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. 2025 Sep 30;25(1):3204.
doi: 10.1186/s12889-025-23931-6.

Associations between moderate-to-high physical activity levels and long COVID symptoms, heart rate recovery, cardiorespiratory fitness, sleep quality, and quality of life in patients with long COVID: a cross-sectional study

Yi-Pang Lo  1   2 , Shang-Lin Chiang  3   4 , Chieh-Yi Song  5 , Wen-Chii Tzeng  5   2 , Cheng-Chiang Chang  3   4 , Chia-Huei Lin  6   7   8
Affiliations

Associations between moderate-to-high physical activity levels and long COVID symptoms, heart rate recovery, cardiorespiratory fitness, sleep quality, and quality of life in patients with long COVID: a cross-sectional study

Yi-Pang Lo et al. BMC Public Health. .

Abstract

Background: Moderate-to-high physical activity (PA) levels have been shown to mitigate health complications, improve cardiovascular health, and enhance patient-reported outcomes, such as sleep quality and quality of life (QoL), among patients with chronic diseases. However, little is known about the associations between moderate-to-high PA levels and long COVID symptoms, heart rate recovery, cardiorespiratory fitness, sleep quality, and QoL among patients with long COVID. This study aimed to examine whether moderate-to-high PA levels are associated with more favorable outcomes in terms of long COVID symptoms, heart rate recovery, cardiorespiratory fitness, and QoL, compared to those with low PA levels.

Methods: A cross-sectional study was conducted to recruit patients with long COVID (n = 219) from an integrated outpatient clinic for post-COVID-19 at a medical center in northern Taiwan. Eligible participants were categorized into moderate-to-high and low PA groups. PA levels, sleep quality, and QoL were assessed using the International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, and World Health Organization Quality of Life Questionnaire-short form, respectively. Cardiorespiratory fitness and heart rate recovery were evaluated using cycle ergometer-based graded exercise tests. Multivariate linear and logistic regression models were used to evaluate the associations between PA levels, long COVID symptoms, heart rate recovery, sleep quality, and QoL.

Results: Participants with a mean age of 48.7 years had a mean duration of post-COVID-19 of 12.3 weeks. Patients with moderate-to-high PA levels had a borderline lower risk of shortness of breath (OR = 0.44, p = 0.065), significantly greater VO₂ peak (B = 4.68, p < 0.001) and 2-minute heart rate recovery (B = 3.79, p = 0.049), better sleep quality (B = -1.68, p = 0.007), and higher scores in the physical (B = 0.99, p = 0.023) and psychological (B = 1.11, p = 0.030) domains of QoL, compared to those with lower PA levels.

Conclusions: Maintaining moderate-to-high PA levels among patients with long COVID may be associated with reduced symptom distress, greater cardiorespiratory fitness and heart rate recovery, and better sleep quality, which are in turn linked to better QoL.

Clinical trial number: not applicable.

Keywords: Cardiorespiratory fitness; Long COVID; Physical activity; Quality of life; Sleep quality; Symptoms.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki. Institutional review board approval (TSGHIRB: A202105159) was obtained from the medical center where this study was conducted. All participants provided written informed consent when they were invited to join the study and were assured that their participation was entirely voluntary and that they could withdraw at any time. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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