Sustained Reduction in Cardiopulmonary Fitness in Long COVID: A Report from the RECOVER-adult Cohort Study.

Publication Title

JACC Adv

Authors

• Julia Moore Vogel
• Trevor Jenkins
• Marta Cerda
• Hillary Chen
• Jason D. Goldman, Providence Swedish Medical Center, Seattle, Washington, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA.Follow
• Stuart D Katz
• Thomas F Patterson
• Hassan Ashktorab
• Logan Bartram
• Souptik Barua
• Hassan Brim
• Jeanette P Brown
• Mario Castro
• Elias Chaibub Neto
• David Chestek
• Matthew S Durstenfeld
• Kristine M Erlandson
• Valerie Flaherman
• Andrea S Foulkes
• Maher Ghamloush
• Francois Haddad
• Jennifer Hadlock
• James R Heath
• Bjoern Hornikel
• Elizabeth W Karlson
• Elizabeth S Kaufman
• Dean L Kellogg
• Emily B Levitan
• Bruce D Levy
• Jeff Martin
• Grace A McComsey
• Torri D Metz
• Robert W Motl
• Talal Moukabary
• Janet M Mullington
• Igho Ofotokun
• Megumi J Okumura
• Sairam Parthasarathy
• Beth A Plunkett
• W Brian Reeves
• Franz Rischard
• JohnRoss Rizzo
• Jake A Scott
• Zaki A Sherif
• Tanayott Thaweethai
• Joel D Trinity
• Meghasyam Tummalacherla
• Alfredo E Urdaneta
• Andrew J Vasey
• Daphne-Dominique Villanueva
• Tiffany A Walker
• Zanthia Wiley
• Solveig K Sieberts
• Jerry A Krishnan

Document Type

Article

Publication Date

6-22-2026

Keywords

digital health; heart rate variability; long COVID; physical activity; wearables.; washington; swedish; covid-19; isb; digital health; heart rate variability; long COVID; physical activity; wearables.; washington; swedish; covid-19; isb

Abstract

BACKGROUND: Long-term effect of COVID-19 (Long COVID) may persist for months or years after SARS-CoV-2 infection, but longer-term cardiopulmonary manifestations have not been previously reported.

OBJECTIVES: The objective of the study was to characterize cardiopulmonary function after SARS-CoV-2 infection in a digital health substudy of the nationwide Researching COVID-19 to Enhance Recovery Adult Cohort Study.

METHODS: Associations between wearable sensor device measures of cardiopulmonary fitness and survey-derived Long COVID symptoms were estimated over a 6-month window at least 6 months after infection using linear regression models adjusted for wear time, age, sex, race/ethnicity, and body mass index.

RESULTS: Among 1,475 participants (72% female, 65% non-Hispanic White) a median of 21 months (IQR: 15-31 months) after infection, 498 (34%) had high symptom burden as characterized by the Researching COVID-19 to Enhance Recovery Long COVID Research Index (LCRI). High LCRI (vs low LCRI) was associated with significantly lower heart rate variability (-4.4 ms; 95% CI: -6.5 to -2.4; P < 0.001), higher resting heart rate (+1.5 beats/min [+0.7 to +2.4]; P < 0.001), fewer metabolic equivalent of task minutes (-96.3 [-128.8 to -63.8]; P < 0.001), lower step counts (-1,624 steps/day [-1,952 to -1,296]; P < 0.001), and lower activity levels (-7.9 minutes/day very or fairly active [-10.9 to -5.0]; P < 0.001). Hierarchal clustering analysis identified two subphenotypes with abnormal cardiovascular measures associated with low quality of life scores.

CONCLUSIONS: Long COVID is associated with worse cardiovascular fitness. Additional studies are needed to determine if Long COVID is a novel risk factor for incident cardiovascular disease.

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Infectious Diseases

Specialty/Research Institute

Cardiology

Specialty/Research Institute

Health Information Technology

DOI

10.1016/j.jacadv.2026.102923