What is the clinical evidence from this study?

Study design: Observational. Population: COVID-19 (n=48440). Intervention: Physical inactivity (consistently inactive) vs. Consistently meeting physical activity guidelines (150+ min/week). Primary outcome: Hospitalisation due to COVID-19 (OR 2.26, 95% CI 1.81-2.83).

April 13, 2021British Journal of Sports Medicine814 citations

Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients

RSRobert E. SallisKaiser Permanente Fontana Medical Center DYDeborah Rohm YoungKaiser Permanente STSara Y. TartofKaiser Permanente

Key Result

Physical inactivity was associated with a higher risk for severe COVID-19 outcomes, with consistently inactive patients having 2.26 times greater odds of hospitalization compared to active patients.

Study Design

Type

Observational (n=48,440)

Multicenter

Yes

Structured PICO

Does physical inactivity increase the risk of hospitalization, ICU admission, and death in adult patients with COVID-19?

Population

48,440 adult patients (≥18 years) with a COVID-19 diagnosis between Jan 1, 2020 and Oct 21, 2020, continuously enrolled for at least 6 months prior, with at least three exercise vital sign measurements in the 2 years prior to the pandemic. Mean age 47.5, 61.9% female, based in Southern California, USA.

Intervention

Consistently inactive (0-10 min/week of moderate to vigorous physical activity based on self-reported exercise vital sign)

Comparator

Consistently meeting physical activity guidelines (≥150 min/week) or doing some activity (11-149 min/week)

Outcome

Hospitalisation, admission to the intensive care unit (ICU), and death due to COVID-19hard clinical

Consistently meeting physical activity guidelines prior to COVID-19 infection is strongly associated with a reduced risk of severe outcomes, including hospitalization, ICU admission, and death.

Main Result

Effect estimate: OR 2.26 (95% CI 1.81-2.83)

Absolute Event Rate: 10.5% vs 3.2%

Limitations

Measure of physical activity was self-reported
No measure of the intensity of exercise beyond the threshold of moderate to strenuous
Observational design cannot establish causality (potential reverse causality)
Potential residual confounding due to unmeasured confounders or measurement error
Sparse data in some variables, such as the highest age category
Self-reported physical activity measure
No measure of exercise intensity beyond 'moderate to strenuous'
Observational design cannot definitively prove causality (potential reverse causality)
Sparse data in some variables, such as the 80+ age category for death outcomes

Abstract

OBJECTIVES: To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines. METHODS: We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient's self-reported physical activity category (consistently inactive=0-10 min/week, some activity=11-149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes. RESULTS: Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity. CONCLUSIONS: Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.

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