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

EPICC COVID-19 Cohort Study Group, 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 FlanaganDerek 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

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)ofad579
JournalOpen Forum Infectious Diseases
Issue number12
StatePublished - Dec 2023


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