Presence of chronic symptomatic disease in addition to PCC, fatigue, functional capacity, and educational attainment were identified as factors of physical activity in adults with post-COVID-19 condition.
Key Findings
Results
Adults with post-COVID-19 condition demonstrated low overall physical activity as measured by accelerometry.
141 participants with valid PA data were included (76.6% female, age range 18-80 years)
Median ENMO was 9.03 [IQR: 7.2-11.2], described as 'indicating low overall PA'
Median time in moderate PA was 45.9 [IQR: 32.1-61.2] minutes per day
Median time in vigorous PA was 0.16 [IQR: 0.04-0.6] minutes per day
PA was measured with ActiGraph wGT3X-BT accelerometers over eight consecutive days
Results
Chronic symptomatic disease other than PCC was associated with lower mean physical activity (ENMO) in participants with post-COVID-19 condition.
β = -1.77 (95% CI = -2.93 to -0.61) for chronic symptomatic disease other than PCC
This association was identified in multivariable linear regression models adjusted for pre-defined covariates
The negative beta coefficient indicates reduced mean ENMO associated with comorbid chronic symptomatic disease
Results
Higher fatigue levels were associated with lower mean physical activity (ENMO) in post-COVID-19 condition participants.
β = 0.09 (95% CI = 0.02 to 0.16) for fatigue associated with lower mean ENMO
Fatigue was identified as a significant factor in multivariable linear regression models
Fatigue is noted as a factor potentially relevant for development of therapeutic strategies to support physical activity
Results
Higher functional capacity was associated with higher mean physical activity and a more favourable intensity gradient in post-COVID-19 condition.
β = 0.14 (95% CI = 0.05 to 0.24) for functional capacity associated with higher mean ENMO
Higher functional capacity was also associated with a more favourable intensity gradient in regression models
Functional capacity was identified as a factor in both the primary outcome (ENMO) and secondary outcome (intensity gradient) analyses
Results
Higher educational attainment was associated with a more favourable physical activity intensity gradient in post-COVID-19 condition.
Higher education was associated with a more favourable intensity gradient in multivariable regression models
Educational attainment was identified as a factor of PA specifically for the secondary outcome (intensity gradient), not the primary outcome (ENMO)
Educational attainment was identified as one of four key factors of PA in this population
Methods
The study was a cross-sectional analysis of baseline data from a randomised-controlled trial, limiting causal inference.
153 participants were enrolled; 141 had valid PA data and were included in analysis
PA was assessed using the primary outcome of mean 24-hour ENMO and secondary outcome of intensity gradient
Authors explicitly stated 'causal relationships cannot be inferred from the present study'
Multivariable linear regression models were adjusted for pre-defined covariates
What This Means
This research studied how physically active people with post-COVID-19 condition (also called long COVID) are, and what factors are linked to their activity levels. Using wrist-worn accelerometers worn for eight days, researchers measured the actual movement of 141 adults with long COVID. They found that these individuals had low overall physical activity levels — spending very little time in vigorous exercise (about 10 seconds per day at the median) and a modest amount in moderate activity (under an hour per day at the median).
The study found four key factors associated with physical activity levels in this group. Having an additional chronic illness on top of long COVID was linked to being less active. Higher fatigue was also linked to lower physical activity. On the positive side, better functional capacity (the ability to perform daily tasks) was linked to being more active overall and having a healthier pattern of activity intensity. Higher education was also associated with a healthier pattern of activity intensity, though not with overall activity levels.
This research suggests that when designing programs to help people with long COVID become more physically active, factors like coexisting chronic illnesses, fatigue, and functional capacity may be important to consider. However, because this was a cross-sectional study (a snapshot in time rather than tracking people over time), the researchers caution that these associations do not necessarily mean one factor causes another — for example, it is unclear whether fatigue reduces activity or whether inactivity worsens fatigue.
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Kopp J, Spies Rodriguez D, Künzi L, Puhan M, Fehr J, Radtke T. (2026). Physical activity in post-COVID-19 condition: A cross-sectional study.. PloS one. https://doi.org/10.1371/journal.pone.0357465