Relationship Between Post-COVID-19 Symptoms and Daily Physical Activity

Antonio Sarmento¹Sandra Webber²Shelley Sargent³Brenda Tittlemier³Diana C. Sanchez-Ramirez^1*

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

Background: Exertion-intolerant symptoms common in 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 post-COVID-19 syndrome (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 to 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 to 0.99], p=0.026) and following day (OR 0.91 [95%CI 0.84 to 0.98], p=0.016). Lower levels of fatigue (OR 0.69 [95%CI 0.49 to 0.99], p=0.043) and chest pain (OR 0.76 [95%CI 0.57 to 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.