Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors 2023 Gil et al

[Sly Saint]

Abstract


The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and August 2020 were consecutively invited for a follow-up in-person visit 6 to 11 months after hospitalization.

Ten symptoms of PASC were assessed using standardized scales. Physical activity was assessed by questionnaire and participants were classified according to WHO Guidelines. 614 patients were analyzed (age: 56 ± 13 years; 53% male). Frequency of physical inactivity in patients exhibiting none, at least 1, 1–4, and 5 or more symptoms of PASC was 51%, 62%, 58%, and 71%, respectively.

Adjusted models showed that patients with one or more persistent PASC symptoms have greater odds of being physically inactive than those without any persistent symptoms (OR: 1.57 [95% CI 1.04–2.39], P = 0.032). Dyspnea (OR: 2.22 [1.50–3.33], P < 0.001), fatigue (OR: 2.01 [1.40–2.90], P < 0.001), insomnia (OR: 1.69 [1.16–2.49], P = 0.007), post-traumatic stress (OR: 1.53 [1.05–2.23], P = 0.028), and severe muscle/joint pain (OR: 1.53 [95% CI 1.08–2.17], P = 0.011) were associated with greater odds of being physically inactive.

This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors. This may help in the early identification of patients who could benefit from additional interventions tailored to combat inactivity (even after treatment of PASC), with potential beneficial impacts on overall morbidity/mortality and health systems worldwide.

https://www.nature.com/articles/s41598-022-26888-3

 

[John Mac]

This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors

Death can be associated with physical inactivity, which if left untreated may become a persistent symptom.

 

[rvallee]

Illness? Boy, I don't know.

Physicians baffled by the concept of illness and unable to pay attention to what their patients are saying is just about the most baffling thing in the modern world. You can train people as much as you want, if you train them wrong a lot of that training really amounts to nothing in some areas.

 

[Peter T]

Have you noticed that people who interact with the police and the criminal justice system are often involved in crime? Let’s abolish the police, the courts and prison, then crime will disappear over night.

The majority of people who die from illness either in hospital or at home do so lying in bed. Let’s get rid of all beds to stop people dying from illnesses.

Do any courses teaching medical research methodology point out that association is not the same as causality and that even if there is a causal relationship the association alone tells us nothing about the direction of causality?

 

[RedFox]

I'm going to die alone, destitute, and in squalor after decades of intense and unremitting suffering because scientists research this instead of treatments.

 

[Trish]

I think this is a key paragraph from the paper:

In our cohort of patients followed 6–11 months after hospitalization in a tertiary hospital, roughly 60% were physically inactive, which exceeds inactivity estimates of 47% for individuals of similar age observed in a population-based study in Brazil19.

Interestingly, adjusted models suggested that PASC may predispose to physical inactivity, particularly when multiple symptoms are present. We were also able to identify specific symptoms predicting physical inactivity: severe muscle/joint pain, fatigue, post-traumatic stress, insomnia, and dyspnea. Importantly, fatigue and dyspnea remained as significant predictors even after adjusting P-value using a highly conservative approach (i.e., Bonferroni correction).

These results are of relevance as both fatigue and dyspnea are very frequent PASC and, therefore, may increase the odds to physical inactivity and, ultimately, the risk of poor health outcomes. Some caution should be taken when interpreting these findings, as the design of this study does not allow causative inferences, however plausibility does exist to conjecture that these symptoms, especially when combined, may prevent one from achieving the recommended levels of physical activity.

Notes:
These were all people who were hospitalised with Covid, and more than half needed intensive care.
The rate of low physical activity was 60%, compared with 47% in age matched population, so not a huge increase in rate of inactivity.
After correction for multiple comparisons, only fatigue and breathlessness correlated with low physical activity.
The authors admit they can't deduce a direction of causation, then proceed to do so anyway, suggesting in the conclusion that treatment should focus on increasing physical activity.
No record of whether the ones reporting fatigue had PEM.

This study is not free of limitations. The observational cross-sectional design hampers establishing cause-and-effect relationships as previously noted, and it may lead to reverse causation bias (i.e., physically inactive individuals may also be prone to PASC, such as fatigue, muscle/joint pain, dyspnea etc.). Physical activity levels were assessed through a questionnaire and reflect the week prior to follow-up assessments. Moreover, the use of questionnaire to assess physical activity is prone to recall bias and overreporting.

In conclusion, among a cohort of COVID-19 survivors showing a high frequency of PASC 6–11 months following hospitalization, the number and type of PASC was predictive of physical inactivity. The novel data provided by this study warrant further investigations to ascertain which COVID-related organ system pathologies may most significantly contribute to the emergence of physical inactivity and help in the early identification of recovering COVID-19 patients who might benefit from interventions to combat inactivity. Considering the potential impact of this risk factor on overall morbidity and mortality and, hence, health systems, healthcare professionals and policy makers should be concerned about COVID-related physical inactivity.

 

[RedFox]

Physical activity is great and whatnot but we can't claim it's a cure-all. Lifestyle interventions difficult to stick to, and only provide some benefit so need to be combined with medicine.

We know PEM is a common long Covid symptom and one of the few medical reasons not to exercise. Presumably, some fraction of this cohort had PEM and thus wisely limited their activity level. (My gut says PEM is less common in LC from severe Covid compared to mild, but still enough to be a major factor) Unfortunately, the authors completely ignored PEM when drafting this study. They didn't bother to ask about it, they didn't even mention it. So we don't know how many had it.