Higher rates of physical activity have been shown to have beneficial effects on numerous communicable diseases, but can the same be said for COVID-19?
Several risk factors for a severe COVID-19 infection are known, such as: B. Age, masculinity, ethnicity and the incidence of obesity, diabetes and cardiovascular disease. It is believed that physical activity also plays a role in predicting COVID-19 outcomes. However, there is still no study to confirm this hypothesis.
It is known that people who are physically active on a regular basis have higher immune activity and lower rates of comorbidity, such as obesity and diabetes, which we know to adversely affect COVID-19 results. Therefore, it is expected that regular physical activity can mitigate poor COVID results. A new study published in the BMJ should clarify this prediction.
Update your clinical knowledge
Methods
This study is a retrospective observational study in which data on physical activity in the electronic health record in the two years prior to March 2020 were evaluated. The study was conducted at Kaiser Permanente Souther California, a healthcare system that serves around 4.7 million residents in southern California.
Participant data were used in the study if they were at least 18 years old between January 1, 2020 and October 21, 2020 and had a positive COVID-19 test or diagnosis. Participants were required to conduct at least three physical activity vital sign (EVS) outpatient visits between March 19, 2018 and March 19, 2020 to ensure that regular physical activity habits were recorded.
The primary outcome measures were hospitalization, admission to the intensive care unit and death due to COVID-19. Demographics, BMI, clinical characteristics, service utilization and comorbidities were compared with statistical tools.
What is the exercise vital sign?
The exercise vital sign is a quick and easy way to assess an individual's physical activity. It consists of two basic questions:
How many days per week do you participate in moderate intensity or more on average (like a bisque walk)?
How many minutes do you train at this level on average?
These two answers are then multiplied to give a total of minutes per week of moderate or strenuous exercise. The outcome measure was validated for worldwide use in a systematic review published at the end of 2017.
Clinical significance & take away
A total of 48,880 patients with an average age of 47.5 years were included in the study, 62% were female and the average BMI was 31.2. Half of the participants had no comorbidities, a fifth had comorbidities and a third had two or more. Only 6.4% consistently met physical activity guidelines and 14.4% were consistently inactive, all others were somewhere in between.
Among patients with COVID, 4,236 were hospitalized with 1,199 ICU-admitted patients, and unfortunately 771 died. Overall, those who consistently followed physical activity guidelines were less likely to be hospitalized were rushed to the intensive care unit or died of COVID than those who were consistently inactive.
"Apart from age, pregnancy and previous history of an organ transplant, the consequent inactivity gave the highest chances for a hospital stay with COVID-19."
Being inactive at all times increased the likelihood of hospitalization by 2.26 times compared to consistently following physical activity guidelines. Those who participated in physical activity were 1.89 times more likely to be hospitalized. Apart from the age and history of the organ transplant, the consistent inactivity gave the highest chances of hospitalization with COVID-19.
Those who were consistently inactive were also 1.73 times more likely to be admitted to the intensive care unit and 2.49 times more likely to die as a result of COVID -19 than people who regularly participated in physical activity.
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Brief summary of the COVID-19 study on retrospective physical activity
People who are consistently inactive are 2.26 times more likely to be hospitalized, 1.73 times more likely to be taken to the intensive care unit and have a 2.49 times higher probability of death .
Apart from age, pregnancy and history of an organ transplant the consistent inactivity gave the highest chances of hospitalization with COVID-19 .
Participation in physical activity has positive effects on poor results.
Advice on all clinical interactions during the pandemic should include regular physical activity. This is in line with the MECC principles.
This is the first study to confirm that physical activity is an important modifiable risk factor for severe COVID-19 outcomes . Being consistently inactive outweighed the likelihood of smoking and virtually all other chronic illnesses. Comparing the results of people who are consistently inactive with those who are partially active suggests that there is a benefit to every activity.
It is possible that the results of this study underestimate the magnitude of the effect of physical inactivity due to the way in which the statistical models adapt for several chronic conditions. In both cases, this study confirms that we should encourage physical activity whenever we can during our clinical contact with patients.
