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. 2022 May;56(10):568-576.
doi: 10.1136/bjsports-2021-105159. Epub 2022 Feb 9.

Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes

Lizelle Steenkamp  1 , Robin Terence Saggers  2   3 , Rossella Bandini  4 , Saverio Stranges  5   6 , Yun-Hee Choi  7 , Jane S Thornton  8 , Simon Hendrie  9 , Deepak Patel  1 , Shannon Rabinowitz  9 , Jon Patricios  10
Affiliations

Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes

Lizelle Steenkamp et al. Br J Sports Med. 2022 May.

Abstract

Objective: To determine the association between directly measured physical activity and hospitalisation, intensive care unit (ICU) admission, ventilation and mortality rates in patients with a confirmed diagnosis of COVID-19.

Methods: Directly measured physical activity data from 65 361 adult patients with a COVID-19 diagnosis from 19 March 2020 to 30 June 2021, were grouped by activity level: low (<60 min/week), moderate (60-149 min/week) and high activity (≥150 min/week). The association of physical activity levels and the risk of adverse outcomes was analysed using modified Poisson regression. We accounted for demographics and comorbidities including conditions known to influence COVID-19 outcomes, as well as patient complexity as measured by the Johns Hopkins Adjusted Clinical Group system. The regression approach was further validated with a Bayesian network model built off a directed acyclic graph.

Results: High physical activity was associated with lower rates of hospitalisation (risk ratio, RR 0.66, 95% CI 0.63 to 0.70), ICU admission (RR 0.59, 95% CI 0.52 to 0.66), ventilation (RR 0.55, 95% CI 0.47 to 0.64) and death (RR 0.58, 95% CI 0.50 to 0.68) due to COVID-19 than those who engaged in low physical activity. Moderate physical activity also was associated with lower rates of hospitalisation (RR 0.87, 95% CI 0.82 to 0.91), admission to ICU (RR 0.80, 95% CI 0.71 to 0.89), ventilation (RR 0.73, 95% CI 0.62 to 0.84) and death (RR 0.79, 95% CI 0.69 to 0.91).

Conclusions: Adults with high and moderate physical activity levels had significantly better outcomes than those with low activity when contracting COVID-19. The apparent protective effects of regular physical activity extended to those with concomitant chronic medical conditions.

Keywords: COVID-19; exercise; physical activity.

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Conflict of interest statement

Competing interests: LS, DP, SR and SH are employed by Discovery Health; JP and JST are editors of BJSM.

Figures

Figure 1
Figure 1
Distribution of patients by average monthly points and activity group.
Figure 2
Figure 2
Directed acyclic graph showing the implicitly assumed causal association between physical activity and risk of COVID-19 outcome. Confounders, potential mediators and associations are displayed. RUB, resource utilisation bands.
Figure 3
Figure 3
CONSORT diagram of patient selection. CONSORT, Consolidated Standards of Reporting Trials.
See this image and copyright information in PMC

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