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

Exercise reduces the risk of severity of COVID-19

In a recent study published in American Journal of Preventive Medicine, researchers examine the association between physical activity and the severity of coronavirus disease 2019 (COVID-19) among demographically diverse individuals with or without chronic health conditions in a dose-dependent manner.

Studies: Association of physical inactivity and COVID-19 outcomes among subgroups. Image credit: ViDl Studio /


Physical activity prior to diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was associated with improved COVID-19 outcomes in individuals with chronic clinical conditions.

However, the amount of physical exercise needed to protect against the effects of the severity of COVID-19 remains unclear. Furthermore, data on the protective effects of physical activity against SARS-CoV-2 infection in individuals without any underlying chronic medical condition are limited.

It is essential to characterize the benefit of physical exercise against the severity of COVID-19 using demographic parameters such as sex, race, age, and ethnicity to guide policy making and tailor the development of health care strategies for effective mitigation of COVID-19 disease.

About studying

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

The study included 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. Study exposure was the median of three or more self-documented reports of physical activity prior to diagnosis of SARS-CoV-2 infection among individuals continuously enrolled in the KPSC system for less than or equal to six months prior to diagnosis.

The team excluded hospitalized pregnant women positive for SARS-CoV-2 whose delivery was scheduled during the study period. Study outcomes included hospital admissions, worsening events, or death within 90 days of diagnosis of SARS-CoV-2 infection.

Data were analyzed in 2022. Physical exercise levels were assessed using the Exercise Vital Signs Score (EVS). In addition, patients were asked to document the number of days and duration of moderate or vigorous physical activity per week.

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

  • Persistently physically inactive (≥3.0 EVS score at ≤10.0 minutes per week)
  • Mostly physically inactive (≥1.0 EVS score for more than 19 minutes per week or a median of 60 minutes or less per week)
  • Some physical exercise with moderate EVS values ​​between 60 and 150 minutes per week
  • Consistently physically active (≥1 EVS less than 150 minutes per week or median exceeding 150 minutes per week)
  • Always physically active (≥3 EDS ratings exceeding 150 minutes per week)

Hospitalizations related to COVID-19 included those reported within three weeks of diagnosis at KPSC hospitals. Deterioration cases required intensive respiratory care and/or intensive care unit (ICU) admission.

Chronic medical conditions included conditions related to adverse outcomes of SARS-CoV-2 infection according to the United States Centers for Disease Control and Prevention (CDC) and present before infection. These included hypertension, cardiovascular disease, diabetes, previous organ transplants, cancer, and chronic obstructive pulmonary disease (COPD).

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

Study results

Of the 194,191 adult patients with COVID-19, 6% were admitted to hospitals, 3% worsened, and 3% died within 90 days of being diagnosed with COVID-19. Participants were 61%, 21%, 7%, and 7% Hispanic, White, Black, Pacific Islander, or Asian, respectively.

More than 50% of participants had body mass index (BMI) values ​​equal to or greater than 30 kg/m2. Additionally, about 22% and 9% of individuals were diagnosed with hypertension and cardiovascular disease.

Among the study participants, 15%, 43%, 22%, 14% and 6% were divided into the groups of always inactive and mostly inactive, with some activity, permanently active and always active. Consistently active and always active individuals were likely to be younger men with lower BMIs and non-smokers.

Persistently inactive and mostly inactive individuals were more likely to be black or Hispanic and to have a BMI equal to or greater than 30 kg/m2and suffer from hypertension or cardiovascular diseases.

Individuals involved in some physical activity groups were 43% more likely to be hospitalized (OR=1.4), 83% more likely to worsen (OR 1.8), and 92% more likely to die (OR=1.9) compared to individuals in the always active category. Conversely, persistently inactive individuals were 91% more likely to be hospitalized (OR 1.9), 139% more likely to worsen (OR=2.4), and 291% more likely to die (OR=3.9) compared to always active individuals .

The odds of hospitalization for individuals engaged in some physical activity were 31% higher for men (OR=1.3) and 84% higher for women (OR=1.8) than for always active individuals, with the interaction suggesting a greater likelihood for women than in men across physical activity groups. Moreover, even with some physical activity, hypertensive individuals were more likely to die than consistently active individuals (OR 1.9).

When comparing mostly physically inactive individuals with always active individuals, significant ORs were noted in patients with cardiovascular disease, including patients with congestive heart failure, myocardial infarction, cerebrovascular disease, and peripheral vascular disease (OR 2.4).

Strong dose-response effects were observed. These findings were generally consistent across age, BMI, sex, ethnicity, and race in hypertensive and cardiovascular disease patients.

Findings suggest that physical inactivity was associated with poorer COVID-19 outcomes across clinical and demographic characteristics. Thus, public health authorities need to incorporate physical activity into their COVID-19 mitigation strategies.

Link to journal:

  • Young, DR, Sallis, JF, Baecker, A., et al. (2022). Association of physical inactivity and COVID-19 outcomes among subgroups. American Journal of Preventive Medicine. doi:10.1016/j.amepre.2022.10.007.

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