Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study
Authors: Richard Stephanie A , Scher Ann I , Rusiecki Jennifer , Byrne Celia , Berjohn Catherine M , Fries Anthony C , Lalani Tahaniyat , Smith Alfred G , Mody Rupal M , Ganesan Anuradha , Huprikar Nikhil , Colombo Rhonda E , Colombo Christopher J , Schofield Christina , Lindholm David A , Mende Katrin , Morris Michael J , Jones Milissa U , Flanagan Ryan , Larson Derek T , Ewers Evan C , Bazan Samantha E , Saunders David , Maves Ryan C , Livezey Jeffrey , Maldonado Carlos J , Edwards Margaret Sanchez , Rozman Julia S , O’Connell Robert J , Simons Mark P , Tribble David R , Agan Brian K , Burgess Timothy H , Pollett Simon D ,   the EPICC COVID-19 Cohort Study Group, Cowden Col J , Darling LTC M , DeLeon S , Lindholm Maj D , Markelz LTC A , Mende K , Merritt S , Merritt T , Turner LTC N , Wellington CPT T , R Carl , Bazan LTC S , Love P K , T Alexander , Dimascio-Johnson N , Elnahas N , Ewers MAJ E , Gallagher LCDR K , Glinn C , Jarral U , Jennings D , Larson LCDR D , Reterstoff K , Rutt A , Silva A , West C , M Henry , Blair P , Chenoweth J , Clark D , Bowman J , Chambers S , Colombo LTC C , Colombo R , Conlon CPT C , Everson CPT K , Faestel COL P , Ferguson COL T , Gordon MAJ L , Grogan LTC S , Lis CPT S , Martin M , Mount COL C , Musfeldt LTC D , Odineal CPT D , Perreault LTC M , Robb-McGrath W , Sainato MAJ R , Schofield C , Skinner COL C , Stein M , Switzer MAJ M , Timlin MAJ M , Wood MAJ S , Banks S , Carpenter R , Kim L , Kronmann CAPT K , Lalani T , Lee LCDR T , Smith LCDR A , Smith R , Tant R , Warkentien CDR T , Berjohn CDR C , Cammarata S , Kirkland N , Libraty D , Maves R , Utz G , Bradley C , Chi S , Flanagan LTC R , Fuentes A , Jones MAJ M , Leslie N , Lucas C , Madar C , Miyasato K , Uyehara C , Adams H , Agan B , Andronescu L , Austin A , Broder C , Burgess CAPT T , Byrne C , Chung K , Davies J , English C , Epsi N , Fox C , Fritschlanski M , Hadley A , Hickey COL P , Laing E , Lanteri LTC C , Livezey LTC J , Malloy A , Mohammed R , Morales C , Nwachukwu P , Olsen C , Parmelee E , Pollett S , Richard S , Rozman J , Rusiecki J , Saunders COL D , Samuels E , Sanchez M , Scher A , Simons CDR M , Snow A , Telu K , Tribble D , Tso M , Ulomi L , Wayman M , Hockenbury N , Chao TSgt T , Chapleau R , Christian M , Fries A , Harrington C , Hogan V , Huntsberger S , Lanter K , Macias E , Meyer J , Purves S , Reynolds K , Rodriguez J , Starr C , Iskander CAPT J , Kamara CDR I , Barton B , Hostler LTC D , Hostler LTC J , Lago MAJ K , Maldonado C , Mehrer J , Hunter MAJ T , Mejia J , Mody R , Montes J , Resendez R , Sandoval P , Barahona I , Baya A , Ganesan A , Huprikar MAJ N , Johnson B , Peel S 
Published: November 2023

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 &lt; .01), difficulty performing daily activities (30.4% vs 12.7%; P &lt; .01), and decreased fitness test (FT) scores (42.7% vs 26.2%; P &lt; .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.