In a recent study published within the American Journal of Preventive Medicine, researchers investigate the association between physical activity and coronavirus disease 2019 (COVID-19) severity outcomes amongst demographically diverse individuals suffering or not affected by chronic medical conditions in a dose-response manner.

Study: Associations of Physical Inactivity and COVID-19 Outcomes Amongst Subgroups. Image Credit: ViDl Studio / Shutterstock.com

Background

Physical activity prior to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis has been related to improved COVID-19 outcomes amongst individuals with chronic clinical conditions.

Nevertheless, the quantity of physical exertion required to guard against COVID-19 severity outcomes stays unclear. Furthermore, data on the protective effects of physical activity against SARS-CoV-2 infection amongst individuals with none underlying chronic medical condition are limited.  

It is important to characterize the advantage of physical exertion against COVID-19 severity by demographic parameters equivalent to sex, race, age, and ethnicity to guide policy-making and tailor healthcare strategy development for effective COVID-19 mitigation.

Concerning the study

In the current retrospective cohort study, researchers evaluate the dose-response association between physical activity and SARS-CoV-2 infection outcomes by patient demographics and the absence or presence of underlying chronic medical conditions.

The study comprised Kaiser Permanente Southern California (KPSC) adults diagnosed with COVID-19 between January 1, 2020, and May 31, 2021, whose electronic health record (EHR) data were analyzed. The study exposure was the median of three or more self-documented physical activity reports before the SARS-CoV-2 infection diagnosis amongst individuals who were constantly enrolled within the KPSC system for lower than or equal to 6 months prior to the diagnosis.

The team excluded hospitalized SARS-CoV-2-positive pregnant women whose delivery was scheduled through the period of the study. The study outcomes included hospital admission, deteriorating events, or death after 90 days of SARS-CoV-2 infection diagnosis.

Data were analyzed in 2022. Physical exertion levels were evaluated based on the exercise vital sign (EVS) scores. As well as, patients were asked to document the variety of days and duration of engagement in moderate or strenuous physical activity per week.

Based on the answers, the study participants were divided into the next groups:

• Consistently physically inactive (≥3.0 EVS assessments at ≤10.0 minutes weekly)
• Mostly physically inactive (≥1.0 EVS assessment for greater than 19 minutes weekly, or a median of 60 or fewer minutes weekly)
• Some physical exertion with median EVS values between 60 and 150 minutes weekly
• Consistently physically lively (≥1 EVS lower than 150 minutes weekly or a median exceeding 150 minutes weekly)
• At all times physically lively (≥3 EVS assessments exceeding 150 minutes weekly)

COVID-19-associated hospital admissions included those reported inside three weeks of diagnosis at KPSC hospitals. Deterioration events required intense respiratory care and/or intensive care unit (ICU) admission.

Chronic medical conditions included those related to adversarial SARS-CoV-2 infection outcomes, based on america Centers for Disease Control and Prevention (CDC), and were present prior to the infection. These included hypertension, cardiovascular diseases, diabetes, prior organ transplantations, cancer, and chronic obstructive pulmonary disease (COPD).  

Logistic regression modeling was performed, and odds ratios (ORs) were calculated.

Study findings

Out of 194,191 adult COVID-19 patients, 6% were admitted to hospitals, 3% developed deterioration events, and three% died inside 90 days of COVID-19 diagnosis. Among the many participants, 61%, 21%, 7%, and seven% were Hispanics, Whites, Blacks, Pacific Islanders, or Asians, respectively.

Greater than 50% of the participants had body mass index (BMI) values equal to or greater than 30 kg/m2. As well as, about 22% and 9% of people were diagnosed with hypertension and cardiovascular diseases, respectively.

Among the many study participants, 15%, 43%, 22%, 14%, and 6% were divided into the all the time inactive and mostly inactive, with some activity, consistently lively, and all the time lively groups, respectively. Consistently lively and all the time lively individuals were likelier to be younger males with lower BMI values and no smoking habits.

Consistently inactive and mostly inactive individuals were more more likely to be Black or Hispanic, have BMI values equal to or greater than 30 kg/m2, and suffer from hypertension or cardiovascular diseases.

Individuals engaged in some physical activity groups had 43% greater odds of hospitalization (OR=1.4), 83% higher odds of decay events (OR 1.8), and 92% greater odds of deaths (OR=1.9) as in comparison with individuals within the all the time lively category. Conversely, consistently inactive individuals had 91% higher hospitalization odds (OR 1.9), 139% higher deterioration event odds (OR=2.4), and 291%  higher death odds (OR=3.9) as in comparison with all the time lively individuals.

The percentages of hospitalization for people engaged in some physical activities were 31% greater for males (OR=1.3) and 84% greater for females (OR=1.8) than all the time lively individuals, with an interaction indicating greater odds for girls than for men across physical activity groups. As well as, even with some physical activity, hypertensive individuals had greater odds of death than always-active individuals (OR 1.9).

When comparing mostly physically inactive individuals with all the time lively individuals, significant ORs were noted for heart problems patients, including those with congestive cardiac failure, myocardial infarction, cerebrovascular diseases, and peripheral vascular diseases (OR 2.4).

Strong dose-response effects were observed. These findings were normally consistent across age, BMI, sex, ethnicity, and race for hypertensive individuals and people with cardiovascular diseases.

The findings indicate that physical inactivity was related to worse COVID-19 outcomes across clinical and demographic characteristics. Thus, public health authorities must incorporate physical activity into COVID-19 mitigation strategies.

Journal reference:

• Young, D. R., Sallis, J. F., Baecker, A., et al. (2022). Associations of Physical Inactivity and COVID-19 Outcomes Amongst Subgroups. American Journal of Preventive Medicine. doi:10.1016/j.amepre.2022.10.007.