Sustained reduction in cardiopulmonary fitness in Long COVID: A report from the RECOVER-Adult cohort study
Vogel, JM; Jenkins, T; Cerda, M; et al., JACC: Advances, June 2026
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Short Summary
In this RECOVER study, researchers looked at the heart and lung health of 1,475 adults about 21 months after getting COVID-19. The study used a wearable wrist device (called a Fitbit) to take measurements of heart and lung health. Researchers found that adults with more Long COVID symptoms showed signs of lower physical fitness. These adults had higher resting heart rate, lower heart rate variability (a measure of heart stress), took fewer daily steps, and spent less time being active. People with lower physical fitness and activity levels also reported having more symptoms, like feeling very tired (fatigue), dizziness, and feeling worse after activity. These findings show that Long COVID may be linked to lasting problems with physical fitness and daily activity almost 2 years after getting COVID-19. This study is important because it points out how wearable wrist devices may help researchers and doctors track how Long COVID affects the body over time.
This summary was prepared by the RECOVER Initiative.
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