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Objective To investigate the relationship between maximal exercise capacity measured before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization due to coronavirus disease 2019 (COVID-19). Patients and Methods We identified patients (≥18 years) who completed a clinically indicated exercise stress test between 01 January 2016 and 29 February 2020 and had a test for SARS-CoV-2 (i.e., real-time reverse transcriptase polymerase chain reaction test) between 29 February 2020 and 31 May 2020. Maximal exercise capacity was quantified in metabolic equivalents of task (METs). Logistic regression was used to evaluate the likelihood that hospitalization secondary to COVID-19 is related to peak METs, with adjustment for 13 covariates previously identified as associated with higher risk for severe illness from COVID-19. Results We identified 246 patients (age= 59±12 years; 42% male; 75% black race) who had an exercise test and tested positive for SARS-CoV-2. Among these, 89 (36%) were hospitalized. Peak METs were significantly lower (P <.001) among patients who were hospitalized (6.7±2.8) compared to those not hospitalized (8.0±2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (OR= 0.83, 95% CI= 0.74, 0.92) and adjusted models (OR= 0.87, 95% CI= 0.76, 0.99). Conclusion Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes. Future studies are needed to determine if improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.

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