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

DOI record: { "DOI": "10.1371/journal.pone.0250508", "ISSN": [ "1932-6203" ], "URL": "http://dx.doi.org/10.1371/journal.pone.0250508", "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>", "author": [ { "ORCID": "http://orcid.org/0000-0001-5212-8688", "affiliation": [], "authenticated-orcid": true, "family": "Christensen", "given": "Rebecca A. G.", "sequence": "first" }, { "affiliation": [], "family": "Arneja", "given": "Jasleen", "sequence": "additional" }, { "affiliation": [], "family": "St. Cyr", "given": "Kate", "sequence": "additional" }, { "affiliation": [], "family": "Sturrock", "given": "Shelby L.", "sequence": "additional" }, { "affiliation": [], "family": "Brooks", "given": "Jennifer D.", "sequence": "additional" } ], "container-title": [ "PLOS ONE" ], "content-domain": { "crossmark-restriction": false, "domain": [ "www.plosone.org" ] }, "created": { "date-parts": [ [ 2021, 5, 5 ] ], "date-time": "2021-05-05T19:42:53Z", "timestamp": 1620243773000 }, "deposited": { "date-parts": [ [ 2021, 5, 5 ] ], "date-time": "2021-05-05T19:43:37Z", "timestamp": 1620243817000 }, "editor": [ { "affiliation": [], "family": "Siegel", "given": "Robert", "sequence": "first" } ], "indexed": { "date-parts": [ [ 2022, 4, 13 ] ], "date-time": "2022-04-13T08:17:08Z", "timestamp": 1649837828702 }, "is-referenced-by-count": 11, "issn-type": [ { "type": "electronic", "value": "1932-6203" } ], "issue": "5", "issued": { "date-parts": [ [ 2021, 5, 5 ] ] }, "journal-issue": { "issue": "5", "published-online": { "date-parts": [ [ 2021, 5, 5 ] ] } }, "language": "en", "license": [ { "URL": "http://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2021, 5, 5 ] ], "date-time": "2021-05-05T00:00:00Z", "timestamp": 1620172800000 } } ], "link": [ { "URL": "https://dx.plos.org/10.1371/journal.pone.0250508", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "340", "original-title": [], "page": "e0250508", "prefix": "10.1371", "published": { "date-parts": [ [ 2021, 5, 5 ] ] }, "published-online": { "date-parts": [ [ 2021, 5, 5 ] ] }, "publisher": "Public Library of Science (PLoS)", "reference": [ { "key": "pone.0250508.ref001", "unstructured": "The World Health Organization, “Coronavirus disease 2019 (COVID-19) Situation Report-94 HIGHLIGHTS,” Geneva, 2020. 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