Physical Activity, Vaccination May Protect Against Long COVID

Adults who were female, did not meet the Physical Activity Guidelines (PAG) for Americans, were not fully vaccinated, or had certain noncommunicable diseases were more likely to report long COVID, according to a recent study published in Frontiers in Public Health.¹

During the COVID-19 pandemic, 12% to 20% of US adults were diagnosed with long COVID, defined as developing symptoms that persisted for 3 months or longer after initial COVID-19 infection. Globally, an estimated 65 million individuals have experienced long COVID, although the actual number is likely much higher due to undocumented infections.

The researchers hypothesized that adults who did not meet the 2018 PAG for aerobic and strengthening activities, were not fully vaccinated, or had certain noncommunicable diseases would have higher odds of reporting long COVID. To test this, they analyzed data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), a nationwide phone-based survey administered annually that collects information on behavioral risk factors, preventive practice behaviors, chronic disease prevalence, and demographics.²

Initially, the researchers conducted univariate analyses of behavioral risk factors and multiple noncommunicable diseases.¹ After controlling for demographic variables, they performed logistic regression analyses to compare long COVID outcomes with exposure variables, including not meeting PAGs, incomplete COVID-19 vaccination, or having the noncommunicable diseases of overweight/obesity, asthma, coronary heart disease, or hypertension.

The study used data from the 2023 BRFSS survey, which included over 433,000 respondents.³ Of these, 46.4% (n = 201,248) reported testing positive for COVID-19, and 13.6% (n = 27,074) reported long COVID. Most adults with COVID-19 (n = 135,179) and long COVID (n = 19,254) were between the ages of 18 and 64. Also, the majority of both the COVID-19 (n = 127,127) and long COVID (n = 19,440) groups consisted of White patients.

Adults not meeting PAGs (n = 13,449; 12.2%) for aerobic (OR, 1.19; 95% CI, 1.0-1.33; P < .0001) or strengthening (OR, 1.02; 95% CI, 1.00-1.03; P < .001) activities had higher odds of reporting long COVID. Similarly, those not fully vaccinated (3 or fewer doses) were more likely to report long COVID (OR, 1.42; 95% CI, 1.24-1.49; P < .0001) compared with fully vaccinated individuals (4 or more doses).

Among noncommunicable diseases, current asthma, hypertension, coronary heart disease, and overweight/obesity were all significantly associated with long COVID. Of these, coronary heart disease demonstrated the strongest association (OR, 2.02; 95% CI, 1.82-2.24). Of adults with long COVID, 21% reported significant limitations in daily activities, 38% reported some limitations, and the remaining 41% reported no significant limitations.

Regionally, parts of the South, Southwest, and lower Midwest had the highest long COVID rates, ranging from 15.48% to 19.40%. This aligns with their higher rates of chronic conditions, negative health behaviors, and lower vaccination coverage.

In contrast, states in the upper Midwest and Northwest had the lowest long COVID prevalence, ranging from 7.60% to 11.53%. These states also had lower rates of chronic conditions and behavioral risk factors, as well as higher vaccination rates. Meanwhile, states in the West and Northeast indicated a moderate long COVID prevalence, ranging from 11.54% to 15.47%.

The researchers acknowledged several limitations, including their reliance on self-reported patient information, which is subject to respondent recall bias. Additionally, the BRFSS is a cross-sectional survey, meaning it cannot prove causality. Despite these limitations, they expressed confidence in their findings.

“These associations support the hypothesis that meeting PAGs and being fully vaccinated may offer protection against [long COVID] following COVID-19, potentially through a synergistic effect between the immune benefits of sufficient physical activity and full vaccination,” the authors concluded.

References

1. Heath GW, Levine D, Oppong G, Alghader M. Prevalence of post COVID-19 condition and associations with risk factors among U.S. adults: 2023 Behavioral Risk Factor Surveillance System. Front Public Health. 2025;13:1662273. doi:10.3389/fpubh.2025.1662273
2. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981-87. Public Health Rep. 1988;103(4):366-375.
3. 2023 BRFSS survey data and documentation. CDC. Last reviewed February 28, 2025. Accessed October 15, 2025. https://www.cdc.gov/brfss/annual_data/annual_2023.html