar to pre COVID at 4.25 years after infection (p=0.068, n=43). Activity levels quantified with accelerometry did not differ between COVID-19 survivors and controls. However, COVID-19 survivors who reported persistent symptoms 8.5 mo after infection (n=29) engaged in less moderate-vigorous physical activity and steps/day than those without persistent symptoms (n=27) (37 vs 49 min/day, p=0.014) and (7915 vs 9540 steps/day, p=0.014). Discussion: Both COVID-19 survivors and matched controls reported reductions in physical activity indicating that lower levels of activity were likely due to the pandemic rather than COVID-19 infection alone. However, those who were most affected by COVID-19 infection with persistent symptoms had the greatest reductions in physical activity even ~8 months and ~4 years post infection.