No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

Abstract

Background Regular physical activity (PA) has been postulated to improve, or at least maintain, immunity across the life span. However, the link between physical (in)activity and coronavirus disease-2019 (COVID-19) remains to be established. This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19. Methods Hospitalized patients with COVID-19 (mean age: 54.9 years) were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital) and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement. Results Median hospital length of stay was 7.0 ± 4.0 days; 3.3% of patients died, 13.8% were admitted to ICU, and 8.6% required mechanical ventilation. Adjusted linear regression models showed that PA indices were not associated with hospital length of stay (work index: β = -0.57 (95%CI: -1.80 to 0.65), p = 0.355; sport index: β = 0.43 (95%CI: -0.94 to 1.80), p = 0.536; leisure-time index: β = 1.18 (95%CI: -0.22 to 2.59), p = 0.099; total activity index: β = 0.20 (95%CI: -0.48 to 0.87), p = 0.563). None of the PA indices were associated with mortality, admission to ICU, or mechanical ventilation requirement (all p > 0.05). Conclusion Among hospitalized patients with COVID-19, PA did not independently associate with hospital length of stay or any other clinically relevant outcomes. These findings should be interpreted as meaning that, among already hospitalized patients with more severe forms of COVID-19, being active is a potential protective factor likely outweighed by a cluster of comorbidities (e.g., type 2 diabetes, hypertension, weight excess) and older age, suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.

The assessment of the risk of COVID-19 infection and its course in the medical staff of a COVID-only and a non-COVID hospital

“…Nevertheless, the studies on the effect of physical activity on the risk of COVID-19 infection and the severity of the course of infection are limited and remain inconclusive, which may be related to the methodology used. [31][32][33] In the study group, no correlation between the declared level of physical activity and the risk of COVID-19 infection or severity of SARS-CoV-2 was found.…”

Evidence-based physical activity for COVID-19: what do we know and what do we need to know?

“…However, recall bias cannot be ruled out, since questionnaires were completed up to 120 days after discharge, and for those who died, patients’ relatives provided the data. In fact, in a small-scale cohort study of 200 patients hospitalised with moderate-to-severe COVID-19 in Brazil, PA over the past 12 months was not associated with length of stay or any other clinical outcome 8. This does not mean that PA is futile in preventing severe cases of COVID-19, but that its benefits may vary across stages of the disease.…”

“…In fact, in a small-scale cohort study of 200 patients hospitalised with moderate-to-severe COVID-19 in Brazil, PA over the past 12 months was not associated with length of stay or any other clinical outcome. 8 This does not mean that PA is futile in preventing severe cases of COVID-19, but that its benefits may vary across stages of the disease.…”

Associations between sedentary behavior and negative emotions in adolescents during home confinement: Mediating role of social support and sleep quality

“…The global outbreak of the Omicron variant of COVID-19 virus in many places, including Shenzhen city (one of the most famous of China's special economic zones), resulted in dramatic changes to public life that were strongly influenced by governmental and public health-related actions ( Pinto et al, 2021 ). With the accelerated spread of the Omicron variant, a specific “city-wide lockdown” was imposed in Shenzhen lasting for 10 days.…”