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https://doi.org/10.18276/cej.2025.1-04

Post-COVID-19 Neuronal Complications and Impact of Physical Activity on the Disease Symptoms: A Narrative Review

Jan 1, 2025
Central European Journal of Sport Sciences and Medicine
Ewa Duchnik +2 more

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The coronavirus disease 2019 (COVID-19) caused a global health crisis, leading to many pathological alternations regarding cells, tissues, organs, and biological systems. Extensive research during the past three years has revealed that even if symptoms of the COVID-19 infection and disease are not severe, the complications after may be critical. Evidence has indicated that apart from the most characteristic complications caused by COVID-19 infection, such as respiratory tract disorders, severe damage to the central and peripheral nervous systems is possible, resulting in neuronal and mental complications. For this reason, the quality of life of severe COVID-19 survivors requires targeting therapy. The most studies focused on a wide spectrum of COVID-19 complications, however, direct evidence of the virus-specific neuropathogenicity and molecular mechanisms involved in this complication are only emerging. We have actual scientific knowledge of post-COVID-19 neurological complications and provide the current evidence on biological mechanisms operating in this process. This review also aims to present how inflammation and oxidative stress may contribute to the disease severity. Finally, we discuss the use of physical exercise (PE) interventions to reduce physical and mental complications in COVID-19 survivors. Findings show that dysregulation of the immune system is characteristic for COVID-19 disease severity. PE can increase muscle strength, respiratory function, decrease dyspnea, and improve survivors’ quality of life. However, randomized controlled trials and observational studies of higher methodological quality are needed to determine effective, individualized and safe amount of exercise to support the evidence.

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COVID-19 and the impact of physical activity on persistent symptoms

Apr 24, 2025
Frontiers in Sports and Active Living
Lauren E Opielinski + 11 more

IntroductionPhysical activity is protective against chronic disease but whether activity is associated with persistent symptoms in non-hospitalized coronavirus disease 2019 (COVID-19) survivors is unknown. The purpose of the study was to determine the impact of the COVID-19 pandemic on physical activity levels and the influence of physical activity on acute COVID-19 and long COVID symptoms in non-hospitalized COVID-19 survivors.MethodsIn total, 64 non-hospitalized COVID-19 survivors (45 female participants, 40 ± 18 years) were assessed for activity levels, body composition, and symptoms of COVID-19 8.5 ± 4.7 months post-infection and categorized into two groups: (1) persistent symptoms and (2) no symptoms at the time of testing. Furthermore, 43 of the 64 participants (28 female participants, 46 ± 18 years) completed a follow-up questionnaire online 51.0 ± 39.7 months (4.25 years) post-infection. A subset of 22 COVID-19 survivors (16 female participants, 35 ± 16 years) were matched for age, sex, and body mass index with healthy controls. Physical activity was quantified using (1) self-reported questionnaire (International Physical Activity Questionnaire; IPAQ-SF) at three time periods; prior to COVID-19 infection, at the time of laboratory testing (8.5 ± 4.7 months after infection), and during an online follow-up (51.0 ± 39.7 months, i.e., 4.25 years after infection); and (2) 7 days of wearing an ActiGraph accelerometer following laboratory testing.ResultsPhysical activity (IPAQ-SF) declined in COVID-19 survivors from pre-COVID-19 infection to 8.5 ± 4.7 months after infection [3,656 vs. 2,656 metabolic equivalent of task (MET) min/week, 27% decrease, p < 0.001, n = 64] and rebounded to levels similar to pre-COVID-19 infection at 4.25 years after infection (p = 0.068, n = 43). Activity levels quantified with accelerometry did not differ between COVID-19 survivors and controls. However, COVID-19 survivors who reported persistent symptoms 8.5 months after infection (n = 29) engaged in less moderate-vigorous physical activity and steps/day than those without persistent symptoms (n = 27) (37 vs. 49 MET min/day, p = 0.014 and 7,915 vs. 9,540 steps/day, p = 0.014).DiscussionBoth COVID-19 survivors and matched controls reported reductions in physical activity indicating that lower levels of activity were likely due to the pandemic rather than COVID-19 infection alone. However, those who were most affected by COVID-19 infection with persistent symptoms had the greatest reductions in physical activity, even at ∼8 months and ∼4 years post-infection.