Associations Of Long Covid With Aerobic And Muscle-strengthening Physical Activity: The Role Of ME And Fatigue

PURPOSE: Individuals with long COVID report low levels of aerobic physical activity (PA). Long COVID, however, is highly comorbid with myalgic encephalomyetlitis (ME), a condition with a primary symptom of long-term fatigue and low levels of PA. Thus, it is unclear whether long COVID is associated with aerobic PA independent of ME and fatigue. Conversely, muscle-strengthening (MS) PA may be an alternate form of PA, however it is unknown whether long COVID and fatigue impact engagement in MS PA. This study examined the association between long COVID and meeting the aerobic and MS PA guidelines after accounting for ME and fatigue in a nationally representative sample. METHODS: This study utilized data from the 2022 National Health Interview Survey (NHIS) [weighted N = 255,371,962; 48.1 (SD = 18.4) yrs, 51.3% female]. Binomial logistic regression models assessed the association between self-report long COVID and the odds of meeting aerobic and MS PA guidelines while adjusting for: 1) sociodemographic and health variables; 2) ME status (ME/no ME); and 3) fatigue [fatigued (tired most days/every day); not fatigued (never tired/some days tired)]. Weighting and variance estimation variables were utilized. RESULTS: Long COVID was reported in 4.5% of participants (weighted N = 11,505,644). The proportions of individuals with long COVID meeting the aerobic (40.0%) and MS (28.1%) PA guidelines were lower than individuals without long COVID (45.5%; 29.3% respectively). Long COVID was significantly associated with lower odds of meeting the aerobic PA guidelines after accounting for sociodemographic and health factors (OR = 0.84; 95% CI: 0.74 - 0.96) and ME status (OR = 0.86; 95% CI: 0.75 - 0.97), but not after accounting for fatigue (OR = 0.90; 95% CI: 0.79 - 1.02). Long COVID was not significantly associated with meeting the MS (ps > 0.05) PA guidelines. CONCLUSION: Long COVID is associated with lower odds of meeting aerobic PA guidelines; however, the association is attenuated by fatigue. Long COVID does not appear to be significantly associated with MS PA guidelines. Future studies investigating symptomatic responses to aerobic and MS PA may help tailor exercise recommendations for individuals with long COVID and prominent fatigue.