Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study, 2023, Richard et al.

[SNT Gatchaman]

Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study
Richard, Stephanie and 187 co-authors

Background
The long-term effects of coronavirus disease 2019 (COVID-19) on physical fitness are unclear, and the impact of vaccination on that relationship is uncertain.

Methods
We compared survey responses in a 1-year study of US military service members with (n = 1923) and without (n = 1591) a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We fit Poisson regression models to estimate the association between history of SARS-CoV-2 infection and fitness impairment, adjusting for time since infection, demographics, and baseline health.

Results
The participants in this analysis were primarily young adults aged 18–39 years (75%), and 71.5% were male. Participants with a history of SARS-CoV-2 infection were more likely to report difficulty exercising (38.7% vs 18.4%; P < .01), difficulty performing daily activities (30.4% vs 12.7%; P < .01), and decreased fitness test (FT) scores (42.7% vs 26.2%; P < .01) than those without a history of infection. SARS-CoV-2-infected participants were at higher risk of these outcomes after adjusting for other factors (unvaccinated: exercising: adjusted risk ratio [aRR], 3.99; 95% CI, 3.36–4.73; activities: aRR, 5.02; 95% CI, 4.09–6.16; FT affected: aRR, 2.55; 95% CI, 2.19–2.98). Among SARS-CoV-2-positive participants, full vaccination before infection was associated with a lower risk of post-COVID-19 fitness impairment (fully vaccinated: exercise: aRR, 0.81; 95% CI, 0.70–0.95; activities: aRR, 0.76; 95% CI, 0.64–0.91; FT: aRR, 0.87; 95% CI, 0.76–1.00; boosted: exercise: aRR, 0.62; 95% CI, 0.51–0.74; activities: aRR, 0.52; 95% CI, 0.41–0.65; FT: aRR, 0.59; 95% CI, 0.49–0.70).

Conclusions
In this study of generally young, healthy military service members, SARS-CoV-2 infection was associated with lower self-reported fitness and exercise capacity; vaccination and boosting were associated with lower risk of self-reported fitness loss.

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[SNT Gatchaman]

A substantial proportion of US service members in this cohort reported that their service-mandated FT scores were affected after COVID-19; this proportion was significantly higher than in those without a known history of SARS-CoV-2 infection. We noted that service members still reported that their FT scores were affected for ≥12 months, although this may reflect the frequency of FT testing (typically once to twice per year). While these surveys represent self-reported perceptions of fitness, these findings correlate with the recent study of Swiss military members who were found to have a lower aerobic threshold evaluated ≥6 months after SARS-CoV-2 infection compared with those without a history of SARS-CoV-2.

This analysis has several strengths, including a large nationwide cohort with 12-month follow-up and comprehensive measurement of several confounders, which allowed for multivariable adjustment for important fitness-related factors (such as age) that differed between those with and without a history of SARS-CoV-2 infection.

It is possible that some participants in the uninfected group may have been infected but were asymptomatic and therefore did not have a history of a positive test; this potential misclassification would decrease our ability to detect a difference between the groups, and our findings may therefore underestimate the true effect size.