Sustained reduction in cardiopulmonary fitness in Long COVID: A report from the RECOVER-Adult cohort study

• June 2026
• JACC: Advances

Publication Details

DOI: 10.1016/j.jacadv.2026.102923

Abstract

Background: Long-term effects 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 (RECOVER) 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.

Authors

Julia Moore Vogel, Trevor Jenkins, Marta Cerda, Hillary Chen, Jason Goldman, 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, RECOVER Consortium

Keywords

digital health; heart rate variability; Long COVID; physical activity; wearables