key: cord-0857422-bmv166sl authors: Carter, S. J.; Baranauskas, M. N.; Raglin, J. S.; Pescosolido, B. A.; Perry, B. L. title: Functional status, mood state, and physical activity among women with post-acute COVID-19 syndrome date: 2022-01-12 journal: medRxiv : the preprint server for health sciences DOI: 10.1101/2022.01.11.22269088 sha: 269a2626974d35da13c3147c4d9e9af355eb1db2 doc_id: 857422 cord_uid: bmv166sl Objectives: While organ-specific pathophysiology has been well-described in SARS-CoV-2 infection, less is known about the attendant effects on functional status, mood state and leisure-time physical activity (PA) in post-acute COVID-19 syndrome. Methods: A case-control design was employed to recruit 32 women (n = 17 SARS-CoV-2; n = 15 controls) matched on age (54 +/- 12 years), body mass index (27 +/- 6 kg/m2), smoking status, and history of cardiopulmonary disease. Participants completed a series of assessments including the Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), Profile of Mood States (POMS), and Godin-Shephard Leisure-Time PA. Results: SARS-CoV-2 participants exhibited poorer functional status (p = 0.008) and reduced leisure-time PA (p = 0.004) compared to controls. Significant between-group differences were also detected for the POMS total mood disturbance with sub-scale analyses revealing elevated tension, confusion, and lower vigor among SARS-CoV-2 participants (all p-values < 0.05). The number of SARS-CoV-2 symptoms (e.g.,loss of taste / smell, muscle aches etc.) were associated (r = 0.620, p = 0.008) with confusion. Conclusion: The sequela of persistent SARS-CoV-2 symptoms elicit clear disturbances in functional status, mood state, and leisure-time PA among women with post-acute COVID-19 syndrome. Women at least four weeks to four months from having a positive laboratory test for SARS-CoV-2 117 and women without a history of SARS-CoV-2 (i.e., controls) were enrolled in a case-control design. Eligible 118 participants recruited from the community within a 115-mile radius of Bloomington, Indiana were matched on age and BMI. Exclusion criteria were individuals < 18 or > 75 years of age, BMI < 18.5 kg/m 2 or > 50 120 kg/m 2 , currently pregnant, lactating or trying to become pregnant, documented history of pulmonary disease 121 and/or self-reported use of tobacco products within the previous six months. SARS The Profile of Mood States (POMS) was used to assess both specific and general mood. The POMS is a 65 item Likert format (0 = "not at all" and "4 = extremely) questionnaire that measures the specific 147 mood factors of tension, depression, anger, vigor, fatigue and confusion [14] . A widely used higher order 148 measure of total mood disturbance (TMD) was assessed by adding the negative mood variables and 149 subtracting the positive variable of vigor. Participants completed the POMS on the basis of the standard 150 instructional format (i.e., "last week including today"), which yields scores of moderate stability known to be 151 responsive to major interventions including longer-term participation on PA programs. Of note, in situations 152 where researchers are interested in acute mood state responses to an exposure of a single stimulus (e.g., 153 exercise), the instructional set is altered (i.e., "how do you feel right now") [15] . The norms provided in the 154 POMS are not closely comparable to the present sample, and as such, results from Nyenhuis et al. [16] 155 that assessed the POMS in 400 adults (52% women, age = 44 ± 18 y) were used to standardize scores to 156 a population norm (Z-score = observed value -population mean / population SD). Z-scores were converted 157 to T-scores with a mean of 50 and SD of 10 [T-score = 50 + (10 x Z-score)]. to pre-SARS-CoV-2 diagnosis (or over the past 6-months among controls). The scale was anchored at "0 165 = no change" and "10 = can no longer perform." A total score (ranging from 0 to 300) was determined by 166 the summation of all components with a higher score indicating poorer functional status. An eight-item scale was used to measure walking self-efficacy in which participants were asked to 168 rate their level of confidence (0%-100% in 10% increments) in ability to walk at a moderately-fast pace 169 All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint Descriptive data are shown in Table 1 . Consistent with the study design, there were no between-200 group differences in age, BMI, or body fat%. According to BMI classifications, 14 of 32 (44%) participants 201 were "normal weight" (18.5-24 kg/m 2 ), 12 of 32 (37%) were "overweight" (25-29.9 kg/m 2 ), and 6 of 32 (19%) (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint The direct and indirect effects of the COVID-19 pandemic remain a concern to personal and public 255 health. Herein, we compared functional status, mood state, and leisure-time PA between women with and 256 without a history of SARS-CoV-2 matched for age, BMI, smoking status, and history of cardiopulmonary 257 disease. In agreement with our hypotheses, SARS-CoV-2 participants reported greater TMD than controls. With respect to normative data, the control group possessed a lower TMD score (i.e., more positive mood), 259 whereas 6 of 17 (35%) SARS-CoV-2 participants exhibited TMD scores above the normative data (i.e., 260 more negative mood). Significant between-group differences were also found in three of the six POMS sub- (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint It is understandable that persistent SARS-CoV-2 symptoms are likely to degrade functional status 308 while also inciting feelings of concern about health and well-being. Indeed, leisure-time PA was negatively 309 associated (r = -0.672, p = 0.047) with the number of symptoms among symptomatic SARS-CoV-2 310 participants in the present work. This finding is consistent with process of interoception wherein peripheral 311 (sensory) feedback provides a moment-to-moment updates of the internal bodily environment [28] . This, in 312 turn, has the potential to trigger a maladaptive cycle that can ultimately interfere with activities of daily living. Given that some SARS-CoV-2 symptoms, notably cough and joint/muscle aches can last beyond 3-4 CoV-2 while employing a case-control design matching participants on age, BMI, smoking status, and 322 history of cardiopulmonary disease. As such, we have reasonable confidence that our observations are due 323 to meaningful between-group differences in functional status, mood state, and leisure-time PA. Nevertheless, there are several limitations that need to be considered. First, the retrospective nature of the 325 work limits our ability to know whether alterations in the observed outcomes were present before testing. Second, because the study sample was purposely limited to women, findings may not be generalizable to (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted January 12, 2022. ; https://doi.org/10.1101/2022.01.11.22269088 doi: medRxiv preprint An interactive web-based dashboard to track COVID-19 in real time A Covid-19: Cases of delta variant rise by 79%, but rate of growth slows Post-acute COVID-370 19 syndrome COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various 372 Long Haul Syndrome): Description of a Multidisciplinary Clinic at Mayo Clinic and 376 Characteristics of the Initial Patient Cohort Post-COVID-19 chronic symptoms: a postinfectious 378 entity? Social determinants of sex 380 differences in disability among older adults: a multi-country decomposition analysis using the World 381 Health Survey Fly AD Considerations for Obesity, Vitamin D, and Physical Activity Amid 383 the COVID-19 Pandemic A Pandemic within the 385 Pandemic? Physical Activity Levels Substantially Decreased in Countries Affected by COVID-19 Exercise and mood: A selective review and synthesis of research employing the 400 profile of mood states Adult and geriatric normative data 402 and validation of the profile of mood states