Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study

Stephanie A Richard; Ann I Scher; Jennifer Rusiecki; Celia Byrne; Catherine M Berjohn; Anthony C Fries; Tahaniyat Lalani; Alfred G Smith; Rupal M Mody; Anuradha Ganesan; Nikhil Huprikar; Rhonda E Colombo; Christopher J Colombo; Christina Schofield; David A Lindholm; Katrin Mende; Michael J Morris; Milissa U Jones; Ryan Flanagan; Derek T Larson; Evan C Ewers; Samantha E Bazan; David Saunders; Ryan C Maves; Jeffrey Livezey; Carlos J Maldonado; Margaret Sanchez Edwards; Julia S Rozman; Robert J O'Connell; Mark P Simons; David R Tribble; Brian K Agan; Timothy H Burgess; Simon D Pollett; EPICC COVID-19 Cohort Study Group

doi:10.1093/ofid/ofad579

Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study

Open Forum Infect Dis. 2023 Nov 17;10(12):ofad579. doi: 10.1093/ofid/ofad579. eCollection 2023 Dec.

Authors

Stephanie A Richard^{1

2}, Ann I Scher³, Jennifer Rusiecki³, Celia Byrne³, Catherine M Berjohn^{1

3

4}, Anthony C Fries⁵, Tahaniyat Lalani^{1

2

6}, Alfred G Smith⁶, Rupal M Mody⁷, Anuradha Ganesan^{1

2

8}, Nikhil Huprikar^{3

8}, Rhonda E Colombo^{1

2

3

9}, Christopher J Colombo^{3

9}, Christina Schofield⁹, David A Lindholm^{3

10}, Katrin Mende^{1

2

10}, Michael J Morris¹⁰, Milissa U Jones¹¹, Ryan Flanagan¹¹, Derek T Larson^{3

4

12}, Evan C Ewers^{3

12}, Samantha E Bazan¹³, David Saunders³, Ryan C Maves¹⁴, Jeffrey Livezey¹⁵, Carlos J Maldonado¹⁶, Margaret Sanchez Edwards^{1

2}, Julia S Rozman^{1

2}, Robert J O'Connell¹, Mark P Simons¹, David R Tribble¹, Brian K Agan^{1

2}, Timothy H Burgess¹, Simon D Pollett^{1

2}; EPICC COVID-19 Cohort Study Group

Collaborators

EPICC COVID-19 Cohort Study Group:
Col J Cowden, Ltc M Darling, S DeLeon, Maj D Lindholm, Ltc A Markelz, K Mende, S Merritt, T Merritt, Ltc N Turner, Cpt T Wellington, Carl R, Ltc S Bazan, P K Love, Alexander T, N Dimascio-Johnson, N Elnahas, Maj E Ewers, Lcdr K Gallagher, C Glinn, U Jarral, D Jennings, Lcdr D Larson, K Reterstoff, A Rutt, A Silva, C West, Henry M, P Blair, J Chenoweth, D Clark, J Bowman, S Chambers, Ltc C Colombo, R Colombo, Cpt C Conlon, Cpt K Everson, Col P Faestel, Col T Ferguson, Maj L Gordon, Ltc S Grogan, Cpt S Lis, M Martin, Col C Mount, Ltc D Musfeldt, Cpt D Odineal, Ltc M Perreault, W Robb-McGrath, Maj R Sainato, C Schofield, Col C Skinner, M Stein, Maj M Switzer, Maj M Timlin, Maj S Wood, S Banks, R Carpenter, L Kim, Capt K Kronmann, T Lalani, Lcdr T Lee, Lcdr A Smith, R Smith, R Tant, Cdr T Warkentien, Cdr C Berjohn, S Cammarata, N Kirkland, D Libraty, R Maves, G Utz, C Bradley, S Chi, Ltc R Flanagan, A Fuentes, Maj M Jones, N Leslie, C Lucas, C Madar, K Miyasato, C Uyehara, H Adams, B Agan, L Andronescu, A Austin, C Broder, Capt T Burgess, C Byrne, K Chung, J Davies, C English, N Epsi, C Fox, M Fritschlanski, A Hadley, Col P Hickey, E Laing, Ltc C Lanteri, Ltc J Livezey, A Malloy, R Mohammed, C Morales, P Nwachukwu, C Olsen, E Parmelee, S Pollett, S Richard, J Rozman, J Rusiecki, Col D Saunders, E Samuels, M Sanchez, A Scher, Cdr M Simons, A Snow, K Telu, D Tribble, M Tso, L Ulomi, M Wayman, N Hockenbury, TSgt T Chao, R Chapleau, M Christian, A Fries, C Harrington, V Hogan, S Huntsberger, K Lanter, E Macias, J Meyer, S Purves, K Reynolds, J Rodriguez, C Starr, Capt J Iskander, Cdr I Kamara, B Barton, Ltc D Hostler, Ltc J Hostler, Maj K Lago, C Maldonado, J Mehrer, Maj T Hunter, J Mejia, R Mody, J Montes, R Resendez, P Sandoval, I Barahona, A Baya, A Ganesan, Maj N Huprikar, B Johnson, S Peel

Affiliations

¹ Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
² Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA.
³ Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
⁴ Naval Medical Center San Diego, San Diego, California, USA.
⁵ US Air Force School of Aerospace Medicine, Wright-Patterson, Ohio, USA.
⁶ Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
⁷ William Beaumont Army Medical Center, El Paso, Texas, USA.
⁸ Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
⁹ Madigan Army Medical Center, Joint Base Lewis McChord, Washington, USA.
¹⁰ Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, USA.
¹¹ Department of Pediatrics, Translational Medicine Unit, Uniformed Services University, Bethesda, Maryland, USA.
¹² Alexander T. Augusta Military Medical Center, Fort Belvoir, Virginia, USA.
¹³ Carl R. Darnall Army Medical Center, Fort Cavazos, Texas, USA.
¹⁴ Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
¹⁵ Department of Pediatrics, Clinical Pharmacology and Medical Toxicology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
¹⁶ Womack Army Medical Center, Fort Liberty, North Carolina, USA.

Abstract

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.

Keywords: COVID-19; fitness; long COVID.

Grants and funding

Y01 AI005072/AI/NIAID NIH HHS/United States