ImportanceThe association of moderate to vigorous physical activity (MVPA) with COVID-19 outcomes is unclear and needs to be investigated.ObjectiveTo identify the association of longitudinal changes in MVPA with SARS-CoV-2 infection and severe COVID-19 outcomes.Design, Setting, and ParticipantsThis nested case-control study used data from 6 396 500 adult patients in South Korean who participated in National Health Insurance Service (NHIS) biennial health screenings from period 1 (2017-2018) to period 2 (2019-2020). Patients were followed from October 8, 2020, until the diagnosis of COVID-19 or December 31, 2021.ExposureModerate to vigorous physical activity was measured by self-report on questionnaires during both NHIS health screenings and calculated by adding the frequency (times per week) of each moderate (≥30 minutes per day) and vigorous (≥20 minutes per day) physical activity.Main Outcomes and MeasuresThe main outcomes were a positive diagnosis of SARS-CoV-2 infection and severe COVID-19 clinical events. Adjusted odds ratio (aORs) and 99% CIs were calculated using multivariable logistic regression analysis.ResultsA total of 183 350 patients with COVID-19 (mean [SD] age, 51.9 [13.8] years; female, 89 369 [48.7%]; male, 93 981 [51.3%]) among 2 110 268 participants were identified. For participants with vs without COVID-19, the proportion of MVPA frequency at period 2 was 35.8% vs 35.9% for physically inactive, 18.9% vs 18.9% for 1 to 2 times per week, 17.7% vs 17.7% for 3 to 4 times per week, and 27.5% vs 27.4% for 5 or more times per week. Among unvaccinated, physically inactive patients at period 1, the odds for infection increased when engaged in MVPA 1 to 2 times per week (aOR, 1.08; 99% CI, 1.01-1.15), 3 to 4 times per week (aOR, 1.09; 99% CI, 1.03-1.16), or 5 or more times per week (aOR, 1.10; 99% CI, 1.04-1.17) at period 2. Conversely, among unvaccinated patients with MVPA of 5 or more times per week at period 1, the odds for infection decreased when engaged 1 to 2 times per week (aOR, 0.90; 99% CI, 0.81-0.98) or physically inactive (aOR, 0.80; 99% CI, 0.73-0.87) at period 2. The trend of MVPA and incident infection was mitigated when participants were fully vaccinated. Furthermore, the odds for severe COVID-19 showed significant but limited associations with MVPA.Conclusions and RelevanceThe findings of this nested case-control study show a direct association of MVPA with risk of SARS-CoV-2 infection, which was mitigated after completion of the COVID-19 vaccination primary series. In addition, higher levels of MVPA were associated with a lower risk of severe COVID-19 outcomes to limited proportions.

Background: Physical activity is known to have strong benefits on prevention and management of cardiovascular disease (CVD). Also, diabetes is known to increase the risk of cardiovascular disease-related morbidity and mortality. However, the evidence of association between changes in physical activity and risk of cardiovascular disease is limited, especially among patients with type 2 diabetes (T2DM). Methods: A total of 20,598 patients with newly diagnosed diabetes were extracted from the Korean National Health Insurance Service-Health Screening Cohort. Self-reported questionnaires using a 7-day recall method were used to assess physical activity and calculated in metabolic equivalent task (MET) score. Physical activity level was measured in the screening period Ⅰ (2009-10) and period Ⅱ (2011-12) and assessed the change in physical activity level with CVD risks. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using multivariable-adjusted Cox proportional hazards regression. Results: Compared with the patients from the screening period Ⅰ(2009-10) to period Ⅱ (2011-12), those who increased their physical activity level from sedentary to active showed a 35% lower risk of overall CVD risk (aHR 0.65, 95% CI 0.44-0.96). Inversely, those who decreased their physical activity level from active to sedentary showed a 79% higher risk of overall CVD risk (aHR 1.79, 95% CI 1.17-2.72). Conclusions: Among patients with newly diagnosed T2DM, change in physical activity showed an inverse relationship with CVD risk. Maintaining a modest level of physical activity is important in reducing CVD risk.

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