Association of Sedentary Lifestyle with Risk of Acute and Post-Acute COVID-19 Sequelae: A Retrospective Cohort Study

Chen Zheng; Wendy Ya-Jun Huang; Feng-Hua Sun; Martin Chi-Sang Wong; Parco Ming-Fai Siu; Xiang-Ke Chen; Stephen Heung-Sang Wong

doi:10.1016/j.amjmed.2023.12.002

Association of Sedentary Lifestyle with Risk of Acute and Post-Acute COVID-19 Sequelae: A Retrospective Cohort Study

Am J Med. 2023 Dec 17:S0002-9343(23)00757-X. doi: 10.1016/j.amjmed.2023.12.002. Online ahead of print.

Authors

Chen Zheng¹, Wendy Ya-Jun Huang², Feng-Hua Sun³, Martin Chi-Sang Wong⁴, Parco Ming-Fai Siu⁵, Xiang-Ke Chen⁶, Stephen Heung-Sang Wong⁷

Affiliations

¹ Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China; Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Tai Po, Hong Kong, China.
² Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
³ Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Tai Po, Hong Kong, China.
⁴ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
⁵ Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
⁶ Division of Life Science, School of Science, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China. Electronic address: xkchen@ust.hk.
⁷ Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China.

PMID: 38110069
DOI: 10.1016/j.amjmed.2023.12.002

Abstract

Background: Evidence suggests that coronavirus disease 2019 (COVID-19) survivors could experience COVID-19 sequelae. Although various risk factors for COVID-19 sequelae have been identified, little is known about whether a sedentary lifestyle is an independent risk factor.

Methods: In this retrospective cohort study, 4850 participants self-reported their COVID-19 sequelae symptoms between June and August 2022. A sedentary lifestyle included physical inactivity (<150 min/week of moderate-to-vigorous intensity physical activity) and prolonged sedentary behavior (≥10 h/day) before the fifth COVID-19 wave was recorded. Logistic regression analysis was performed to determine the relationships between sedentary lifestyle and risk of acute and post-acute (lasting ≥2 months) COVID-19 sequelae.

Results: A total of 1443 COVID-19 survivors and 2962 non-COVID-19 controls were included. Of the COVID-19 survivors, >80% and >40% self-reported acute and post-acute COVID-19 sequelae, respectively. In the post-acute phase, COVID-19 survivors who were physically inactive had a 37% lower risk of insomnia, whereas those with prolonged sedentary behavior had 25%, 67%, and 117% higher risks of at least one symptom, dizziness, and "pins and needles" sensation, respectively. For the acute phase, prolonged sedentary behavior was associated with a higher risk of fatigue, "brain fog," dyspnea, muscle pain, joint pain, dizziness, and "pins and needles" sensation. Notably, sedentary behavior, rather than physical inactivity, was correlated with a higher risk of severe post-COVID-19 sequelae in both acute and post-acute phases.

Conclusions: Prolonged sedentary behavior was independently associated with a higher risk of both acute and post-acute COVID-19 sequelae, whereas physical inactivity played contradictory roles in COVID-19 sequelae.

Keywords: COVID-19 sequelae; Long COVID; Omicron variant; Physical inactivity; Post-COVID conditions; Sedentary behaviors; Sedentary lifestyle.