COVID-19 survivors are physically inactive with high levels of sedentary time, regardless of patient characteristics, disease severity or cardiac dysfunction
Authors: Van Bakel BMA , Van Den Heuvel FMA , Vos JL , Rotbi H , Bakker EA , Nijveldt R , Thijssen DHJ , Eijsvogels TMH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation

Background
More than 250 million cases of the coronavirus disease-2019 (COVID-19) infection were confirmed across the globe since 2020, leading to a substantial number of COVID-19 related hospital admissions. Many COVID-19 survivors experience long-term health consequences, but data on physical activity patterns and the impact on recovery post-infection are scarce.

Purpose
This study aimed to objectively assess physical (in)activity patterns among COVID-19 survivors and to explore the association with patient characteristics, disease severity and cardiac dysfunction. We hypothesized that COVID-19 survivors will demonstrate low volumes of physical activity and a high sedentary time, especially those with a more severe disease course (e.g. longer hospital duration; admission to intensive care), cardiac dysfunction, and persistent symptoms at 3-6 months post-discharge.

Methods
In this cross-sectional cohort study, we objectively assessed physical activity, sedentary behaviour and sleep duration for 24 hrs/day during 8 subsequent days in COVID-19 survivors at 3-6 months post-hospitalisation. Activity patterns were compared across pre-defined subgroups based on patient- and disease characteristics, cardiac biomarker release during hospitalisation, abnormal transthoracic echocardiogram regarding left- and right ventricular function and volumes at 3-6 months of follow-up, and persistence of symptoms post-discharge.

Results
Physical activity patterns were assessed in 37 patients (60±10 years old; 78% male) at 125 [116; 132] days after discharge. Patients spent 4.2 [3.2; 5.3] hrs/day in light-intensity physical activity and 1.0 [0.8; 1.4] hrs/day in moderate-to-vigorous intensity physical activity. Median sleep duration was 8.6 [8.2; 9.1] hrs/day. Time spent sitting was 9.8 [8.7; 11.2] hrs/day, which was accumulated in 6.0 [4.7; 6.9] prolonged sitting bouts (≥30 min) and 41.4 [31.5; 48.1] short sitting bouts (&lt;30 min, Central Figure). No differences in activity patterns were found across subgroups, but sleep duration was slightly higher in women versus men (9.2 vs 8.5 hrs/day, p=0.03) and patients with versus without persistent symptoms (9.1 vs 8.3 hrs/day, p=0.02).

Conclusions
COVID-19 survivors are physically inactive for most of their time at 3-6 months post-hospitalisation. Physical (in)activity patterns are not impacted by patient- nor disease characteristics, underlining the need for a uniform approach for re-activation of COVID-19 survivors.
Central Figure.
A: objectively measured light-intensity physical activity (LIPA), moderate-to-vigorous intensity physical activity (MVPA), sleep duration and sedentary time in COVID-19 patients at 3-6 months post-hospitalisation (median and interquartile range).
B: sitting bout frequency (mean + standard deviation).