# Post-COVID-19 Physical Activity and Symptom Burden in Patients with Asthma and COPD Compared with Individuals Without Chronic Disease: A Multicenter Cross-Sectional Study

## TL;DR

This study compares physical activity and post-COVID-19 symptoms in asthma and COPD patients with those without chronic disease, finding significant declines in activity and persistent symptoms.

## Contribution

The study provides new insights into the impact of the pandemic on physical activity and symptom persistence in chronic respiratory disease patients compared to healthy individuals.

## Key findings

- Physical activity levels declined significantly in all groups post-pandemic, with the lowest levels in COPD patients.
- Post-COVID-19 symptoms like dyspnea, cough, fatigue, and myalgia persisted for at least six months across all groups.
- COPD patients experienced higher rates of severe COVID-19 and hospitalization compared to asthma patients and healthy individuals.

## Abstract

Background/Objectives: The COVID-19 pandemic led to profound lifestyle changes and long-term functional consequences, particularly among individuals with chronic respiratory diseases. Patients with asthma and chronic obstructive pulmonary disease (COPD) may be especially vulnerable to reductions in physical activity and persistent post-COVID-19 symptoms. This study aimed to compare lifestyle characteristics, physical activity levels, and post-COVID-19 symptom persistence in patients with asthma and COPD with those of individuals without chronic disease in the post-pandemic period. Methods: This national, multicenter, cross-sectional study was conducted in 2022 at five pulmonary outpatient clinics. Participants were categorized into three groups: asthma (n = 165), COPD (n = 82), and individuals without chronic disease (n = 431). Demographic and clinical data were collected through face-to-face structured interviews. Physical activity levels were assessed using the short form of the International Physical Activity Questionnaire and expressed as metabolic equivalent of task (MET) scores before and after the pandemic. Dyspnea severity was evaluated using the modified Medical Research Council scale. COVID-19 history, disease severity, and persistent symptoms were recorded. Results: A total of 678 participants were included. The median age was highest in the COPD group (68 (61–74) years), followed by the asthma group (54 (42–64) years) and individuals without chronic disease (38 (27–50) years). Female sex predominated among patients with asthma (77%), whereas male sex was more frequent in the COPD group (83%); sex distribution was similar among individuals without chronic disease (51% female). Across all groups, post-COVID-19 symptoms—including dyspnea, cough, fatigue, and myalgia—persisted for at least six months after infection. Physical activity levels, assessed by metabolic equivalent of task (MET) scores, declined significantly in the post-pandemic period in all groups, with the lowest levels observed in patients with COPD. COVID-19 severity and hospitalization rates were higher in patients with COPD, while intensive care unit admission rates were comparable between patients with asthma and individuals without chronic disease. Conclusions: In the post-pandemic period, physical activity levels declined markedly, and lifestyle changes were negatively affected in patients with asthma and COPD. Post-COVID-19 symptoms persisted longer than expected even in those without chronic disease. Therefore, individualized home-based exercise programs and psychosocial support should be considered to improve physical activity and quality of life, particularly in patients with chronic respiratory diseases, while preventive strategies should also be implemented at the population level.