Characterization of Post-Viral Infection Behaviors […]: Prospective, Observational, Longitudinal Cohort Analyses of Fitbit [& PROs], 2025,Zhang,Unger+

[SNT Gatchaman]

Characterization of Post-Viral Infection Behaviors Among Patients With Long COVID: Prospective, Observational, Longitudinal Cohort Analyses of Fitbit Data and Patient-Reported Outcomes

Spoiler: Authors

Tianmai M Zhang; Sydney P Sharp; John D Scott; Douglas Taren; Jane C Samaniego; Elizabeth R Unger; Jeanne Bertolli; Jin-Mann S Lin; Christian B Ramers; Job G Godino

BACKGROUND
Long COVID encompasses a range of health problems that can be highly debilitating. While some research has relied on self-reported measures of symptoms and functioning, few studies have characterized symptoms in relation to behaviors and physiology measured objectively through wearable devices.

OBJECTIVE
The primary aim of this study was to identify longitudinal patterns in physical activity, physiology, and patient-reported outcomes (PROs) among patients with long COVID at a Federally Qualified Health Center in the United States. The secondary aim was to identify meaningful subgroups or phenotypes within this cohort and examine how PROs and symptoms overlay with physical activity characteristics.

METHODS
This was a prospective, observational, longitudinal cohort study recruiting a subset of low-income patients enrolled in the Long COVID and Fatiguing Illness Recovery Program. From March 2022 to May 2023, a total of 172 patients with long COVID or myalgic encephalomyelitis/chronic fatigue syndrome were given Fitbit Charge 5 (Fitbit Inc) devices and instructed to wear them continuously for up to a year. Patients completed PRO questionnaires (PROMIS-29 [Patient-Reported Outcomes Measurement Information System-29] and symptom questionnaires, etc) at baseline, 3, and 6 months. Inclusion in longitudinal analysis required at least 20 hours of valid wear data per day for a minimum of 7 days. The World Health Organization guideline on moderate to vigorous physical activity (MVPA) was used to differentiate MPVA-active and MVPA-inactive patients. Linear mixed effects regression was performed to assess longitudinal associations between physical activity levels and PROs.

RESULTS
Among 172 patients, 80.2% (n=138) were female, 75.6% (n=130) were White, 45.3% (n=78) were unemployed, and 94.8% (n=163) had estimated annual income below US $50,000. Of these patients, 82 (47.7%) met valid wear criteria, providing 50.5 days of Fitbit data on average. At baseline, MVPA-inactive patients (n=41) reported statistically more severe problems regarding physical function, fatigue, and dyspnea than MVPA-active patients (n=41) on both continuous and categorical scales, with P<.05 from both Student t tests (2-tailed) and chi-squared tests. Longitudinal analysis found that MVPA-inactive patients showed a decreased ability to participate in social roles (estimated group difference=–4.21 T-score points over 3 months, 95% CI –6.64 to –1.78, P<.001) and a higher intensity of sleep symptoms (estimated group difference=2.06 severity score points over 3 months, 95% CI 0.40 to 3.71, P=.02) over time.

CONCLUSIONS
This study showed that patients with long COVID could remain MVPA-active despite experiencing symptoms. These findings provide insights into the relationship between PROs, physical activity, and long COVID, which suggests the importance of considering individual activity profiles when tailoring treatment plans, especially in a low-income population. The findings of this study should be interpreted as hypothesis-generating, considering its exploratory nature and limitations, including high attrition rates and missing data.

Web | DOI | PDF | JMIR Formative Research | Open Access

 

[SNT Gatchaman]

Typical symptoms associated with long COVID, such as cognitive impairment, fatigue, and post-exertional malaise (PEM), closely resemble those in patients diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and other IACCs.

Using convenience sampling, participants were recruited when they agreed to complete their physical therapy visit or through a provider or physical therapist referral. Inclusion criteria included being aged 18 years or older, documented persistent symptoms and a decline in health-related quality of life consistent with long COVID based on patient report and clinical determination, ME/CFS or other IACCs, and having a smartphone.

Of those enrolled, 82 (47.7%) were classified as valid wear patients, providing 7566 valid wear days in total during the entire study period. Noncompliance with Fitbit wear was related to forgetfulness, rashes, and limited digital proficiency.

Noncompliance with PRO completion was associated with survey length, difficulty reaching patients, and symptom-related challenges.

 

[SNT Gatchaman]

Our finding that a lower MVPA [moderate-vigorous physical activity] level was associated with more improvements in outcomes in the long-term seems to suggest some benefit from reduced activity.

Given our observational results, we propose that it may be beneficial for health professionals to ask patients about their normal pattern of physical activity and symptoms that follow or worsen after activity. If the patient’s responsibilities require a substantial amount of MVPA, strategies for mitigating its potentially negative effects on symptoms could be explored. One potential strategy is activity pacing, that is, dividing physical activities into multiple portions that are more manageable and balancing them with rests.

 

[Sean]

Our finding that a lower MVPA [moderate-vigorous physical activity] level was associated with more improvements in outcomes in the long-term seems to suggest some benefit from reduced activity.​

As we have been saying for [checks notes] effing decades.

And the earlier patients can implement this management strategy, the better the long-term outcomes will be.