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Original article

Vol. 151 No. 4344 (2021)

One year follow-up of physical performance and quality of life in patients surviving COVID-19: a prospective cohort study

  • Martina Betschart
  • Spencer Rezek
  • Ines Unger
  • Natalie Ott
  • Swantje Beyer
  • André Böni
  • David Gisi
  • Harriet Shannon
  • Martijn A. Spruit
  • Cornel Sieber
Cite this as:
Swiss Med Wkly. 2021;151:w30072


INTRODUCTION: The coronavirus disease (COVID-19) continues to affect many countries globally, with the long-term impact of the disease now being recognized. According to the latest research, some of the affected individuals continue to experience functional limitations, reduced physical performance and impaired health-related quality of life (HRQoL) even after eight months. This prospective cohort study aimed to describe the longer-term recovery of physical performance and HRQoL in COVID-19 survivors over one year.

METHOD: A cohort (n = 43; 32-84 years old) hospitalized with COVID-19 between March and June 2020 was followed over one year and assessed at three time points: hospital discharge, 3 months and 12 months post-admission. Participants experienced mild (10/43) to critical (6/43) pneumonia and stayed in the hospital for a median of 10 days (IQR 9). Participants were assessed for physical performance (six-minute walk test), HRQoL (EQ-5D-5L), COVID-19 related limitations in functionality (PCFS), hospital-related anxiety and depression (HADS-A/-D), lung function (FEV1, FVC) and dyspnea during activity (mMRC). All assessments were conducted by physiotherapists trained in cardio-respiratory rehabilitation.

RESULTS: After discharge, 8/34 showed reduced physical performance, 9/42 had lower HRQoL and 14/32 had COVID-19 induced limitations in functionality on the PCFS scale. Physical performance did not change significantly between discharge and 12-month follow-up, but 15/34 participants showed clinically relevant improvements in walking distance (>30 m). However, 16/34 had a decreased walking distance >30 m when comparing 3-month to 12-month follow-up. At 12 months, 12/41 of participants still perceived COVID-19 related limitations in daily life on the PCFS scale. For HRQoL, 12/41 participants still perceived moderate-to-severe symptoms of pain and discomfort and 13/41 slight-to-severe symptoms of anxiety and depression.

CONCLUSION: This cohort of adult patients hospitalized for mild to severe COVID-19 in Switzerland was generally mildly affected but still reported some limitations after one year. These results offer preliminary indications for ongoing support after hospitalization and point towards the need for specific, individualized follow-up to support their recovery. (NCT04375709)


  1. World Health Organisation, W. WHO Coronavirus (COVID-19) Dashboard. 2021.
  2. Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021 Apr;27(4):601–15.
  3. Morin L, Savale L, Pham T, Colle R, Figueiredo S, Harrois A, et al.; Writing Committee for the COMEBAC Study Group. Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19. JAMA. 2021 Apr;325(15):1525–34.
  4. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021 Jan;397(10270):220–32.
  5. Anastasio F, Barbuto S, Scarnecchia E, Cosma P, Fugagnoli A, Rossi G, et al. Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life. Eur Respir J. 2021 Sep;58(3):2004015.
  6. Goërtz YM, Van Herck M, Delbressine JM, Vaes AW, Meys R, Machado FV, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res. 2020 Oct;6(4):00542-2020.
  7. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb;395(10223):497–506.
  8. Wong AW, Shah AS, Johnston JC, Carlsten C, Ryerson CJ. Patient-reported outcome measures after COVID-19: a prospective cohort study. Eur Respir J. 2020 Nov;56(5):2003276.
  9. Vaes, A.W. ; Goertz, Y.M.J. ; Van Herck, M. ; Machado, F.V.C. ; Meys, R. ; Delbressine, J.M. ; Houben-Wilke, S. ; Gaffron, S. ; Maier, D. ; Burtin, C. ; Posthuma, R. ; Van Loon, N. ; Franssen, F.M. ; Hajian, B. ; Simons, S.O. ; M., v.B.J.F.; Klok, F.A.; Spaetgens, B.; Pinxt, C.M.H.; Liu, L.Y.L.; Wesseling, G.; Spies, Y.; Vijlbrief, H.; van't Hul, A.J.; Janssen, D.J.; Spruit, M.A. Recovery from COVID-19: a sprint or marathon? 6 months follow-up data of online long COVID-19 support group members. ERJ Open Res 2021. 2021.
  10. van Gassel RJ, Bels J, Remij L, van Bussel BC, Posthuma R, Gietema HA, et al. Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study. Crit Care Med. 2021 Oct;49(10):1726–38.
  11. Meys R, Delbressine JM, Goërtz YM, Vaes AW, Machado FV, Van Herck M, et al. Generic and Respiratory-Specific Quality of Life in Non-Hospitalized Patients with COVID-19. J Clin Med. 2020 Dec;9(12):E3993.
  12. Baricich A, Borg MB, Cuneo D, Cadario E, Azzolina D, Balbo PE, et al.; No-more Covid Group. Midterm functional sequelae and implications in rehabilitation after COVID-19: a cross-sectional study. Eur J Phys Rehabil Med. 2021 Apr;57(2):199–207.
  13. Aranda J, Oriol I, Martín M, Feria L, Vázquez N, Rhyman N, et al. Long-term impact of COVID-19 associated acute respiratory distress syndrome. J Infect. 2021 Aug;S0163-4453(21)00396-0.
  14. Raman B, Cassar MP, Tunnicliffe EM, Filippini N, Griffanti L, Alfaro-Almagro F, et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021 Jan;31:100683.
  15. Belli S, Balbi B, Prince I, Cattaneo D, Masocco F, Zaccaria S, et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J. 2020 Oct;56(4):2002096.
  16. van den Borst B, Peters JB, Brink M, Schoon Y, Bleeker-Rovers CP, Schers H, et al. Comprehensive health assessment three months after recovery from acute COVID-19. Clin Infect Dis. 2020 Nov.
  17. Wu X, Liu X, Zhou Y, Yu H, Li R, Zhan Q, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med. 2021 Jul;9(7):747–54.
  18. Huang L, Yao Q, Gu X, Wang Q, Ren L, Wang Y, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021 Aug;398(10302):747–58.
  19. Vaes AW, Machado FV, Meys R, Delbressine JM, Goertz YM, Van Herck M, et al. Care Dependency in Non-Hospitalized Patients with COVID-19. J Clin Med. 2020 Sep;9(9):E2946.
  20. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al.; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007 Nov;18(6):805–35.
  21. Wolfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Muller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020 Apr;581(7809):465–9.
  22. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar;382(13):1199–207.
  23. Betschart M, Rezek S, Unger I, Beyer S, Gisi D, Shannon H, et al. Feasibility of an Outpatient Training Program after COVID-19. Int J Environ Res Public Health. 2021 Apr;18(8):3978.
  24. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul;166(1):111–7.
  25. EuroQol Research Foundation [Internet]; [cited 2020 March 21]. Available from:
  26. Klok FA, Boon GJ, Barco S, Endres M, Geelhoed JJ, Knauss S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020 Jul;56(1):2001494.
  27. Machado FV, Meys R, Delbressine JM, Vaes AW, Goërtz YM, van Herck M, et al. Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19. Health Qual Life Outcomes. 2021 Feb;19(1):40.
  28. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest. 1988 Mar;93(3):580–6.
  29. World Health Organisation. W. Clinical management of COVID-19: intermim guidance. [Internet] WHO; [modified 27 May 2020; cited 2021 26 January ]. Available from:
  30. Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999 Aug;14(2):270–4.
  31. Poulain M, Durand F, Palomba B, Ceugniet F, Desplan J, Varray A, et al. 6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD. Chest. 2003 May;123(5):1401–7.
  32. Todt BC, Szlejf C, Duim E, Linhares AO, Kogiso D, Varela G, et al. Clinical outcomes and quality of life of COVID-19 survivors: A follow-up of 3 months post hospital discharge. Respir Med. 2021 Aug;184:106453.
  33. Grochtdreis T, Dams J, König HH, Konnopka A. Health-related quality of life measured with the EQ-5D-5L: estimation of normative index values based on a representative German population sample and value set. Eur J Health Econ. 2019 Aug;20(6):933–44.
  34. Hinz A, Kohlmann T, Stöbel-Richter Y, Zenger M, Brähler E. The quality of life questionnaire EQ-5D-5L: psychometric properties and normative values for the general German population. Qual Life Res. 2014 Mar;23(2):443–7.
  35. Polkey MI, Spruit MA, Edwards LD, Watkins ML, Pinto-Plata V, Vestbo J, et al.; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study Investigators. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med. 2013 Feb;187(4):382–6.
  36. Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec;44(6):1447–78.
  37. Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017 Apr;23(2):377–81.
  38. Chan KS, Pfoh ER, Denehy L, Elliott D, Holland AE, Dinglas VD, et al. Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest. 2015 May;147(5):1316–26.