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Intrahospital supervised exercise training improves survival rate among hypertensive COVID-19 patients

Fernandez et al., Journal of Applied Physiology, doi:10.1152/japplphysiol.00544.2022
Feb 2023  
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Mortality 47% Improvement Relative Risk Exercise  Fernandez et al.  LATE TREATMENT Is late treatment with exercise beneficial for COVID-19? Retrospective 439 patients in Chile Lower mortality with exercise (p=0.018) Fernandez et al., J. Applied Physiology, Feb 2023 Favorsexercise Favorsinactivity 0 0.5 1 1.5 2+
Exercise for COVID-19
9th treatment shown to reduce risk in October 2020
*, now with p < 0.00000000001 from 66 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments.
Retrospective 439 severe COVID-19 hospitalized patients with hypertension, 201 receiving a supervised exercise program, showing significantly lower mortality with exercise. Exercise included of aerobic, breathing, and musculoskeletal exercises, 3 to 4 times per week. There were significantly more control patients on beta-adrenergic blockers and thiazide diuretics.
There are many possible mechanisms of action, including improved circulation, stress reduction, hormone regulation, improved sleep, increased antioxidant levels, and increased nitric oxide levels in the respiratory system. Over-exercising may be detrimental and lead to impaired immune function.
risk of death, 47.5% lower, RR 0.53, p = 0.02, high activity levels 16 of 201 (8.0%), low activity levels 62 of 238 (26.1%), NNT 5.5, adjusted per study, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fernandez et al., 2 Feb 2023, retrospective, Chile, peer-reviewed, 10 authors. Contact:,
This PaperExerciseAll
Francisco Fernandez, Manuel Vazquez-Muñoz, Andrea Canals, Alexis Arce-Álvarez, Camila Salazar-Ardiles, Cristian Alvarez, Rodrigo Ramirez- Campillo, Gregoire P Millet, Mikel Izquierdo, Ph.D David C Andrade, Andres Bello, Santiago
New & Noteworthy In the present study, we found that exercise training improves the survival rate in hypertensive COVID-19 patients during their hospitalization period. Our results provide strong evidence for the therapeutic efficacy of exercise training as a feasible approach to improving the outcomes of COVID-19 patients who suffer from hypertension during their hospitalization.
CONFLICT OF INTEREST None. AUTHOR CONTRIBUTION F.F., and M.V-M., contributed to the draft and preparation of the manuscript. F.F., M.V-M., and A.C., contributed to the analysis of the data. A.A.A., C.S-A., C.A., R-R-C., G.P-M., and M.I., contributed to the preparation of the manuscript. D.C.A. contributed to the concept of the project. D.C.A. contributed to the preparation of the manuscript. All authors approved the final version of the manuscript.
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{ 'indexed': {'date-parts': [[2023, 2, 3]], 'date-time': '2023-02-03T05:36:32Z', 'timestamp': 1675402592540}, 'reference-count': 0, 'publisher': 'American Physiological Society', 'funder': [ { 'DOI': '10.13039/501100002850', 'name': 'ANID | Fondo Nacional de Desarrollo Científico y Tecnológico', 'doi-asserted-by': 'publisher', 'award': ['11220870']}, { 'DOI': '10.13039/501100020884', 'name': 'Agencia Nacional de Investigación y Desarrollo', 'doi-asserted-by': 'publisher', 'award': ['ACT210083']}, {'name': 'Minera Escondida Ltda.', 'award': ['MEL2203']}], 'content-domain': {'domain': [''], 'crossmark-restriction': True}, 'abstract': '<jats:p> Among the people most affected by coronavirus disease 2019 (COVID-19) are those ' 'suffering from hypertension (HTN). However, pharmacological therapies for HTN are ineffective ' 'against COVID-19 progression and severity. It has been proposed that exercise training (EX) ' 'could be used as post-COVID treatment, which does not rule out the possible effects during ' 'hospitalization for COVID-19. Therefore, we aimed to determine the impact of supervised EX on ' 'HTN patients with COVID-19 during hospitalization. Among a total of 1,508 hospitalized ' 'COVID-19 patients (confirmed by PCR), 439 subjects were classified as having HTN and were ' 'divided into two groups: EX (n=201) and control (n=238) groups. EX (3 to 4 times per week ' 'during all hospitalizations) consisted of aerobic exercises (15 to 45 min) (i.e., walking); ' 'breathing exercises (10 to 15 min) (i.e., diaphragmatic breathing, pursed-lip breathing, ' 'active abdominal contraction); and musculoskeletal exercises (8-10 sets of 12-15 ' 'repetitions/week) (lifting dumbbells, standing up and sitting, lumbar stabilization). Our ' 'data revealed that the EX (clinician: patient, 1:1 ratio) intervention was able to improve ' 'survival rates among controlled HTN patients with COVID-19 during their hospitalization when ' 'compared to the control group (chi-squared: 4.83; hazard ratio: 1.8; 95% CI: 1.117 to 2.899; ' 'p=0.027). Multivariate logistic regression analysis revealed that EX was a prognostic marker ' '(odds ratio: 0.449; 95% CI: 0.230 to 0.874; p=0.018) along with sex and invasive and ' 'non-invasive mechanical ventilation. Our data showed that an intrahospital supervised EX ' 'program reduced the mortality rate among HTN patients suffering from COVID-19 during their ' 'hospitalization. </jats:p>', 'DOI': '10.1152/japplphysiol.00544.2022', 'type': 'journal-article', 'created': {'date-parts': [[2023, 2, 2]], 'date-time': '2023-02-02T14:53:49Z', 'timestamp': 1675349629000}, 'update-policy': '', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Intrahospital supervised exercise training improves survival rate among hypertensive COVID-19 ' 'patients', 'prefix': '10.1152', 'author': [ { 'given': 'Francisco', 'family': 'Fernandez', 'sequence': 'first', 'affiliation': [ { 'name': 'Exercise Applied Physiology Laboratory, Centro de Investigación ' 'en Fisiología y Medicina de Altura, Departamento Biomedico, ' 'Facultad de Ciencias de la Salud, Universidad de Antofagasta, ' 'Antofagasta, Chile'}, { 'name': 'Programa de Magister en Fisiología Clínica del Ejercicio, ' 'Facultad de Ciencias, Universidad Mayor, Santiago, Chile'}]}, { 'given': 'Manuel', 'family': 'Vazquez-Muñoz', 'sequence': 'additional', 'affiliation': [ { 'name': 'Escuela de Kinesiología, Facultad de Odontología y Ciencias de ' 'la Rehabilitación, Universidad San Sebastián, Santiago, Chile'}]}, { 'given': 'Andrea', 'family': 'Canals', 'sequence': 'additional', 'affiliation': [ { 'name': 'Unidad de Estadística, Departamento de Calidad, Clínica Santa ' 'María, Santiago, Chile'}]}, { 'given': 'Alexis', 'family': 'Arce-Álvarez', 'sequence': 'additional', 'affiliation': [ { 'name': 'Escuela de Kinesiología, Facultad de Odontología y Ciencias de ' 'la Rehabilitación, Universidad San Sebastián, Santiago, Chile'}]}, { 'given': 'Camila', 'family': 'Salazar-Ardiles', 'sequence': 'additional', 'affiliation': [ { 'name': 'Exercise Applied Physiology Laboratory, Centro de Investigación ' 'en Fisiología y Medicina de Altura, Departamento Biomedico, ' 'Facultad de Ciencias de la Salud, Universidad de Antofagasta, ' 'Antofagasta, Chile'}, { 'name': 'Navarrabiomed, Hospital Universitario de Navarra (HUN), ' 'Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, ' 'Spain'}]}, { 'given': 'Cristian', 'family': 'Alvarez', 'sequence': 'additional', 'affiliation': [ { 'name': 'Exercise and Rehabilitation Sciences Laboratory, School of ' 'Physical Therapy, Faculty of Rehabilitation Sciences, ' 'Universidad Andres Bello, Santiago, Chile'}]}, { 'given': 'Rodrigo', 'family': 'Ramirez-Campillo', 'sequence': 'additional', 'affiliation': [ { 'name': 'Exercise and Rehabilitation Sciences Laboratory, School of ' 'Physical Therapy, Faculty of Rehabilitation Sciences, ' 'Universidad Andres Bello, Santiago, Chile'}]}, { 'given': 'Grégoire P.', 'family': 'Millet', 'sequence': 'additional', 'affiliation': [ { 'name': 'Institute of Sport Sciences, University of Lausanne, Lausanne, ' 'Switzerland'}]}, { 'given': 'Mikel', 'family': 'Izquierdo', 'sequence': 'additional', 'affiliation': [ { 'name': 'Navarrabiomed, Hospital Universitario de Navarra (HUN), ' 'Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain'}, { 'name': 'CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de ' 'Salud Carlos III, Madrid, Spain'}]}, { 'given': 'David C.', 'family': 'Andrade', 'sequence': 'additional', 'affiliation': [ { 'name': 'Exercise Applied Physiology Laboratory, Centro de Investigación ' 'en Fisiología y Medicina de Altura, Departamento Biomedico, ' 'Facultad de Ciencias de la Salud, Universidad de Antofagasta, ' 'Antofagasta, Chile'}]}], 'member': '24', 'published-online': {'date-parts': [[2023, 2, 2]]}, 'container-title': 'Journal of Applied Physiology', 'original-title': [], 'language': 'en', 'link': [ { 'URL': '', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 2, 2]], 'date-time': '2023-02-02T14:53:59Z', 'timestamp': 1675349639000}, 'score': 1, 'resource': {'primary': {'URL': ''}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 2, 2]]}, 'references-count': 0, 'alternative-id': ['10.1152/japplphysiol.00544.2022'], 'URL': '', 'relation': {}, 'ISSN': ['8750-7587', '1522-1601'], 'subject': ['Physiology (medical)', 'Physiology'], 'container-title-short': 'Journal of Applied Physiology', 'published': {'date-parts': [[2023, 2, 2]]}, 'assertion': [ { 'value': '2022-09-12', 'order': 0, 'name': 'received', 'label': 'Received', 'group': {'name': 'publication_history', 'label': 'Publication History'}}, { 'value': '2023-01-23', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'publication_history', 'label': 'Publication History'}}, { 'value': '2023-02-02', 'order': 3, 'name': 'published', 'label': 'Published', 'group': {'name': 'publication_history', 'label': 'Publication History'}}]}
Late treatment
is less effective
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