High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there potential implications for COVID-19?

Eur J Clin Invest. 2021 Mar;51(3):e13490. doi: 10.1111/eci.13490. Epub 2021 Jan 22.


Background: There is an ongoing debate on a potential protective role of habitual physical activity and passive heat therapy on the risk of COVID-19, a respiratory infectious disease that can manifest as severe pneumonia. To explore these putative roles, we evaluated the independent and joint associations of cardiorespiratory fitness (CRF) and frequency of sauna bathing (FSB) with pneumonia risk in a prospective cohort study of 2275 men aged 42-61 years at recruitment.

Material and methods: Objectively measured CRF and self-reported sauna bathing habits were assessed at baseline. CRF was categorized as low and high (median cut-offs) and FSB as low and high (defined as ≤1 and 2-7 sessions/wk, respectively). Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident pneumonia.

Results: During a median follow-up of 26.6 years, 529 cases of pneumonia occurred. Comparing high vs low CRF, the multivariable-adjusted HR (95% CIs) for pneumonia was 0.75 (0.61-0.91). Comparing high vs low FSB, the corresponding HR was 0.81 (0.68-0.97). Compared to men with low CRF & low FSB, the multivariable-adjusted HRs of pneumonia for the following groups: high CRF & low FSB; low CRF & high FSB; and high CRF & high FSB were 0.88 (0.65-1.20), 0.89 (0.71-1.13), and 0.62 (0.48-0.80) respectively.

Conclusions: In a general male Caucasian population, a combination of high fitness levels and frequent sauna baths is associated with a substantially lowered future pneumonia risk compared with each modality alone. The implications of these findings in altering COVID-19 disease or its severity deserve study.

Keywords: COVID-19; cardiorespiratory fitness; pneumonia; sauna.

MeSH terms

  • COVID-19 / epidemiology
  • Cardiorespiratory Fitness*
  • Cohort Studies
  • Finland / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia / epidemiology*
  • Prospective Studies
  • SARS-CoV-2
  • Safety Management
  • Steam Bath / statistics & numerical data*