Prepandemic Physical Activity and Risk of COVID-19 Diagnosis and Hospitalization in Older Adults
DVM, MPH; Dennis Muñoz-Vergara, PhD Peter M Wayne, MS Eunjung Kim, MBBS, ScD ; I-Min Lee, ScD Julie E Buring, MD, DrPH Joann E Manson, ScD, MPH Howard D Sesso, Wayne Muñoz-Vergara, Kim, Buring, Manson, Sesso Lee
doi:10.1001/jamanetworkopen.2023.55808
IMPORTANCE Higher prepandemic physical activity (PA) levels have been associated with lower risk and severity of COVID-19. OBJECTIVE To investigate the association between self-reported prepandemic PA levels and the risk and severity of COVID-19 in older US adults. DESIGN, SETTING, AND PARTICIPANTS This cohort study combined cohorts from 3 ongoing prospective randomized clinical trials of US adults aged 45 years or older who provided prepandemic self-reports of baseline leisure-time PA and risk factors for COVID-19 outcomes using the most recent questionnaire completed as of December 31, 2019, as the baseline PA assessment. In multiple surveys from May 2020 through May 2022, participants indicated whether they had at least 1 positive COVID-19 test result or were diagnosed with or hospitalized for COVID-19. EXPOSURE Prepandemic PA, categorized into 3 groups by metabolic equivalent hours per week: inactive (0-3.5), insufficiently active (>3.5 to <7.5), and sufficiently active (Ն7.5).
MAIN OUTCOME AND MEASURES Primary outcomes were risk of COVID-19 and hospitalization for COVID-19. Multivariable logistic regression was used to estimate odd ratios (ORs) and 95% CIs for the association of COVID-19 diagnosis and/or hospitalization with each of the 2 upper PA categories vs the lowest PA category.
RESULTS The pooled cohort included 61 557 participants (mean [SD] age, 75.7 [6.4] years; 70.7% female), 20.2% of whom were inactive; 11.4%, insufficiently active; and 68.5%, sufficiently active. A total of 5890 confirmed incident cases of COVID-19 were reported through May 2022, including 626 hospitalizations. After controlling for demographics, body mass index, lifestyle factors, comorbidities, and medications used, compared with inactive individuals, those insufficiently active had no significant reduction in infection (OR, 0.96; 95% CI, 0.86-1.06) or hospitalization (OR, 0.98; 95% CI, 0.76-1.28), whereas those sufficiently active had a significant reduction in infection (OR, 0.90; 95% CI, 0.84-0.97) and hospitalization (OR, 0.73; 95% CI, 0.60-0.90). In subgroup analyses, the association between PA and SARS-CoV-2 infection differed by sex, with only sufficiently active women having decreased odds (OR, 0.87; 95% CI, 0.79-0.95; P = .04 for interaction).
CONCLUSIONS AND RELEVANCE In this cohort study of adults aged 45 years or older, those who adhered to PA guidelines before the pandemic had lower odds of developing or being hospitalized for COVID-19. Thus, higher prepandemic PA levels may be associated with reduced odds of SARS-CoV-2 infection and hospitalization for COVID-19.
Author Contributions: Drs Kim and Sesso had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Muñoz-Vergara and Wayne contributed equally to this work. Concept and design: Wayne, Manson, Sesso.
Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Muñoz-Vergara, Wayne, Sesso.
Critical review of the manuscript for important intellectual content: All authors. Statistical analysis: Muñoz-Vergara, Kim. Obtained funding: Wayne, Lee, Sesso. Administrative, technical, or material support: Muñoz-Vergara, Lee, Manson, Sesso. Supervision: Wayne, Manson, Sesso. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Conflict of Interest Data Sharing Statement: See Supplement 2. Additional Contributions: We thank the COSMOS, VITAL, and WHS study participants and research staff for their tremendous dedication and commitment.
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