Inverse Relationship of Maximal Exercise Capacity to Hospitalization Secondary to Coronavirus Disease 2019

Abstract

Objective To investigate the relationship between maximal exercise capacity measured before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization due to coronavirus disease 2019 (COVID-19). Patients and Methods We identified patients (≥18 years) who completed a clinically indicated exercise stress test between 01 January 2016 and 29 February 2020 and had a test for SARS-CoV-2 (i.e., real-time reverse transcriptase polymerase chain reaction test) between 29 February 2020 and 31 May 2020. Maximal exercise capacity was quantified in metabolic equivalents of task (METs). Logistic regression was used to evaluate the likelihood that hospitalization secondary to COVID-19 is related to peak METs, with adjustment for 13 covariates previously identified as associated with higher risk for severe illness from COVID-19. Results We identified 246 patients (age= 59±12 years; 42% male; 75% black race) who had an exercise test and tested positive for SARS-CoV-2. Among these, 89 (36%) were hospitalized. Peak METs were significantly lower (P <.001) among patients who were hospitalized (6.7±2.8) compared to those not hospitalized (8.0±2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (OR= 0.83, 95% CI= 0.74, 0.92) and adjusted models (OR= 0.87, 95% CI= 0.76, 0.99). Conclusion Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes. Future studies are needed to determine if improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.

Low cardiorespiratory and mitochondrial fitness as risk factors in viral infections: implications for COVID-19

“…High CRF has been suggested to be beneficial in COVID-19 by better controlling proinflammatory responses and potentially enhancing antiviral host responses following infection. 4 In line with this assumption, an inverse association of CRF with hospitalisation due to COVID-19 has recently been described 5 : women in the lowest quartile of peak metabolic equivalents of tasks had about twofold greater hospitalisation rates than those of the highest quartile. The effect for men was even more pronounced.…”

Pulmonary function and COVID-19

“…A further key limitation in this area is the lack of knowledge regarding baseline (i.e., pre-morbid) PFT and exercise capacity. Studies have shown that baseline cardiorespiratory fitness is predictive of need for hospital-based care for COVID infection [ 24 ]. Thus, it is likely that there will be selection bias when following-up post-COVID cardiorespiratory functional parameters in the respect that those developing more severe COVID-19 infection are likely to have poor baseline functional status.…”

COVID-19: A Challenge to Physiology of Aging

“…With that, when the epidemiological, physiological, and gerontological aspects of COVID-19 are considered together, the age-dependent changes in the endothelium appear at the forefront with regard to hospitalizations and deaths caused by COVID-19. Indeed, hospitalization rate secondary to COVID-19 has been found to correlate inversely with the maximal exercise capacity assessed up to 5 years earlier in study participants ( Brawner et al, 2020 ). The conditions of the endothelium rather than of the immune system is what can contribute to limiting this capacity.…”