Prevalence and patterns of physical deconditioning and fatigue in post-COVID-19 patients: evidence from a case-control study

M. Obaidul Alam; M. A. Shakoor; Mohammad Muhibbur Rahman; Shamim Farhad; A. B. M. Mehedi

doi:10.18203/2320-6012.ijrms20252029

Authors

M. Obaidul Alam Department of Medicine, Rangpur Medical College and Hospital, Rangpur, Bangladesh https://orcid.org/0009-0001-8382-5037
M. A. Shakoor Department of Physical Medicine & Rehabilitation, Bangladesh Medical University (BMU), Dhaka, Bangladesh https://orcid.org/0000-0001-6801-9179
Mohammad Muhibbur Rahman Department of Physical Medicine & Rehabilitation, Government Employees Hospital, Dhaka, Bangladesh https://orcid.org/0000-0002-1149-1058
Shamim Farhad Department of Physical Medicine & Rehabilitation, Government Employees Hospital, Dhaka, Bangladesh https://orcid.org/0000-0002-3988-6430
A. B. M. Mehedi Department of Physical Medicine and Rehabilitation, National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh https://orcid.org/0009-0004-1129-1293

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252029

Keywords:

Physical deconditioning, Fatigue, COVID-19, Canadian occupational performance measure, Modified medical research council

Abstract

Background: Physical deconditioning and fatigue are increasingly recognized as a significant consequence of the COVID-19 pandemic, especially in individuals recovering from infection. The aim of the study was to determine the proportion, pattern and severity of physical deconditioning and fatigue among post-COVID-19 patients versus non-infected controls.

Methods: Physical deconditioning and fatigue are increasingly recognized as a significant consequence of the COVID-19 pandemic, especially in individuals recovering from infection. This study aimed at determining the proportion, pattern and severity of physical deconditioning and fatigue among post-COVID-19 patients versus non-infected controls.

Results: Demographically both groups were similar with male predominance in this study. Significantly higher proportions of fatigue (89.3% vs. 64.6%) and physical deconditioning (94.0% vs. 68.3%) were observed among cases compared to controls. Moderate to severe fatigue and higher grades of deconditioning were notably prevalent among cases, whereas controls reported milder symptoms. COVID-19 patients suffered more severe deconditioning across functional mobility, productivity.

Conclusions: COVID-19 survivors exhibit a higher prevalence and greater severity of physical deconditioning and fatigue across daily life domains compared to non-infected individuals. Integration of comprehensive rehabilitation and early intervention is critical for optimizing recovery and restoring quality of life in affected patients.

Metrics

Metrics Loading ...

References

Sharma A, Ahmad Farouk I, Lal SK. COVID-19: A Review on the Novel Coronavirus Disease Evolution, Transmission, Detection, Control and Prevention. Viruses. 2021;13(2):202. DOI: https://doi.org/10.3390/v13020202

WHO. Emerging Diseases and Zoonoses (EZD) and Epidemic and Pandemic Preparedness and Prevention (EPP) Team, 2024. Available at: https://www.who.int/publications/m/item/covid19epidemiological-update. Accessed on 01 May 2025.

Worldometer. Bangladesh COVID - Coronavirus Statistics, 2025. Available at: https://www.worldometers.info/coronavirus/country/bangladesh/. Accessed on 01 May 2025.

Nobi G, Alam MO, Mehedi ABM, Azad AK, Rashid I, Shakoor MA, et al. Assessment of Physical Deconditioning due to COVID-19 Lock Down: A Comparison between COVID-19 Affected and Non-affected Person. Med Today. 2025;37(1):27-32.

Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. Geroscience. 2020;42(6):1547-78. DOI: https://doi.org/10.1007/s11357-020-00272-3

Panagioti M, Khan K, Keers RN, Abuzour A, Phipps D, Kontopantelis E, et al. Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ. 2019;366:l4185. DOI: https://doi.org/10.1136/bmj.l4185

Kiekens C, Boldrini P, Andreoli A, Avesani R, Gamna F, Grandi M, et al. Rehabilitation and respiratory management in the acute and early post-acute phase. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency. Eur J Phys Rehabil Med. 2020;56(3):323-6. DOI: https://doi.org/10.23736/S1973-9087.20.06305-4

Welch C, K Hassan-Smith Z, A Greig C, M Lord J, A Jackson T. Acute Sarcopenia Secondary to Hospitalisation - An Emerging Condition Affecting Older Adults. Aging Dis. 2018;9(1):151-64. DOI: https://doi.org/10.14336/AD.2017.0315

Woods JA, Hutchinson NT, Powers SK, Roberts WO, Gomez-Cabrera MC, Radak Z, et al. The COVID-19 pandemic and physical activity. Sports Med Health Sci. 2020;2(2):55-64. DOI: https://doi.org/10.1016/j.smhs.2020.05.006

Bloomfield SA. Changes in musculoskeletal structure and function with prolonged bed rest. Med Sci Sports Exerc. 1997;29(2):197-206. DOI: https://doi.org/10.1097/00005768-199702000-00006

Zhang S, Bai W, Yue J, Qin L, Zhang C, Xu S, et al. Eight months follow-up study on pulmonary function, lung radiographic, and related physiological characteristics in COVID-19 survivors. Sci Rep. 2021;11(1):13854. DOI: https://doi.org/10.1038/s41598-021-93191-y

Atalan A. Is the lockdown important to prevent the COVID-19 pandemic? Effects on psychology, environment and economy-perspective. Ann Med Surg (Lond). 2020;56:38-42. DOI: https://doi.org/10.1016/j.amsu.2020.06.010

Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Progress in Cardiovascular Diseases. 2020;63(3):386-8. DOI: https://doi.org/10.1016/j.pcad.2020.03.009

Mozolev O, Polishchuk O, Kravchuk L, Tatarin O, Zharovska O, Kazymir V. Results of monitoring the physical health of female students during the COVID-19 pandemic. J Phys Edu Sport. 2020;20(6):3280-7.

Ammar A, Trabelsi K, Brach M, Chtourou H, Boukhris O, Masmoudi L, et al. Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insights from the ECLB-COVID19 multicentre study. Biol Sport. 2021;38(1):9-21. DOI: https://doi.org/10.5114/biolsport.2020.96857

Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ. 2020;369:m1557. DOI: https://doi.org/10.1136/bmj.m1557

Althomali OW, Hussain Shaik D, Kanwal R, Amin J, Acar T, Abdelmoniem Ibrahim A, et al. The Impact of COVID-19 on Functional Capacity and Pulmonary Outcomes in the Hail Region: A Cross-Sectional Study. J Clin Med. 2024;13(18):5571. DOI: https://doi.org/10.3390/jcm13185571

Tay SS, Visperas CA, Zaw EM, Tan MM, Samsudin F, Koh XH. Functional outcomes of COVID-19 patients who underwent acute inpatient rehabilitation and the exploration of the benefits of adjunct robotic therapy and the effects of frailty. Proceedings of Singapore Healthcare. 2023;32:20101058221150078. DOI: https://doi.org/10.1177/20101058221150078

Law M, Polatajko H, Pollock N, Mccoll MA, Carswell A, Baptiste S. Pilot Testing of the Canadian Occupational Performance Measure: Clinical and Measurement Issues. Can J Occup Ther. 1994;61(4):191-7. DOI: https://doi.org/10.1177/000841749406100403

Pattanakuhar S, Suksathien R, Thirapatarapong W. Recommendations for Preparedness of Medical Rehabilitation Services in Thailand during COVID-19 Outbreak. ASEAN J Rehabilitation Med. 2020;30(1):2-7. DOI: https://doi.org/10.3724/SP.J.1329.2020.01004

Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581-6. DOI: https://doi.org/10.1136/thx.54.7.581

Sire A, Andrenelli E, Negrini F, Patrini M, Lazzarini SG, Ceravolo MG, et al. Rehabilitation and COVID-19: a rapid living systematic review by Cochrane Rehabilitation Field updated as of December 31st, 2020 and synthesis of the scientific literature of 2020. Eur J Phys Rehabil Med. 2021;57(2):181-8. DOI: https://doi.org/10.23736/S1973-9087.21.06870-2

Curci C, Negrini F, Ferrillo M, Bergonzi R, Bonacci E, Camozzi DM, et al. Functional outcome after inpatient rehabilitation in postintensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021;57(3):443-50. DOI: https://doi.org/10.23736/S1973-9087.20.06660-5

Barker-Davies RM, O'Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, Ellis H, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020;54(16):949-59. DOI: https://doi.org/10.1136/bjsports-2020-102596

Mahboob S, Johora F, Abbasy AA, et al. Demographic Characteristics and Clinical Features of COVID-19 Patients Admitted in a Combined Military Hospital of Bangladesh. medRxiv. 2022. DOI: https://doi.org/10.1101/2022.02.12.22270893

Hasan MS, Paul SK, Nasreen SA, Haque N, Khan MK, Haque Z. Socio-Demographic Characteristics, Clinical Presentations and Treatment Outcome of RT-PCR Positive Covid-19 Patients of Mymensingh Region. Mymensingh Med J. 2025;34(1):227-33.

Khanam R, Islam S, Rahman S, Ahmed S, Islam A, Hasan T, et al. Sero-prevalence and risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 infection in women and children in a rural district of Bangladesh: A cohort study. J Glob Health. 2022;12:05030. DOI: https://doi.org/10.7189/jogh.12.05030

Poole-Wright K, Guennouni I, Sterry O, Evans RA, Gaughran F, Chalder T. Fatigue outcomes following COVID-19: a systematic review and meta-analysis. BMJ Open. 2023;13(4):e063969. DOI: https://doi.org/10.1136/bmjopen-2022-063969

Badenoch JB, Rengasamy ER, Watson C, Jansen K, Chakraborty S, Sundaram RD, et al. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2021;4(1):fcab297. DOI: https://doi.org/10.1093/braincomms/fcab297

Hoshijima H, Mihara T, Seki H, Hyuga S, Kuratani N, Shiga T. Incidence of long-term post-acute sequelae of SARS-CoV-2 infection related to pain and other symptoms: A systematic review and meta-analysis. PLoS One. 2023;18(11):e0250909. DOI: https://doi.org/10.1371/journal.pone.0250909

Malik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-A systematic review and meta-analysis. J Med Virol. 2022;94(1):253-62. DOI: https://doi.org/10.1002/jmv.27309

Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One. 2020;15(11):e0240784. DOI: https://doi.org/10.1371/journal.pone.0240784

Carfì A, Bernabei R, Landi F. Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-5. DOI: https://doi.org/10.1001/jama.2020.12603

Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011;11:37. DOI: https://doi.org/10.1186/1471-2377-11-37

Ceravolo MG, Andrenelli E, Arienti C, Côté P, de Sire A, Iannicelli V, et al. Rehabilitation and COVID-19: rapid living systematic review by Cochrane Rehabilitation Field - third edition. Update as of June 30th, 2021. Eur J Phys Rehabil Med. 2021;57(5):850-7. DOI: https://doi.org/10.23736/S1973-9087.21.07301-9

Nobi G, Alam MO, Mehedi ABM, Azad AK, Rashid I, Shakoor MA, et al. Assessment of Physical Deconditioning due to COVID-19 Lock Down: A Comparison between COVID-19 Affected and Non-affected Person. Medicine Today. 2025;37(1):27-32. DOI: https://doi.org/10.3329/medtoday.v37i1.79268

Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017-32. DOI: https://doi.org/10.1038/s41591-020-0968-3

Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society- and American Thoracic Society-coordinated international task force. Eur Respir J. 2020;56(6):2002197. DOI: https://doi.org/10.1183/13993003.02197-2020

Blitshteyn S, Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: a case series of 20 patients. Immunol Res. 2021;69(2):205-11. DOI: https://doi.org/10.1007/s12026-021-09185-5

Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-15. DOI: https://doi.org/10.1038/s41591-021-01283-z