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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.
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1 University of Sao Paulo, Applied Physiology and Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, School of Medicine FMUSP, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722); Universidade de Sao Paulo, Rheumatology Division, Faculdade de Medicina FMUSP Hospital das Clinicas HCFMUSP, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)
2 Faculdade de Medicina da Universidade de São Paulo, Diretoria Executiva dos LIMs, Sao Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)
3 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, Departamento e Instituto de Psiquiatria, São Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036)
4 University of São Paulo, Otorrhinolaringoly Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)
5 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Medicina Física e de Reabilitação, São Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036)
6 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, São Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036); Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Laboratório de Genética e Hematologia Molecular, São Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036)
7 Faculdade de Medicina da Universidade de São Paulo, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722); Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Departamento de Clínica Médica, Laboratório de Imunologia Clínica e Alergia, São Paulo, Brazil (GRID:grid.411074.7) (ISNI:0000 0001 2297 2036)
8 Faculdade de Medicina da Universidade de São Paulo, Departamento de Cardio-Pneumologia, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)
9 University of Sao Paulo, Faculdade de Medicina da Universidade de São Paulo, School of Medicine, São Paulo, Brazil (GRID:grid.11899.38) (ISNI:0000 0004 1937 0722)