11. Long Covid and Associations with Physical Activity, Vaccination Status and Selected Chronic Conditions Among Us Aged 18 and Older Reporting Having Had Covid-19: Results from the 2023 Behavioral Risk Factor Surveillance System

During the COVID-19 pandemic physical activity and being vaccinated were shown to provide protection from serious/critical cases of COVID-19. In the wake of the pandemic, there emerged between 12%-20% of US adults who had COVID-19 and manifested symptoms for COVID-19 three months following their illness but lacked an active infection. Hence these adults have been diagnosed with Long COVID'(LC). The purpose of this study was to examine the associations of physical activity, vaccination status, and selected chronic conditions among US adults identified as having LC using CDC's 2023 Behavioral Risk Factor Surveillance System (BRFSS) with the hypotheses that those adults meeting the aerobic physical activity guidelines (PAG) and those having at least one COVID-19 vaccination (VAX) would have lesser odds of reporting LC. Methods: We examined the association of LC among the 46.4% of adults 18 years and older who had tested positive for COVID-19 (n = 201,248) and a subset these adults who reported having LC (n = 27,074, 13.6%). Both univariate and logistic regression analyses were conducted using SPSS (v29) for complex samples. A series of logistic regression analyses controlling for age, sex, overweight/obesity, type 2 diabetes, race/ethnicity, and educational attainment comparing the outcome variable of LC with the exposure variables of 1) not meeting the PAG and 2) having at < 3 VAX vs. 4 or more VAX were conducted. Results: Adults (n = 9,809; 15.9%) who did not achieve the PAG were at greater odds of reporting LC (OR= 1.19 95% CI = 1.06, 1.33) compared with those meeting the PAG (n = 13,449; 12.2%). Respondents reporting 3 or less VAX with LC (n = 5,092; 13.8%) were at greater odds of reporting LC (OR=1.42, 95% CI = 1.24, 1.49) compared with those reporting 4 or more VAX with LC (n = 1894; 10.04%). Discussion: The present findings support the hypothesis that adults who did not achieve the PAG recommendations manifest greater risk for LC following a case of COVID-19. In addition, those adults who have had 3 or less Vax compared to those with those receiving 4 or more VAX also independently demonstrate greater risk for LC. A suggested mechanism from these findings is the potential synergism between the immune protective effects of sufficient physical activity and having 4 or more COVID-19 vaccinations.