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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

Lee et al., British Journal of Sports Medicine, doi:10.1136/bjsports-2021-104203
Jul 2021  
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Mortality 74% Improvement Relative Risk Severe case 58% Case 16% Exercise for COVID-19  Lee et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective 52,365 patients in South Korea (Jan - Jul 2020) Lower mortality (p=0.046) and severe cases (p=0.03) c19early.org Lee et al., British J. Sports Medicine, Jul 2021 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.
4,400+ studies for 79 treatments. c19early.org
Retrospective 212,768 adults in South Korea, showing lower risk of COVID-19 cases, severity, and mortality with physical activity. Notably, results for aerobic and muscle strengthening activities combined were much better than results for either one in isolation.
risk of death, 74.0% lower, RR 0.26, p = 0.046, high activity levels 2 of 11,072 (0.0%), low activity levels 32 of 41,293 (0.1%), NNT 1683, adjusted per study, odds ratio converted to relative risk, model 2,aerobic and muscle strengthening vs. insufficient aerobic and muscle strengthening, multivariable.
risk of severe case, 57.8% lower, RR 0.42, p = 0.03, high activity levels 39 of 11,072 (0.4%), low activity levels 273 of 41,293 (0.7%), adjusted per study, odds ratio converted to relative risk, model 2,aerobic and muscle strengthening vs. insufficient aerobic and muscle strengthening, multivariable.
risk of case, 15.6% lower, RR 0.84, p = 0.03, high activity levels 291 of 11,072 (2.6%), low activity levels 1,293 of 41,293 (3.1%), NNT 199, adjusted per study, odds ratio converted to relative risk, model 2,aerobic and muscle strengthening vs. insufficient aerobic and muscle strengthening, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Lee et al., 22 Jul 2021, retrospective, South Korea, peer-reviewed, 25 authors, study period 1 January, 2020 - 31 July, 2020.
This PaperExerciseAll
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
Professor Seung Won Lee, Jinhee Lee, Sung Yong Moon, Hyun Young Jin, Jee Myung Yang, Shuji Ogino, Mingyang Song, Sung Hwi Hong, Ramy Abou Ghayda, Andreas Kronbichler, Ai Koyanagi, Louis Jacob, Elena Dragioti, Lee Smith, Edward Giovannucci, I-Min Lee, Dong Hoon Lee, Keum Hwa Lee, Youn Ho Shin, So Young Kim, Min Seo Kim, Hong-Hee Won, Ulf Ekelund, Professor Jae Il Shin, Dong Keon Yon
British Journal of Sports Medicine, doi:10.1136/bjsports-2021-104203
Purpose To 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. Methods Data 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. Results Out 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. Conclusion Adults 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.
Competing interests None declared. Patient consent for publication Not required. Ethics approval The National Health Insurance Service-National Sample Cohort has ethical approval form the Institutional Review Board of Sejong University (SJU-HR-E-2020-003). Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available on reasonable request. Study protocol, statistical code: available from DKYon (email: yonkkang@ gmail. com). Data set: available from the National Health Insurance Service of Korea (NHIS-COVID-19 data) through a data use agreement. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by..
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Sparse data bias: a problem ' 'hiding in plain sight. BMJ 2016;352:i1981. doi:10.1136/bmj.i1981', 'DOI': '10.1136/bmj.i1981'}], 'container-title': ['British Journal of Sports Medicine'], 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://syndication.highwire.org/content/doi/10.1136/bjsports-2021-104203', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 7, 22]], 'date-time': '2021-07-22T17:25:55Z', 'timestamp': 1626974755000}, 'score': 1, 'resource': {'primary': {'URL': 'https://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2021-104203'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 7, 22]]}, 'references-count': 42, 'alternative-id': ['10.1136/bjsports-2021-104203'], 'URL': 'http://dx.doi.org/10.1136/bjsports-2021-104203', 'relation': {}, 'ISSN': ['0306-3674', '1473-0480'], 'issn-type': [{'value': '0306-3674', 'type': 'print'}, {'value': '1473-0480', 'type': 'electronic'}], 'subject': [ 'Physical Therapy, Sports Therapy and Rehabilitation', 'Orthopedics and Sports Medicine', 'General Medicine'], 'published': {'date-parts': [[2021, 7, 22]]}}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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