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  ID Week
Oct 19, -23 2022
Washington DC

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Impaired Fitness Peaks 1 Month After COVID Onset but May Persist 12 Months
  IDWeek 2022, October 19-23, 2022, Washington, DC
Mark Mascolini
Active-duty US service members reported new exercising difficulties and impaired daily activities (like walking and climbing stairs) after SARS-CoV-2 infection, and those deficits peaked 1 month after infection [1]. But self-perceived changes in standard physical fitness scores lasted 12 months after infection in this study of more than 4000 service members who responded to fitness questions over the course of a year.
Much research has documented persistent symptoms after recovery from acute COVID. For example, one study recorded substantial symptoms for 90 to 150 days after COVID diagnosis in 21% of people versus 9% of a SARS-CoV-2-negative comparison group [2]. Because frequency and predictors of long-term COVID effects are important in the US Military Health System-and in everyone infected with the coronavirus-military researchers analyzed data from a large ongoing study.
EPICC (Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential) aims to describe the course and outcomes of SARS-CoV-2 infection in Military Health System beneficiaries, including adults and children. Eligibility for EPICC required outpatient or inpatient confirmed COVID, SARS-CoV-2 exposure, a COVID-like illness, testing for SARS-CoV-2, or vaccination against COVID. Enrollment occurred from March 2020 to May 2022 at 10 EPICC study sites (2530 enrolled) and via one online recruitment portal (5405 enrolled). Participants undergo an array of virologic, immunologic, and clinical assessments for 12 months. Follow-up will continue through 2023.
The goal of the analysis reported at IDWeek was to "evaluate the impact of COVID-19 on the fitness of active-duty service members" who self-report difficulty exercising, difficulty with routine daily activities, and their perception of whether COVID affected their service-mandated Physical Fitness Test scores. Participants complete fitness surveys at enrollment and at 1, 3, 6, 9, and 12 months. The fitness study includes active-duty members 18 to 64 years old without known COVID reinfection who completed at least one fitness survey.
Of the 4092 study participants, 2109 (52%) tested positive for SARS-CoV-2. Median age was slightly but significantly older in SARS-CoV-2-positive than negative people (34.0 vs 33.0, P < 0.01). Proportion of females did not differ significantly between the positive and negative groups (29.4% and 28.2%), but the positive group included a larger proportion of Hispanics (16.8% vs 13.9%) and whites (61.8% vs 61.0%) and slightly lower proportions of blacks (7.1% vs 8.0%) and Asians (4.6% vs 6.4%) (P < 0.01 overall for race/ethnicity). The SARS-CoV-2-positive group had a lower proportion of underweight or normal-weight people (27.1% vs 32.0%) and a larger proportion of obese people (19.5% vs 17.5%) and severely obese people (5.6% vs 3.5%) (P < 0.01 overall). The positive and negative groups did not differ significantly in Charlson comorbidity index categories.
A substantially and significantly higher proportion of service members who had COVID reported new or increased difficulty exercising (37.8% vs 17.1%, P < 0.01). One specific reason for diminished exercise capacity stood out in participants with versus without COVID-shortness of breath or difficulty breathing (80.1% vs 67.8%, P < 0.01).
An almost tripled proportion of SARS-CoV-2-positive than negative service members reported new or increased difficulty doing daily activities (29.6% vs 11.9%, P < 0.01). People with versus without COVID attributed this deficit more often to fatigue (77.7% vs 64.7%, P < 0.01) or shortness of breath (82.7% vs 77.0%, P = 0.06). A significantly larger proportion of the COVID group than the no-COVID group said they thought their Physical Fitness Test or Combat Fitness Test score had been affected (38.9% vs 24.7%, P < 0.01).
Analysis of answers to survey questions over time indicated that difficulty exercising or doing daily activities peaked 1 month after COVID diagnosis and dwindled back to pre-COVID levels 6 to 9 months after diagnosis. But the negative impact on Physical Fitness Test scores remained above pre-COVID levels for 12 months.
Generalized linear models fit separately for each outcome determined that testing positive for SARS-CoV-2 was strongly associated with impaired fitness survey reports (difficulty exercising, difficulty with daily activities, report of physical fitness), even after the analysis was adjusted for weight, age, service branch, time since infection (or enrollment for no-COVID participants), and comorbidities. Other predictors of reported fitness difficulties were older age or being overweight, obese, or severely obese. Being male was associated with lower risk of reporting fitness difficulties.
A generalized linear model determined that COVID vaccination before infection cut the risk of difficulty exercising 18% (adjusted risk ratio 0.82, 95% confidence interval 0.69 to 0.96, P = 0.015) and the risk of difficulty with daily activities 24% (adjusted risk ratio 0.76, 95% confidence interval 0.63 to 0.93, P = 0.007). But vaccination did not have a significant impact on Physical Fitness Test score.
The researchers noted that this analysis is limited by self-report of fitness outcomes. They suggested that EPICC or other studies could perform similar analyses with directly recorded physical fitness scores or with objective cardiorespiratory measures.
This big 12-month study of US active-duty service members-who would be considered more fit than the general population-confirms widespread reports of weakness and fatigue in the year after SARS-Cov-2 infection.
1. Richard SA, Scher A, Rusiecki J, et al. SARS-CoV-2 infection is associated with decreased reported physical fitness in a US military longitudinal cohort. IDWeek 2022, October 19-23, 2022, Washington, DC. Abstract 80.
2. Ballering AV, van Zon SKR, Olde Hartman TC, Rosmalen JGM. Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Lancet. 2022;400:452-461. doi: 10.1016/S0140-6736(22)01214-4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fulltext