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We analyzed the baseline data of the Sulcovid-19, a longitudinal study that monitors the health indicators of individuals infected with COVID-19 in the city of Rio Grande, Rio Grande do Sul, Brazil. Participants should be 18 or older, have received a COVID-19 diagnosis through RT-PCR testing between December 2020 and March 2021, experienced COVID-19 symptoms, and have received medical care in Rio Grande. The Health Research Ethics Committee (CEPAS) of the Federal University of Rio Grande (FURG) (CAAE:39081120.0.0000.5324) approved the study protocol.
To identify adults who had been infected with SARS-CoV-2 contact was established with the Epidemiological Health Surveillance department of the Rio Grande. Subsequently, a list was compiled, consisting of 4,014 individuals who had tested positive for SARS-CoV-2 through RT-PCR, along with their corresponding information such as name, address, telephone number, and presence of symptoms. Following the creation of this list, inclusion and exclusion criteria were applied, resulting in 3,822 individuals being deemed eligible for the study. More information can be found in Flowchart 1 in the supplementary file.
Data collection was conducted through telephone interviews carried out by trained interviewers who underwent a rigorous selection process and received comprehensive training and qualification. The questionnaire used can be verified in the supplementary file. When necessary, home visits were offered as an alternative for face-to-face data collection. Further information regarding the study design and recruitment process can be found elsewhere [10].
We investigated a total of 19 symptoms commonly associated with Long COVID. These symptoms included headache, dyspnea (shortness of breath), dry cough, cough with phlegm, pain or discomfort when breathing, ageusia (loss of taste), anosmia (loss of smell), change in sensation (such as numbness, tingling, needling, pressure, cold/heat), fatigue, sore throat, coryza (runny nose), nasal congestion, diarrhea, nausea, arthralgia (joint pain), myalgia (muscle pain), memory loss, attention loss and alteration of the skin.
To assess Long COVID symptoms, participants were asked if they had experienced any of these symptoms after their SARS-CoV-2 infection and whether they were still experiencing them at the time of the survey. We considered a Long COVID symptom when the participant answered “yes” to both questions. Each of the 19 symptoms was analyzed as an individual outcome, and a composite variable for Long COVID was created if at least one of the symptoms was reported.
Furthermore, we categorized the symptoms into groups based on the affected body systems. These groupings included digestive symptoms (nausea and/or vomiting), musculoskeletal symptoms (muscle pain, joint pain, and/or fatigue), neurological symptoms (headache, memory loss, and/or loss of attention), respiratory symptoms (shortness of breath, dry cough, cough with phlegm, pain or discomfort in breathing, coryza, and/or nasal congestion), and sensory symptoms (ageusia, anosmia, and/or altered sensitivity). This categorization allowed for a more comprehensive analysis of the specific systems impacted by Long COVID.
We further grouped the symptoms into four broader categories, as follows: (1) musculoskeletal, neurological, and/or respiratory; (2) musculoskeletal and/or neurological; (3) musculoskeletal and/or respiratory; and (4) neurological and/or respiratory. These categories were treated as dichotomous variables, indicating whether the participant experienced at least one symptom or not.
PA was assessed based on participants self-reported frequency (days per week) and duration (time per day). Firstly, participants were asked about their PA practice in the 12 months before their SARS-CoV-2 infection. Secondly, they were asked about their PA after their infection. Those who engaged in 150 min/week or more of PA were considered active, following the WHO guidelines [11]. The independent variable was operationalized into three categories considering both timepoints, as follows: (1) remained inactive, (2) became inactive, and (3) remained active. The category “became active” was excluded due to the small number of participants (n = 14) [12].
To control for confounding the following variables were used: sex (male/female), age (18–59 years/60 years or more), income (R$ 0-1000/1001–2000/2001–4000/4001 or more in Brazilian Real), body mass index (BMI) [13] (eutrophic/low weight; overweight/obese), self-reported medical diagnosis of comorbidity (depression, hypertension, diabetes mellitus, heart problems, renal failure, respiratory problems – asthma, chronic obstructive pulmonary disease, osteoporosis, arthritis, arthrosis, or rheumatism), and hospitalization (no/yes).
All analyses were performed in Stata® 15.0. Descriptive data were presented as proportions along with their corresponding 95% confidence intervals (95%CI). We used Poisson regression to investigate the relationship between Long COVID symptoms and PA. Adjusted analyses were performed by Poisson regression with robust variance adjustment. Associations were considered statically significant when the 95% CIs did not overlap between categories.
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