Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults
Ezzatvar et al.,
Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and..,
British Journal of Sports Medicine, doi:10.1136/bjsports-2022-105733 (meta analysis)
Systematic review and meta-analysis of 16 studies, showing lower risk of cases, hospitalization, severe cases, and mortality with regular physical activity. A non-linear dose-response relationship was seen with benefits reducing above 500 MET-min/week.
Currently there are
53 exercise studies and meta analysis shows:
risk of death, 43.0% lower, RR 0.57, p < 0.001.
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risk of severe case, 34.0% lower, RR 0.66, p < 0.001.
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risk of hospitalization, 36.0% lower, RR 0.64, p < 0.001.
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risk of case, 11.0% lower, RR 0.89, p < 0.001.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Ezzatvar et al., 22 Aug 2022, peer-reviewed, 4 authors.
Abstract: Review
Yasmin Ezzatvar ,1 Robinson Ramírez-Vélez ,2,3 Mikel Izquierdo ,2,3
Antonio Garcia-Hermoso 2
► Additional supplemental
material is published online
only. To view, please visit the
journal online (http://d x.doi.
org/1 0.1136/b jsports-2022-
105733).
1
Departamento de Enfermería,
Universitat de València,
Valencia, Spain
2
Navarrabiomed, Hospital
Universitario de Navarra (HUN),
Universidad Pública de Navarra
(UPNA), IdiSNA, Pamplona,
Spain
3
CIBER de Fragilidad y
Envejecimiento Saludable,
Instituto de Salud Carlos III,
Madrid, Spain
Correspondence to
Antonio Garcia-Hermoso,
Navarrabiomed, Hospital
Universitario de Navarra (HUN),
Universidad Pública de Navarra
(UPNA), IdiSNA, Pamplona
31006, Spain;
a ntonio.garciah@u navarra.es
Accepted 22 June 2022
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by BMJ.
To cite: Ezzatvar Y, Ramírez-
Vélez R, Izquierdo M, et al.
Br J Sports Med Epub ahead
of print: [please include Day
Month Year]. doi:10.1136/
bjsports-2022-105733
ABSTRACT
Objective To quantify the association between physical
activity and risk of SARS-CoV-2 infection, COVID-19-
associated hospitalisation, severe illness and death due
to COVID-19 in adults.
Design A systematic review and meta-analysis.
Data sources Three databases were systematically
searched through March 2022.
Eligibility criteria for selecting studies Peer-
reviewed articles reporting the association between
regular physical activity and at least one COVID-19
outcome in adults were included. Risk estimates (ORs,
relative risk (RR) ratios or HRs) were extracted and
pooled using a random-effects inverse-variance model.
Results Sixteen studies were included (n=1 853 610).
Overall, those who engaged in regular physical activity
had a lower risk of infection (RR=0.89; 95% CI 0.84 to
0.95; I2=0%), hospitalisation (RR=0.64; 95% CI 0.54 to
0.76; I2=48.01%), severe COVID-19 illness (RR=0.66;
95% CI 0.58 to 0.77; I2=50.93%) and COVID-19-related
death (RR=0.57; 95% CI 0.46 to 0.71; I2=26.63%) as
compared with their inactive peers. The results indicated
a non-linear dose–response relationship between
physical activity presented in metabolic equivalent of
task (MET)-min per week and severe COVID-19 illness
and death (p for non-linearity <0.001) with a flattening
of the dose–response curve at around 500 MET-min per
week.
Conclusions Regular physical activity seems to be
related to a lower likelihood of adverse COVID-19
outcomes. Our findings highlight the protective effects
of engaging in sufficient physical activity as a public
health strategy, with potential benefits to reduce the
risk of severe COVID-19. Given the heterogeneity and
risk of publication bias, further studies with standardised
methodology and outcome reporting are now needed.
PROSPERO registration number CRD42022313629.
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