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

Background: A growing body of evidence suggests that coronavirus disease 2019 (COVID-19) survivors could experience COVID-19 sequelae. Although a wide range of risk factors for COVID-19 sequelae have been identified, little is known about whether sedentary lifestyle is an independent risk factor.Methods: In this retrospective cohort study, 4,850 enrolled participants self-reported symptoms of COVID-19 sequelae between June 2022 and August 2022. Sedentary lifestyle, including physical inactivity (PIA) and sedentary behavior (SB), before the wave was recorded. Logistic regression analysis was performed to determine the relationships between sedentary lifestyle and the risk of acute and post-acute (lasting ≥ 2 months) COVID-19 sequelae.Findings: A total of 1,443 COVID-19 survivors and 2,962 non-COVID-19 controls were included. More than 80% and 40% of COVID-19 survivors self-reported acute and post-acute COVID-19 sequelae, respectively. In the post-acute phase, COVID-19 survivors with PIA (< 150 min moderate-vigorous physical activity [MVPA]/week) had a 37% lower risk of insomnia, whereas those with prolonged SB (≥ 10 h/day) had 25%, 67%, and 117% higher risks of at least one symptom, dizziness, and “pins and needles” sensation, respectively. PIA was correlated with a higher risk of at least one symptom and a lower risk of dyspnea and muscle pain, whereas SB was associated with a higher risk of at least one symptom, fatigue, “brain fog”, dyspnea, muscle pain, joint pain, dizziness, and “pins and needles” sensation in the acute phase of the disease. Notably, SB but not PIA was correlated with a higher risk of severe post-COVID-19 sequelae in both the acute and post-acute phases.Interpretation: Prolonged SB was independently associated with a higher risk of both acute and post-acute COVID-19 sequelae, whereas PIA played contradictory roles in COVID-19 sequelae. Further studies should focus on interventions targeting SB when developing preventative strategies against COVID-19 sequelae.Funding: This work was supported by the Research Grants Council (RGC) General Research Fund (GRF), Hong Kong [14608521]; and University Grants Committee, The Chinese University of Hong Kong, Hong Kong [3110155]. Z.C. was supported by the Research Fellowship Scheme, The Chinese University of Hong Kong.Declaration of Interest: All authors declare no related conflict of interest in this paper.Ethical Approval: This study was approved by the Survey and Behavioral Research Ethics Committee, The Chinese University of Hong Kong (SBRE-21-0762).