Living a healthy lifestyle has many proven benefits, such as helping to prevent chronic disease. Studies have shown, for example, that a healthy lifestyle can lower the risk of cardiovascular disease and type 2 diabetes. Now, a large study of female healthcare workers has shown that healthy living before getting infected with COVID-19 may also protect against Long COVID.*

Inflammation and Long COVID

In JAMA Internal Medicine, researchers from Harvard University’s T.H. Chan School of Public Health explain that persistent inflammation has been linked to post-COVID complications in multiple organ systems. It’s also been associated with post-viral fatigue syndrome and other post-infection diseases. Healthy lifestyle behaviors can protect against inflammation, however. These include:

• Maintaining a healthy body mass index (BMI) for your frame
• Not smoking
• Eating fresh whole foods
• Moderating alcohol intake
• Exercising regularly
• Getting enough sleep

These behaviors have also been linked to fewer hospitalizations and deaths from the disease. 

What the researchers did

In this study, the Harvard researchers wanted to establish whether engaging in these healthy lifestyle behaviors prior to COVID-19 infection was protective against Long COVID.

• 1,981 women from the Nurses’ Health Study II who tested positive for COVID-19 were followed between April 2020 and November 2021.
• Average age was 64.7 years, 97.4% were White, and about 43% were active in healthcare.
• Definitions of healthy behaviors included:
  • At least 150 minutes/week of moderate-vigorous physical activity
  • 5-15 g/day of alcohol (one drink has about 10 g)
  • A high-quality diet involving fruits and vegetables, whole grains, nuts, legumes, vegetable protein, fish, and healthy fats

Long COVID was defined as at least four (4) weeks of persistent symptoms self-reported over seven surveys.

What they found

Long COVID was reported by 44% of respondents, the vast majority having symptoms lasting two months or longer, and more than half saying it occasionally impaired daily activities. The most common symptoms were (in descending order):

• Fatigue
• Smell or taste issues
• Breathlessness
• Brain fog
• Memory issues

Concerning the effect of healthy living before infection on Long COVID risk:

• Women with five or all six healthy behaviors saw a 49% lower risk of Long COVID compared to women with no healthy lifestyle behaviors.
• Healthy behaviors independently associated with lower Long COVID risk included maintaining a BMI of 18.5 to 24.9 and getting 7 to 9 hours of sleep.

The researchers calculated that, if the effects were causal, 36% of Long COVID cases could have been prevented through the combined effect of at least five of the healthy lifestyle behaviors before the pandemic.

• Further, women who developed Long COVID despite five to six healthy behaviors averaged fewer symptoms (except for smell/taste issues and headache) and less risk of daily life activity impairment than women with zero-four healthy behaviors.

What it means

While the results can’t be generalized to the wider public because they overwhelmingly involved White, middle-aged, unvaccinated women, the authors concluded that pre-infection healthy living “was associated with a substantially decreased risk of [Long COVID].”

An unhealthy lifestyle can interfere with adaptive immunity, they wrote, and such immune dysfunction has been found in people with Long COVID. They call for future research to explore whether lifestyle interventions can lower Long COVID risk or reduce related symptoms.

*Hein, I. (2023, February 6). Healthy Lifestyle Before Infection LInked to Lower Long COVID Risk. MedPage Today. https://www.medpagetoday.com/infectiousdisease/longcovid/102977