A Kaiser Permanente study of nearly 50,000 people with COVID-19 suggested that regular physical activity provided strong protection from hospitalisation, intensive care unit admission, and death. Even exercising inconsistently lowered the odds for severe COVID-19 outcomes when compared to people who were not active at all.
"This is a wake-up call for the importance of healthy lifestyles and especially physical activity," said Dr Robert E Sallis, a family and sports medicine physician at the Kaiser Permanente Fontana Medical Centre. "Kaiser Permanente's motivation is to keep people healthy, and this study truly shows how important that is during this pandemic and beyond. People who regularly exercise had the best chance of beating COVID-19, while people who were inactive did much worse."
To study the effect of exercise on COVID-19 outcomes, researchers identified 48,440 adults with a COVID-19 diagnosis from January 1, 2020, to October 21, 2020, who had 2 or more measurements of their Exercise Vital Sign between March of 2018 and March of 2020.
The Exercise Vital Sign measurement has been used at every outpatient encounter within Kaiser Permanente Southern California since 2009. To get the measurement, patients are asked how many days a week they engage in moderate to strenuous exercise and, on average, how many minutes they engage in exercise at that level. The responses are recorded in each patient's electronic health record.
The patients in this study had a median age of 47, included 61.9% females, and reflected the diverse racial makeup of the Southern California population. Of the total cohort, 6.4% were consistently active and 14.4% were consistently inactive, with the remainder falling in the inconsistently active category.
Among all COVID-19 patients, 8.6% were hospitalised, 2.4% were admitted to the ICU, and 1.6% died. The results of the study show inactivity is strongly associated with poor COVID-19 outcomes.
Physical activity provided strong protection from hospitalisation, ICU admission, and death among COVID-19 patients.
Being consistently inactive more than doubled the odds of hospitalisation compared with being consistently active.
Patients who were consistently inactive had 1.73 times greater odds of ICU admission than patients who were consistently active.
The odds for death were 2.49 times greater for patients who were consistently inactive compared with patients who were consistently active.
Other than being over age 60 or having a history of organ transplant, being consistently inactive conferred the highest risk for death from COVID-19.
Even patients who were inconsistently active had lower odds for severe COVID-19 when compared to those who were consistently inactive, suggesting any amount of physical activity has benefit.
"What surprised me the most from this study was the strength of the association between inactivity and poor outcomes from COVID-19," said study co-author Dr Deborah Rohm Young, of the Kaiser Permanente Southern California department of research & evaluation. "Even after we included variables such as obesity and smoking in the analysis, we still saw inactivity was strongly associated with much higher odds of hospitalisation, ICU admission, and death compared with moderate physical activity or any activity at all."
Sallis said his prescription is straightforward: "Walk 30 minutes a day, 5 days a week at a moderate pace and that will give you a tremendous protective effect against COVID-19." He added that the way someone can gauge whether they are walking at a moderate pace is that they are too winded to sing but can still talk.
"I continue to believe that exercise is medicine that everyone should take – especially in this era of COVID-19," Sallis said.
Study details
Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients
Robert Sallis, Deborah Rohm Young, Sara Y Tartof, James F Sallis, Jeevan Sall, Qiaowu Li, Gary N Smith, Deborah A Cohen
Published in the British Journal of Sports Medicine on 13 April 2021
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.
Kaiser Permanente Southern California material
British Journal of Sports Medicine study (Open access)
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