People with long COVID often report fatigue and other symptoms that make it challenging for them to enjoy life like they once did.
A study published recently in JACC: Advances found that people with more long-COVID symptoms are less active and have poorer cardiovascular health measures. But more investigation is needed to understand the relationship between activity levels and cardiovascular disease (CVD) for those with long COVID.
The results “demonstrate associations between a high burden of persistent long COVID symptoms and objective indicators of impaired cardiopulmonary fitness,” wrote the US researchers. “Additional research, including those employing longitudinal designs, is needed to determine if long COVID at least six months after SARS-CoV-2 infection is a novel risk factor for cardiopulmonary disease.”
‘Significantly lower’ heart rate variability and higher resting heart rate
The scientists examined wearable activity tracker data for six months from 1,475 participants who were enrolled in the Researching COVID-19 to Enhance Recovery Adult Cohort Study (RECOVER) to evaluate certain measures of cardiovascular health, such as heart rate variability, resting heart rate, heart rate while exercising, activity level, and step count.
Previous research looked at wearable data in patients about six months post-COVID infection. For this study, the team examined data from patients at an average of 21 months after infection to understand the longer-term impact of long COVID on cardiopulmonary fitness.
Longitudinal analyses of physical activity with long-term follow-up are needed to evaluate whether the indicators of cardiovascular fitness and decreases in physical activity translate into an increased risk of cardiovascular disease.
Most participants were female (76%), White (65%), overweight or obese (70%), and had low symptom burden (66%) as defined by the 2024 Long COVID Research Index (LCRI).
Those with a greater symptom burden (34%) took fewer steps daily, spent less time being active, and engaged in more sedentary behavior than those with fewer symptoms. People with more symptoms also experienced “significantly lower” heart rate variability (HRV) and elevated resting heart rates. Having lower HRV and a higher resting heart rate has been linked to CVD and even death.
“In the Long COVID population, prior studies suggest that reduced cardiopulmonary fitness and decreased physical activity reflects a combination of limited exercise capacity and intentional pacing to reduce the risk of postexertional malaise, rather than a lack of motivation or interest in exercise,” the authors wrote.
“Our wearable sensor data cannot definitely disentangle the effects of physiologic impairment (eg, ventilatory, circulatory, and neuromuscular limitations) vs intentional effort restriction on the cardiopulmonary fitness among participants.”
Past research has identified a connection between long COVID and CVD. An analysis published in June in the journal Clinical Medicine Insights: Cardiology found 11.9% of patients with long COVID experienced CVD, while 6.8% of people without long COVID had it. A study from Sweden published earlier this year also showed an association between having a long-COVID diagnosis and experiencing a cardiovascular event, such as cardiac arrhythmias (abnormal heartbeat) and coronary artery disease.
The authors of this most recent study urge more investigation into the relationship between activity levels and CVD.
“Longitudinal analyses of physical activity with long-term follow-up are needed to evaluate whether the indicators of cardiovascular fitness and decreases in physical activity translate into an increased risk of cardiovascular disease,” they wrote.
