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0 0.5 1 1.5 2+ Hospitalization 74% unadjusted Improvement Relative Risk Exercise for COVID-19  Brawner et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective study in the USA (February - May 2020) Lower hospitalization with higher activity levels (p=0.0012) Brawner et al., Mayo Clinic Proceedings, Oct 2020 Favors exercise Favors inactivity

Inverse Relationship of Maximal Exercise Capacity to Hospitalization Secondary to Coronavirus Disease 2019

Brawner et al., Mayo Clinic Proceedings, doi:10.1016/j.mayocp.2020.10.003
Oct 2020  
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Retrospective 246 COVID-19 patients in the USA, showing the risk of hospitalization inversely associated with maximal exercise capacity. Adjusted results are only provided for MET as a continuous variable.
risk of hospitalization, 74.2% lower, OR 0.26, p = 0.001, unadjusted, inverted to make OR<1 favor high activity levels, highest fitness quartile vs. lowest fitness quartile, RR approximated with OR, excluded in exclusion analyses: unadjusted results with no group details.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Brawner et al., 10 Oct 2020, retrospective, USA, peer-reviewed, 10 authors, study period 29 February, 2020 - 30 May, 2020.
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Inverse Relationship of Maximal Exercise Capacity to Hospitalization Secondary to Coronavirus Disease 2019
PhD Clinton A Brawner, PhD Jonathan K Ehrman, Shane Bole, PhD Dennis J Kerrigan, MD Sachin S Parikh, DO; Barry K Lewis, MD Ryan M Gindi, MD Courtland Keteyian, MD Khaled Abdul-Nour, PhD Steven J Keteyian
Mayo Clinic Proceedings, doi:10.1016/j.mayocp.2020.10.003
Objective: To investigate the relationship between maximal exercise capacity measured before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalization due to coronavirus disease 2019 (COVID-19). Methods: We identified patients (!18 years) who completed a clinically indicated exercise stress test between January 1, 2016, and February 29, 2020, and had a test for SARS-CoV-2 (ie, real-time reverse transcriptase polymerase chain reaction test) between February 29, 2020, and May 30, 2020. Maximal exercise capacity was quantified in metabolic equivalents of task (METs). Logistic regression was used to evaluate the likelihood that hospitalization secondary to COVID-19 is related to peak METs, with adjustment for 13 covariates previously identified as associated with higher risk for severe illness from COVID-19. Results: We identified 246 patients (age, 59AE12 years; 42% male; 75% black race) who had an exercise test and tested positive for SARS-CoV-2. Among these, 89 (36%) were hospitalized. Peak METs were significantly lower (P<.001) among patients who were hospitalized (6.7AE2.8) compared with those not hospitalized (8.0AE2.4). Peak METs were inversely associated with the likelihood of hospitalization in unadjusted (odds ratio, 0.83; 95% CI, 0.74-0.92) and adjusted models (odds ratio, 0.87; 95% CI, 0.76-0.99). Conclusion: Maximal exercise capacity is independently and inversely associated with the likelihood of hospitalization due to COVID-19. These data further support the important relationship between cardiorespiratory fitness and health outcomes. Future studies are needed to determine whether improving maximal exercise capacity is associated with lower risk of complications due to viral infections, such as COVID-19.
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