Associations Between Pre-Quarantine Exercise and Persistent Symptoms After SARS-CoV-2 Infection

Long-term symptoms after SARS-CoV-2 infection such as fatigue, shortness of breath and cognitive impairment represent a major burden on society. Risk factors include female sex, smoking, comorbidities and socioeconomic deprivation. Physical activity (PA) has been suggested as a potential protective factor, although all population groups, including athletes, were affected. Therefore, this study aimed to investigate the influence of PA duration and intensity on the odds of the presence of long-term symptoms.

This cross-sectional study included 5413 individuals following acute COVID-19 within the CoCo-Fakt online monitoring study. The type, duration and intensity of exercise in the four weeks before quarantine were recorded, and the odds of the presence of long-term symptoms beyond 12 weeks after infection were determined, adjusted for demographics, health status and acute COVID-19 outcomes.

Among participants, 561 (10.4%) reported long-term symptoms. Those with long-term symptoms reported a longer duration (p = 0.019, d = -0.61) of exercise in the four weeks before quarantine compared to those without long-term symptoms. Adjusted for demographics, health status and acute COVID-19 outcomes, higher exercise intensity (MET/day) was associated with 16.7% increased odds of long-term symptoms (Nagelkerke R² = 18.0%). After the Bonferroni-Holm correction, this association did not remain significant.

Current data suggests that PA has a protective effect on post-COVID-19 condition when performed at a moderate level. In our study, however, neither PA intensity nor duration emerged as a predictor of long-term symptoms. Future studies must clarify which intensities and types of exercise can help to maintain overall physical and mental health and to prevent or improve the long-term outcomes following SARS-CoV-2 infection, considering individual circumstances.