Adherence to Healthy Lifestyle Prior to Infection and Risk of Post–COVID-19 Condition

Abstract

ImportanceFew modifiable risk factors for post–COVID-19 condition (PCC) have been identified.ObjectiveTo investigate the association between healthy lifestyle factors prior to SARS-CoV-2 infection and risk of PCC.Design, Setting, and ParticipantsIn this prospective cohort study, 32 249 women in the Nurses’ Health Study II cohort reported preinfection lifestyle habits in 2015 and 2017. Healthy lifestyle factors included healthy body mass index (BMI, 18.5-24.9; calculated as weight in kilograms divided by height in meters squared), never smoking, at least 150 minutes per week of moderate to vigorous physical activity, moderate alcohol intake (5 to 15 g/d), high diet quality (upper 40% of Alternate Healthy Eating Index–2010 score), and adequate sleep (7 to 9 h/d).Main Outcomes and MeasuresSARS-CoV-2 infection (confirmed by test) and PCC (at least 4 weeks of symptoms) were self-reported on 7 periodic surveys administered from April 2020 to November 2021. Among participants with SARS-CoV-2 infection, the relative risk (RR) of PCC in association with the number of healthy lifestyle factors (0 to 6) was estimated using Poisson regression and adjusting for demographic factors and comorbidities.ResultsA total of 1981 women with a positive SARS-CoV-2 test over 19 months of follow-up were documented. Among those participants, mean age was 64.7 years (SD, 4.6; range, 55-75); 97.4% (n = 1929) were White; and 42.8% (n = 848) were active health care workers. Among these, 871 (44.0%) developed PCC. Healthy lifestyle was associated with lower risk of PCC in a dose-dependent manner. Compared with women without any healthy lifestyle factors, those with 5 to 6 had 49% lower risk (RR, 0.51; 95% CI, 0.33-0.78) of PCC. In a model mutually adjusted for all lifestyle factors, BMI and sleep were independently associated with risk of PCC (BMI, 18.5-24.9 vs others, RR, 0.85; 95% CI, 0.73-1.00, P = .046; sleep, 7-9 h/d vs others, RR, 0.83; 95% CI, 0.72-0.95, P = .008). If these associations were causal, 36.0% of PCC cases would have been prevented if all participants had 5 to 6 healthy lifestyle factors (population attributable risk percentage, 36.0%; 95% CI, 14.1%-52.7%). Results were comparable when PCC was defined as symptoms of at least 2-month duration or having ongoing symptoms at the time of PCC assessment.Conclusions and RelevanceIn this prospective cohort study, pre-infection healthy lifestyle was associated with a substantially lower risk of PCC. Future research should investigate whether lifestyle interventions may reduce risk of developing PCC or mitigate symptoms among individuals with PCC or possibly other postinfection syndromes.

Poor sleep quality, insomnia, and short sleep duration before infection predict long-term symptoms after COVID-19

“…Our results were consistent with a recent study on a sample of female nurses that found an association between short sleep duration collected in 2017 and the occurrence of post-COVID-19 conditions. 44…”

Effect of Physical Exercise–Based Rehabilitation on Long COVID: A Systematic Review and Meta-analysis

“…Moreover, physical exercise-based rehabilitation resulted in limited adverse effects during routine clinical practice for some individuals who had had COVID-19. A major adverse event (i.e., increased dyspnea and exhaustion after training) was only reported during the first week of in-person training by a person who had been admitted to the intensive care unit during COVID-19 (59), whereas minor adverse events were observed in a small number of studies (51,59,61). Overall, physical exercise-based rehabilitation is generally considered safe and effective for individuals with long COVID; however, the severity of illness experienced by the patient during the infection should be seriously considered before the implementation of physical exercise-based rehabilitation.…”

Long COVID: Clinical characteristics, proposed pathogenesis and potential therapeutic targets

“…Given the lack of evidence-based treatments, prevention of long COVID is a key to reducing the overall burden of this condition. Both vaccination against SARS-CoV-2 and certain modifiable lifestyle factors are associated with lower risk of long COVID-19 ( Wang et al, 2023 ), and there is evidence that acute treatments including antivirals and metformin may be of benefit ( Carfì et al, 2020 ; Xu et al, 2020 ).…”