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Observational Study
. 2021 Jan;96(1):32-39.
doi: 10.1016/j.mayocp.2020.10.003. Epub 2020 Oct 10.

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

Clinton A Brawner  1 , Jonathan K Ehrman  2 , Shane Bole  3 , Dennis J Kerrigan  2 , Sachin S Parikh  2 , Barry K Lewis  2 , Ryan M Gindi  2 , Courtland Keteyian  4 , Khaled Abdul-Nour  2 , Steven J Keteyian  2
Affiliations
Observational Study

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

Clinton A Brawner et al. Mayo Clin Proc. 2021 Jan.

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).

Methods: We identified patients (≥18 years) who completed a clinically indicated exercise stress test between January 1, 2016, and February 29, 2020, and had a test for SARS-CoV-2 (ie, real-time reverse transcriptase polymerase chain reaction test) between February 29, 2020, and May 30, 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 with those not hospitalized (8.0±2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (odds ratio, 0.83; 95% CI, 0.74-0.92) and adjusted models (odds ratio, 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 whether improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.

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Figures

Figure 1
Figure 1
Development of the cohort. SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
Unadjusted rate of hospitalization among patients with coronavirus disease 2019 (COVID-19) by quartiles of peak metabolic equivalents of task (METs).
Figure 3
Figure 3
Predicted probability of hospitalization among patients with coronavirus disease 2019 (COVID-19) associated with peak metabolic equivalents of task (METs) by sex (A), age (B), and obesity (C). Predicted probability is based on the adjusted logistic regression (Table 2).
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