Relationship between post-COVID-19 symptoms and daily physical activity, 2025, Sarmento

[Dolphin]

Frontiers | Relationship between post-COVID-19 symptoms and daily physical activity

BackgroundExertion-intolerant symptoms common in post-COVID-19 syndrome (PCS), often resembling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), ...

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ORIGINAL RESEARCH article

Front. Rehabil. Sci., 15 September 2025

Sec. Interventions for Rehabilitation

Volume 6 - 2025 | https://doi.org/10.3389/fresc.2025.1646093
This article is part of the Research TopicPost-Acute COVID RehabilitationView all 12 articles

Relationship between post-COVID-19 symptoms and daily physical activity​

Antonio Sarmento1

Sandra Webber2

Shelley Sargent3

Brenda Tittlemier3Diana C. Sanchez-Ramirez1*

• 1Department of Respiratory Therapy, University of Manitoba, Winnipeg, MB, Canada
• 2Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
• 3Rehabilitation Physiotherapy Department, Health Sciences Centre, Winnipeg, MB, Canada

Background: Exertion-intolerant symptoms common in post-COVID-19 syndrome (PCS), often resembling myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), challenge conventional rehabilitation and highlight the need for research into the poorly understood relationship between PCS symptoms and physical activity.

Objectives: We aimed to investigate the longitudinal associations between PCS symptoms and physical activity (same and following day), while accounting for the presence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) symptoms. Additionally, to compare the characteristics and outcomes of PCS patients with and without ME/CFS symptoms.

Methods: Adults with PCS participated in an in-person evaluation that included assessment of dyspnea (Borg scale), fatigue (Fatigue Severity Scale), ME/CFS symptoms screening (DePaul Symptom Questionnaire), and functional capacity. Participants were also instructed to complete a daily PCS symptoms survey and wear a smartwatch for a week to track daily physical activity (step count).

Results: Eighteen individuals with PCS (78% females, 51 ± 11 years) participated in the study, averaging 4,067 steps per day (95%CI 3,638–4,497) over 117 days of valid data. Individuals with ME/CFS symptoms (n = 11) reported more severe PCS symptoms and had lower functional capacity than those without ME/CFS symptoms. After adjusting for ME/CFS symptoms, greater dizziness was associated with fewer steps on the same [OR 0.94 (95%CI 0.88–0.99), p = 0.026] and following day [OR 0.91 (95%CI 0.84–0.98), p = 0.016]. Lower levels of fatigue [OR 0.69 (95%CI 0.49–0.99), p = 0.043] and chest pain [OR 0.76 (95%CI 0.57–0.99), p = 0.048] were associated with walking ≥5,000 steps on the previous day.

Conclusion: Regardless of the presence of ME/CFS symptoms, dizziness was negatively associated with physical activity on both the same and following day in PCS individuals. Additionally, lower levels of fatigue and chest pain were linked to walking 5,000 steps or more the previous day.

Impact: These results provide insights into the relationships between symptoms and daily physical activity in PCS, which can help tailor interventions and improve the management of this condition. This research also highlights the value of using wearable devices and smartphone apps to collect data for monitoring individuals with PCS over time.

 

[Utsikt]

Impact: These results provide insights into the relationships between symptoms and daily physical activity in PCS,

Insights is a very generous word for tracking a few patients over a short amount of time.

which can help tailor interventions and improve the management of this condition.

There is nothing in this research than can be used to inform interventions or management strategies.

This research also highlights the value of using wearable devices and smartphone apps to collect data for monitoring individuals with PCS over time.

Again, they are very generous with themselves. There is no need for yet another proof of concept of things that have been done hundreds if not thousands of tim already.

 

[Jonathan Edwards]

This looks like a good sort of study to do but judging by the abstract it may not have been done well enough to be any use.

 

[Utsikt]

This looks like a good sort of study to do but judging by the abstract it may not have been done well enough to be any use.

They could just copy Fluge and Mella’s setup for Dara P2, and add some kind of body position monitor.

 

[Trish]

People in the study doing over 5000 steps a day are also less symptomatic. Someone should tell them correlation doesn't imply causation, yet they have interpreted this as meaning pwLC should by subjected to rehab programs taking them 5000 steps per day.

They don't give any thought to the possiblity that it's the other way around - people who are sicker are less able to exercise. They talk about adjusting their data to take into account existence of ME/CFS but don't say how they do it.

 

[Kitty]

Additionally, lower levels of fatigue and chest pain were linked to walking 5,000 steps or more the previous day.

How do you even qualify to enter a study on an ME/CFS-like syndrome if you can walk 5,000 steps, let alone if you feel better the next day? They sound like they ought to be the exclusion criteria.

Dizziness can be a problem if it's present, but it's hardly the main concern of most people with ME/CFS symptoms.

 

[rvallee]

Additionally, lower levels of fatigue and chest pain were linked to walking 5,000 steps or more the previous day.

The total lack of valid reasoning just screws with my head. They always take obvious associations and work them backward. It's never less symptoms that allow for more functioning, no, it must always be more functioning reducing the symptoms. Always the less likely direction of causality. Every. Single. Time. They claim a bidirectional relationship, but are essentially wearing polarized lenses that only allow them to see light from one direction. The one they want it to come from.

ME/CFS patients had an average of 3700 steps per day, compared to 4600. Those are the very mildest end, although the 6 minute walking test is more revealing: 268 vs 437, which suggests that those with mild ME/CFS are pushing themselves too much.

Anyway, I don't see how this is useful. Almost none of the LC studies so far even had the possibility of being useful, there is absolutely nothing actionable, not even an insight that wasn't known for years. It's so damn awful across the board.

 

[rvallee]

How do you even qualify to enter a study on an ME/CFS-like syndrome if you can walk 5,000 steps, let alone if you feel better the next day? They sound like they ought to be the exclusion criteria.

Dizziness can be a problem if it's present, but it's hardly the main concern of most people with ME/CFS symptoms.

There's also something odd about this in that the non-ME/CFS participants averaged less than this 5K threshold, which it could be argued indicates less illness burden, and nothing else. About the cutoff to healthy functioning. As long as one applies common sense and some reasoning to understand that the smoke doesn't start the fire, and capturing the smoke won't put out the fire either.

So far all the garbage-tier research in LC has done is confirm that patient reports have been reliable and accurate, that most of the imprecision derives from the nature of the problem, in a similar way as weather being unpredictable is normal and expected because it's a highly dynamic system, but the profession is completely unable to work the implications of this, would rather keep on tweaking the elaborate fantasies they constructed about why we are "ill without illness".