Physical Activity, Vaccination May Protect Against Long COVID

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.