Association of Physical Activity With SARS-CoV-2 Infection and Severe Clinical Outcomes Among Patients in South Korea

Abstract

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.

COVID-19-related cardiovascular disease risk due to weight gain: a nationwide cohort study

“…Vaccination can lower the severity and mortality of COVID-19, and may also alter the obesity-cardiovascular disease link in COVID-19 patients [ 37 ]. At a similar time, the proportion of unvaccinated individuals among those infected with COVID-19 is approximately around 40% according to previous studies [ 38 , 39 ]. Our NHIS claims data study extensively controlled for confounding factors (age, sex, habits, comorbidities, medications), boosting causal inference.…”

Physical Activity Modifies the Severity of COVID-19 in Hospitalized Patients—Observational Study

“…This information seems important not only for individuals but also for health authorities regarding healthcare direction. Although the potential biological mechanism of how PA affects our immunity at the system or cell levels, or how it modulates the release of different substances is explained in a comprehensive review by Jakobsson et al [ 43 ]; our study complements this knowledge with clinical trial results.…”