Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study

Abstract

PurposeTo determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.MethodsData regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.ResultsOut of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500–1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.ConclusionAdults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.

Physical Activity and Well-Being during the Second COVID19-Related Lockdown in Germany in 2021

“…In a sample of 48,440 patients in the US, PA in compliance with current recommendations was associated with a reduced risk of hospitalization, intensive care unit admission and mortality [7]. Similar results were reported in a nationwide study in South-Korea [8]. Brawner and colleagues found that cardiorespiratory fitness was independently and inversely associated with the risk of COVID-19-related hospitalization [9].…”

Health-Related Behaviors and Odds of COVID-19 Hospitalization in a Military Population

“…Hospitalization criteria should be similar across Air Force military treatment facilities, and potential heterogeneity was accounted for by geographical matching of cases and controls. Furthermore, the use of hospitalization as an indicator of COVID-19 severity is widespread in studies of civilian populations ( 1 , 2 , 6 – 8 ).…”

“…These conditions are causally or noncausally related to various health-related behaviors, some of which are independently associated with COVID-19 severity. For example, current and former smoking status is associated with disease progression ( 6 ), and physical inactivity increases risk of hospitalization, intensive care unit admission, and mortality ( 7 , 8 ).…”

Potential Physiological and Cellular Mechanisms of Exercise That Decrease the Risk of Severe Complications and Mortality Following SARS-CoV-2 Infection

“…A prospective observational study in hospitalized patients with COVID-19 that assessed muscle strength on admission observed that the length of hospital stay was significantly shorter among patients in the highest tertile of strength [82]. Recently, a study investigating a cohort of 76,395 South Korean adults found that adults engaging in the recommended levels of PA had a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death [83]. In the aforementioned study, the authors argue that enhanced immunosurveillance, delayed onset of immunosenescence and reduced systemic inflammation, all to be discussed here, as possible explanations as immunological effects decreasing the risk of infection and severity due to COVID-19.…”