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Factors affecting exercise performance at the 6-min walk test in long-COVID: a multicenter study from Italy
Marco Floridia1, Liliana Elena Weimer2, Paolo Palange3
1National Center for Global Health, Istituto Superiore Di Sanità, Viale Regina Elena 299, 00161, Rome, Italy. marco.floridia@iss.it.
Internal and Emergency Medicine
|June 30, 2026
Summary
Exercise capacity after COVID-19 is impacted by factors like disease severity, comorbidities, and lingering symptoms. Performance may gradually improve over time, but specific variables significantly affect outcomes.
Area of Science:
- Cardiology
- Pulmonology
- Infectious Diseases
- Rehabilitation Medicine
Background:
- Exercise intolerance is a common post-COVID-19 complication.
- Factors influencing exercise capacity after infection require further investigation.
Purpose of the Study:
- To assess clinical and demographic variables affecting exercise capacity post-COVID-19 using the 6-minute walk test (6MWD).
- To identify predictors of impaired exercise performance (6MWD < 60% of predicted value).
Main Methods:
- Multivariable analyses of 686 patients at a mean of 184 days post-COVID-19.
- Outcomes included absolute 6MWD and impaired performance.
- Variables analyzed: age, sex, comorbidities, COVID-19 severity, symptoms, vaccination, time since infection.
Main Results:
- Mean 6MWD was 474m; 8.3% had impaired performance.
- 6MWD was reduced by severe/critical COVID-19, six comorbidities (e.g., diabetes, heart disease), and four persistent symptoms (e.g., dyspnea, depressed mood).
- 6MWD improved by 2.6m/month post-infection; impaired performance linked to female sex, intensive respiratory support, specific comorbidities, and symptoms like nausea/vomiting.
Conclusions:
- Exercise performance after COVID-19 is multifactorial, with significant clinical impact from disease severity, comorbidities, and persistent symptoms.
- Spontaneous improvement in exercise capacity is observed over time post-infection.
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