October 3, 2025Open Access

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

YLYi-Pang LoTri-Service General Hospital Songshan Branch SCShang-Lin ChiangTri-Service General Hospital CSChieh-Yi SongNational Defense Medical Center

Key Points

Participants with moderate-to-high physical activity levels experienced better sleep quality and improved quality of life.
Data analysis revealed significant differences in heart rate recovery, with moderate-to-high activity linked to increased VO₂ peak and 2-minute recovery.
The study employed multivariate regression models to explore relationships between activity levels and long COVID symptoms.
Maintaining higher physical activity appears essential for enhancing physical and psychological health outcomes following COVID-19.

Abstract

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. 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. 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. 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. not applicable.

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