The association of estimated cardiorespiratory fitness with COVID-19 incidence and mortality: A cohort study

{ 'indexed': {'date-parts': [[2022, 4, 13]], 'date-time': '2022-04-13T08:17:08Z', 'timestamp': 1649837828702}, 'reference-count': 42, 'publisher': 'Public Library of Science (PLoS)', 'issue': '5', 'license': [ { 'start': { 'date-parts': [[2021, 5, 5]], 'date-time': '2021-05-05T00:00:00Z', 'timestamp': 1620172800000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': ['www.plosone.org'], 'crossmark-restriction': False}, 'short-container-title': ['PLoS ONE'], 'abstract': '<jats:sec id="sec001">\n' '<jats:title>Background</jats:title>\n' '<jats:p>It has been suggested that cardiorespiratory fitness (CRF) may be used to identify ' 'those at greatest risk for severe COVID-19 illness. However, no study to date has examined ' 'the association between CRF and COVID-19. The objectives of this study were to determine ' 'whether CRF is independently associated with testing positive with or dying from ' 'COVID-19.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec002">\n' '<jats:title>Methods</jats:title>\n' '<jats:p>This is a prospective cohort study of 2,690 adults from the UK Biobank Study that ' 'were followed from March 16<jats:sup>th</jats:sup>, 2020 to July 26<jats:sup>th</jats:sup>, ' '2020. Participants who were tested for COVID-19 and had undergone CRF assessment were ' 'examined. CRF was estimated (eCRF) and categorized as low (&lt;20<jats:sup>th</jats:sup> ' 'percentile), moderate (20<jats:sup>th</jats:sup> to 80<jats:sup>th</jats:sup> percentile) and ' 'high (≥80<jats:sup>th</jats:sup> percentile) within sex and ten-year age groups (e.g. 50–60 ' 'years). Participants were classified as having COVID-19 if they tested positive (primarily ' 'PCR tests) at an in-patient or out-patient setting as of July 26, 2020. Participants were ' 'classified as having died from COVID-19 if the primary or underlying cause of death was ' 'listed ICD-10 codes U071 or U072 by June 30<jats:sup>th</jats:sup>, 2020. Adjusted risk ' 'ratios (aRR) and 95% confidence intervals (CI) were estimated and a forward model building ' 'approach used to identify covariates.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec003">\n' '<jats:title>Findings</jats:title>\n' '<jats:p>There was no significant association between eCRF and testing positive for COVID-19. ' 'Conversely, individuals with moderate (aRR = 0.43, 95% CI: 0.25, 0.75) and high fitness (aRR ' '= 0.37, 95% CI: 0.16, 0.85) had a significantly lower risk of dying from COVID-19 than those ' 'with low fitness.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec004">\n' '<jats:title>Conclusions</jats:title>\n' '<jats:p>While eCRF was not significantly associated with testing positive for COVID-19, we ' 'observed a significant dose-response between having higher eCRF and a decreased risk of dying ' 'from COVID-19. This suggests that prior gains in CRF could be protective against dying from ' 'COVID-19 should someone develop the virus.</jats:p>\n' '</jats:sec>', 'DOI': '10.1371/journal.pone.0250508', 'type': 'journal-article', 'created': {'date-parts': [[2021, 5, 5]], 'date-time': '2021-05-05T19:42:53Z', 'timestamp': 1620243773000}, 'page': 'e0250508', 'update-policy': 'http://dx.doi.org/10.1371/journal.pone.corrections_policy', 'source': 'Crossref', 'is-referenced-by-count': 11, 'title': [ 'The association of estimated cardiorespiratory fitness with COVID-19 incidence and mortality: ' 'A cohort study'], 'prefix': '10.1371', 'volume': '16', 'author': [ { 'ORCID': 'http://orcid.org/0000-0001-5212-8688', 'authenticated-orcid': True, 'given': 'Rebecca A. 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