Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study

{ 'indexed': {'date-parts': [[2022, 4, 4]], 'date-time': '2022-04-04T20:42:17Z', 'timestamp': 1649104937092}, 'reference-count': 49, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2021, 10, 19]], 'date-time': '2021-10-19T00:00:00Z', 'timestamp': 1634601600000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2021, 10, 19]], 'date-time': '2021-10-19T00:00:00Z', 'timestamp': 1634601600000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [ { 'DOI': '10.13039/501100003793', 'name': 'Hjärt-Lungfonden', 'doi-asserted-by': 'publisher', 'award': ['20200564']}, { 'DOI': '10.13039/501100009238', 'name': 'Försvarsmakten', 'doi-asserted-by': 'publisher', 'award': ['AF9220915']}, { 'DOI': '10.13039/501100004359', 'name': 'Vetenskapsrådet', 'doi-asserted-by': 'publisher', 'award': ['2017-00273']}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'short-container-title': ['Int J Behav Nutr Phys Act'], 'published-print': {'date-parts': [[2021, 12]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>The impact of cardiorespiratory fitness (CRF) and other ' 'lifestyle-related factors on severe COVID-19 risk is understudied. The present study aims to ' 'investigate lifestyle-related and socioeconomic factors as possible predictors of COVID-19, ' 'with special focus on CRF, and to further study whether these factors may attenuate obesity- ' 'and hypertension-related risks, as well as mediate associations between socioeconomic factors ' 'and severe COVID-19 risk.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>Out of initially 407,131 participants who participated in nationwide ' 'occupational health service screening between 1992 and 2020, ' '<jats:italic>n</jats:italic>\u2009=\u2009857 cases (70% men, mean age 49.9\xa0years) of ' 'severe COVID-19 were identified. CRF was estimated using a sub-maximum cycle test, and other ' 'lifestyle variables were self-reported. Analyses were performed including both unmatched, ' '<jats:italic>n</jats:italic>\u2009=\u2009278,598, and sex-and age-matched, ' '<jats:italic>n</jats:italic>\u2009=\u20093426, controls. Severe COVID-19 included ' 'hospitalization, intensive care or death due to COVID-19.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Patients with more severe COVID-19 had significantly lower CRF, ' 'higher BMI, a greater presence of comorbidities and were more often daily smokers. In matched ' 'analyses, there was a graded decrease in odds for severe COVID-19 with each ml in CRF ' '(OR\u2009=\u20090.98, 95% CI 0.970 to 0.998), and a two-fold increase in odds between the ' 'lowest and highest (&lt;\u200932 vs.\u2009≥\u200946\xa0' 'ml·min<jats:sup>−1</jats:sup>·kg<jats:sup>−1</jats:sup>) CRF group. Higher BMI (per unit ' 'increase, OR\u2009=\u20091.09, 1.06 to 1.12), larger waist circumference (per cm, OR\u2009' '=\u20091.04, 1.02 to 1.06), daily smoking (OR\u2009=\u20090.60, 0.41 to 0.89) and high ' 'overall stress (OR\u2009=\u20091.36, 1.001 to 1.84) also remained significantly associated ' 'with severe COVID-19 risk. Obesity- and blood pressure-related risks were attenuated by ' 'adjustment for CRF and lifestyle variables. Mediation through CRF, BMI and smoking accounted ' 'for 9% to 54% of the associations between low education, low income and blue collar/low ' 'skilled occupations and severe COVID-19 risk. The results were consistent using either ' 'matched or unmatched controls.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>Both lifestyle-related and socioeconomic factors were associated with ' 'risk of severe COVID-19. However, higher CRF attenuated the risk associated with obesity and ' 'high blood pressure, and mediated the risk associated with various socioeconomic factors. ' 'This emphasises the importance of interventions to maintain or increase CRF in the general ' 'population to strengthen the resilience to severe COVID-19, especially in high-risk ' 'individuals.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s12966-021-01198-5', 'type': 'journal-article', 'created': { 'date-parts': [[2021, 10, 19]], 'date-time': '2021-10-19T10:12:28Z', 'timestamp': 1634638348000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 2, 'title': [ 'Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case ' 'control study'], 'prefix': '10.1186', 'volume': '18', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-3901-7833', 'authenticated-orcid': False, 'given': 'Elin', 'family': 'Ekblom-Bak', 'sequence': 'first', 'affiliation': []}, {'given': 'Daniel', 'family': 'Väisänen', 'sequence': 'additional', 'affiliation': []}, {'given': 'Björn', 'family': 'Ekblom', 'sequence': 'additional', 'affiliation': []}, {'given': 'Victoria', 'family': 'Blom', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lena V.', 'family': 'Kallings', 'sequence': 'additional', 'affiliation': []}, {'given': 'Erik', 'family': 'Hemmingsson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Gunnar', 'family': 'Andersson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Peter', 'family': 'Wallin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jane', 'family': 'Salier Eriksson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Tobias', 'family': 'Holmlund', 'sequence': 'additional', 'affiliation': []}, {'given': 'Magnus', 'family': 'Lindwall', 'sequence': 'additional', 'affiliation': []}, {'given': 'Andreas', 'family': 'Stenling', 'sequence': 'additional', 'affiliation': []}, {'given': 'Amanda', 'family': 'Lönn', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2021, 10, 19]]}, 'reference': [ { 'key': '1198_CR1', 'doi-asserted-by': 'crossref', 'unstructured': 'Ramos-Casals M, Brito-Zeron P, Mariette X. 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The study was approved by the Stockholm ' 'Ethics Review Board (Dnr 2020–02727), and adhered to the Declaration of ' 'Helsinki.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'Author GA (responsible for research and method) and PW (CEO and responsible for ' 'research and method) are employed by HPI Health Profile Institute. The ' 'remaining authors declare that they have no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '135'}