Pre-pandemic physical activity as a predictor of infection and mortality associated with COVID-: Evidence from the National Health Insurance Service
Yanan Zhao, Jennifer Hale-Gallardo, Saengryeol Park, Hyeseong Kim, So-Youn Park, In-Hwan Oh
Introduction: During the coronavirus disease (COVID-) pandemic, many populations have experienced reduced physical activity (PA) levels, weight gain, and increased anxiety and depression. However, according to a previous study, engaging in PA has a positive e ect on damages caused by COVID-. Therefore, this study aimed to investigate the association between PA and COVID-using the National Health Insurance Sharing Service Database in South Korea. Methods: Logistic regression analysis was used to analyze the association of PA with COVID-and mortality. The analysis was adjusted for body mass index, sex, age, insurance type, comorbidity, and region of residence at baseline. Disability and lifestyle (weight, smoking, and drinking status) were adjusted consecutively.
Results: The results indicated that engaging in insu cient PA as per the WHO guidelines predicts a higher risk of COVID-when controlling for personal characteristics, comorbidity, lifestyle, disability, and mortality. Discussion: This study revealed the need to engage in PA and manage weight to reduce the risk of infection and mortality associated with COVID-. Because engaging in PA is an important component of weight management and can help restore physical and mental health after the COVID-pandemic, it should be emphasized as a pillar of recovery after COVID-.
Author contributions Conceptualization and analysis: I-HO and S-YP. Writing: SP and HK. All authors contributed to the article and approved the submitted version.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Bo, Yang, Wang, Zhang, Cheung, Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China, Psychol Med,
doi:10.1017/S0033291720000999
Buffart, Westendorp, Van Den Berg-Emons, Stam, Roebroeck, Perceived barriers to and facilitators of physical activity in young adults with childhoodonset physical disabilities, J Rehabil Med,
doi:10.2340/16501977-0420
Chin, Kahathuduwa, Binks, Luciano, Cenacchi et al., COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in Italian medicine students, Eur J Sport Sci,
doi:10.1080/17461391.2020.1842910
Cho, Lee, Kim, Ha, Gwon, Physical activity and the risk of COVID-19 infection and mortality: a nationwide population-based case-control study, J Clin Med,
doi:10.3390/jcm10071539
Clarke, Janssen, A compositional analysis of time spent in sleep, sedentary behavior and physical activity with all-cause mortality risk, Int J Behav Nutr Phys Act,
doi:10.1186/s12966-021-01092-0
Ezzatvar, Ramírez-Vélez, Izquierdo, Garcia-Hermoso, Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and nonlinear dose-response meta-analysis of data from 1 853 610 adults, Br J Sports Med,
doi:10.1136/bjsports-2022-105733
Han, Tan, Turk, Sridhar, Leung et al., Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe, Lancet,
doi:10.1016/S0140-6736(20)32007-9
Jaarsma, Smith, Promoting physical activity for disabled people who are ready to become physically active: a systematic review, Psychol Sport Exerc,
doi:10.1016/j.psychsport.2017.08.010
Klopfenstein, Zahra, Kadiane-Oussou, Lepiller, Royer et al., New loss of smell and taste: uncommon symptoms in COVID-19 patients on Nord Franche-Comte cluster, France, Int J Infect Dis,
doi:10.1016/j.ijid.2020.08.012
Lee, Lee, Park, Shin, Kim, Cohort profile: the national health insurance service-national sample cohort (NHIS-NSC), South Korea, Int J Epidemiol,
doi:10.1093/ije/dyv319
Lei, Huang, Zhang, Yang, Yang et al., Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the COVID-19 epidemic in Southwestern China, Med Sci Monit,
doi:10.12659/MSM.924609
Park, Park, Cheong, Oh, Meister et al., Clinical characteristics and risk factors for COVID-19 infection and disease severity: a nationwide observational study in Estonia, Int J Sport Exerc Psychol,
doi:10.1371/journal.pone.0270192
Pieh, Budimir, Probst, The effect of age, gender, income, work, physical activity, and relationship status on mental health during coronavirus disease (COVID-19) lockdown in Austria, J Psychosom Res,
doi:10.1016/j.jpsychores.2020.110186
Quested, Kritz, Hancox, Ntoumanis, Thøgersen-Ntoumani, Promoting self-determined motivation for physical activity: From theory to intervention work
Twenge, Joiner, Us, Census Bureau-assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID-19 pandemic, Depress Anxiety,
doi:10.1002/da.23077
Yang, Park, Yoon, Ryoo, Park et al., Nationwide changes in physical activity, nutrient intake, and obesity in South Korea during the COVID-19 pandemic era, Front Endocrinol,
doi:10.3389/fendo.2022.965842
Zhang, Kang, Gong, Xu, Wang et al., The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes, BioRxiv,
doi:10.1101/2020.01.30.927806
{ 'indexed': {'date-parts': [[2023, 2, 15]], 'date-time': '2023-02-15T05:51:47Z', 'timestamp': 1676440307870},
'reference-count': 26,
'publisher': 'Frontiers Media SA',
'license': [ { 'start': { 'date-parts': [[2023, 2, 14]],
'date-time': '2023-02-14T00:00:00Z',
'timestamp': 1676332800000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'https://creativecommons.org/licenses/by/4.0/'}],
'funder': [ { 'DOI': '10.13039/501100003725',
'name': 'National Research Foundation of Korea',
'doi-asserted-by': 'publisher'},
{ 'DOI': '10.13039/501100003650',
'name': 'National Rehabilitation Center',
'doi-asserted-by': 'publisher'}],
'content-domain': {'domain': ['frontiersin.org'], 'crossmark-restriction': True},
'abstract': '<jats:sec><jats:title>Introduction</jats:title><jats:p>During the coronavirus disease 2019 '
'(COVID-19) pandemic, many populations have experienced reduced physical activity (PA) levels, '
'weight gain, and increased anxiety and depression. However, according to a previous study, '
'engaging in PA has a positive effect on damages caused by COVID-19. Therefore, this study '
'aimed to investigate the association between PA and COVID-19 using the National Health '
'Insurance Sharing Service Database in South '
'Korea.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Logistic '
'regression analysis was used to analyze the association of PA with COVID-19 and mortality. '
'The analysis was adjusted for body mass index, sex, age, insurance type, comorbidity, and '
'region of residence at baseline. Disability and lifestyle (weight, smoking, and drinking '
'status) were adjusted '
'consecutively.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The '
'results indicated that engaging in insufficient PA as per the WHO guidelines predicts a '
'higher risk of COVID-19 when controlling for personal characteristics, comorbidity, '
'lifestyle, disability, and '
'mortality.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>This study '
'revealed the need to engage in PA and manage weight to reduce the risk of infection and '
'mortality associated with COVID-19. Because engaging in PA is an important component of '
'weight management and can help restore physical and mental health after the COVID-19 '
'pandemic, it should be emphasized as a pillar of recovery after COVID-19.</jats:p></jats:sec>',
'DOI': '10.3389/fpubh.2023.1072198',
'type': 'journal-article',
'created': {'date-parts': [[2023, 2, 14]], 'date-time': '2023-02-14T16:56:15Z', 'timestamp': 1676393775000},
'update-policy': 'http://dx.doi.org/10.3389/crossmark-policy',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Pre-pandemic physical activity as a predictor of infection and mortality associated with '
'COVID-19: Evidence from the National Health Insurance Service',
'prefix': '10.3389',
'volume': '11',
'author': [ {'given': 'Saengryeol', 'family': 'Park', 'sequence': 'first', 'affiliation': []},
{'given': 'Hyeseong', 'family': 'Kim', 'sequence': 'additional', 'affiliation': []},
{'given': 'So-Youn', 'family': 'Park', 'sequence': 'additional', 'affiliation': []},
{'given': 'In-Hwan', 'family': 'Oh', 'sequence': 'additional', 'affiliation': []}],
'member': '1965',
'published-online': {'date-parts': [[2023, 2, 14]]},
'reference': [ { 'key': 'B1',
'doi-asserted-by': 'publisher',
'first-page': '117',
'DOI': '10.1016/j.ijid.2020.08.012',
'article-title': 'New loss of smell and taste: uncommon symptoms in COVID-19 patients on '
'Nord Franche-Comte cluster, France',
'volume': '100',
'author': 'Klopfenstein',
'year': '2020',
'journal-title': 'Int J Infect Dis.'},
{ 'key': 'B2',
'doi-asserted-by': 'publisher',
'first-page': '7806',
'DOI': '10.1101/2020.01.30.927806',
'article-title': 'The digestive system is a potential route of 2019-nCov infection: a '
'bioinformatics analysis based on single-cell transcriptomes',
'volume': '3',
'author': 'Zhang',
'year': '2020',
'journal-title': 'BioRxiv'},
{'key': 'B3', 'unstructured': 'Coronavirus disease (COVID-19)'},
{'key': 'B4', 'unstructured': 'COVID-19 Weekly Epidemiological Update'},
{'key': 'B5', 'unstructured': 'Cases in Korea2022'},
{ 'key': 'B6',
'doi-asserted-by': 'publisher',
'first-page': '954',
'DOI': '10.1002/da.23077',
'article-title': 'Census Bureau-assessed prevalence of anxiety and depressive symptoms in '
'2019 and during the 2020 COVID-19 pandemic',
'volume': '37',
'author': 'Twenge',
'year': '2020',
'journal-title': 'Depress Anxiety.'},
{ 'key': 'B7',
'doi-asserted-by': 'publisher',
'first-page': '110186',
'DOI': '10.1016/j.jpsychores.2020.110186',
'article-title': 'The effect of age, gender, income, work, physical activity, and '
'relationship status on mental health during coronavirus disease '
'(COVID-19) lockdown in Austria',
'volume': '136',
'author': 'Pieh',
'year': '2020',
'journal-title': 'J Psychosom Res.'},
{ 'key': 'B8',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.12659/MSM.924609',
'article-title': 'Comparison of prevalence and associated factors of anxiety and '
'depression among people affected by versus people unaffected by '
'quarantine during the COVID-19 epidemic in Southwestern China',
'volume': '26',
'author': 'Lei',
'year': '2020',
'journal-title': 'Med Sci Monit.'},
{ 'key': 'B9',
'doi-asserted-by': 'publisher',
'first-page': 'e068993',
'DOI': '10.1136/bmj-2021-068993',
'article-title': 'Risks of mental health outcomes in people with COVID-19: cohort study',
'volume': '376',
'author': 'Xie',
'year': '2022',
'journal-title': 'BMJ'},
{ 'key': 'B10',
'doi-asserted-by': 'publisher',
'first-page': '1052',
'DOI': '10.1017/S0033291720000999',
'article-title': 'Posttraumatic stress symptoms and attitude toward crisis mental health '
'services among clinically stable patients with COVID-19 in China',
'volume': '51',
'author': 'Bo HX Li',
'year': '2021',
'journal-title': 'Psychol Med.'},
{ 'key': 'B11',
'doi-asserted-by': 'publisher',
'first-page': '411',
'DOI': '10.1017/S1368980099000567',
'article-title': 'The influence of physical activity on mental wellbeing',
'volume': '2',
'author': 'Fox',
'year': '1999',
'journal-title': 'Public Health Nutr.'},
{ 'key': 'B12',
'doi-asserted-by': 'publisher',
'first-page': '1226',
'DOI': '10.1111/obr.12460',
'article-title': 'Physical activity and obesity: what we know and what we need to know',
'volume': '17',
'author': 'Chin',
'year': '2016',
'journal-title': 'Obes Rev.'},
{ 'key': 'B13',
'doi-asserted-by': 'publisher',
'first-page': '1459',
'DOI': '10.1080/17461391.2020.1842910',
'article-title': 'COVID-19 lockdown: Physical activity, sedentary behaviour and sleep in '
'Italian medicine students',
'volume': '21',
'author': 'Luciano',
'year': '2021',
'journal-title': 'Eur J Sport Sci.'},
{ 'key': 'B14',
'doi-asserted-by': 'publisher',
'first-page': '1539',
'DOI': '10.3390/jcm10071539',
'article-title': 'Physical activity and the risk of COVID-19 infection and mortality: a '
'nationwide population-based case-control study',
'volume': '10',
'author': 'Cho',
'year': '2021',
'journal-title': 'J Clin Med.'},
{ 'key': 'B15',
'doi-asserted-by': 'publisher',
'first-page': '1188',
'DOI': '10.1136/bjsports-2022-105733',
'article-title': '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',
'volume': '56',
'author': 'Ezzatvar',
'year': '2022',
'journal-title': 'Br J Sports Med.'},
{ 'key': 'B16',
'doi-asserted-by': 'publisher',
'first-page': 'e15',
'DOI': '10.1093/ije/dyv319',
'article-title': 'Cohort profile: the national health insurance service–national sample '
'cohort (NHIS-NSC), South Korea',
'volume': '46',
'author': 'Lee',
'year': '2017',
'journal-title': 'Int J Epidemiol.'},
{ 'key': 'B17',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1080/1612197X.2022.2066708',
'article-title': 'Moderate-to-vigorous physical activity and risk of all-cause mortality '
'in people with anxiety disorders in South Korea',
'volume': '3',
'author': 'Park',
'year': '2022',
'journal-title': 'Int J Sport Exerc Psychol'},
{ 'key': 'B18',
'doi-asserted-by': 'publisher',
'first-page': 'e0270192',
'DOI': '10.1371/journal.pone.0270192',
'article-title': 'Clinical characteristics and risk factors for COVID-19 infection and '
'disease severity: a nationwide observational study in Estonia',
'volume': '17',
'author': 'Meister',
'year': '2022',
'journal-title': 'PLoS ONE.'},
{ 'key': 'B19',
'doi-asserted-by': 'publisher',
'first-page': '1525',
'DOI': '10.1016/S0140-6736(20)32007-9',
'article-title': 'Lessons learnt from easing COVID-19 restrictions: an analysis of '
'countries and regions in Asia Pacific and Europe',
'volume': '396',
'author': 'Han',
'year': '2020',
'journal-title': 'Lancet.'},
{ 'key': 'B20',
'doi-asserted-by': 'publisher',
'first-page': '965842',
'DOI': '10.3389/fendo.2022.965842',
'article-title': 'Nationwide changes in physical activity, nutrient intake, and obesity '
'in South Korea during the COVID-19 pandemic era',
'volume': '13',
'author': 'Yang',
'year': '2022',
'journal-title': 'Front Endocrinol.'},
{ 'key': 'B21',
'unstructured': '[Internet]. Sejong; Sports for the Disabled Division. Press release, the '
'participation rate of people with disabilities in sports for the '
'disabled in 21 years decreased by 20.2% due to the influence of '
'COVID-19'},
{ 'key': 'B22',
'unstructured': 'Promoting self-determined motivation for physical activity: From theory '
'to intervention work3761\n'
' QuestedE\n'
' KritzM\n'
' HancoxJE\n'
' NtoumanisN\n'
' Thøgersen-NtoumaniC\n'
' In Essentials of exercise and sport psychology; An open access '
'textbook2021'},
{ 'key': 'B23',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1186/s12966-021-01092-0',
'article-title': 'A compositional analysis of time spent in sleep, sedentary behavior and '
'physical activity with all-cause mortality risk',
'volume': '18',
'author': 'Clarke',
'year': '2021',
'journal-title': 'Int J Behav Nutr Phys Act.'},
{ 'key': 'B24',
'doi-asserted-by': 'publisher',
'first-page': '881',
'DOI': '10.2340/16501977-0420',
'article-title': 'Perceived barriers to and facilitators of physical activity in young '
'adults with childhood-onset physical disabilities',
'volume': '41',
'author': 'Buffart',
'year': '2009',
'journal-title': 'J Rehabil Med.'},
{ 'key': 'B25',
'doi-asserted-by': 'publisher',
'first-page': '205',
'DOI': '10.1016/j.psychsport.2017.08.010',
'article-title': 'Promoting physical activity for disabled people who are ready to become '
'physically active: a systematic review',
'volume': '37',
'author': 'Jaarsma',
'year': '2018',
'journal-title': 'Psychol Sport Exerc.'},
{'key': 'B26', 'unstructured': 'Tracking SARS-CoV-2 Variants2022'}],
'container-title': 'Frontiers in Public Health',
'original-title': [],
'link': [ { 'URL': 'https://www.frontiersin.org/articles/10.3389/fpubh.2023.1072198/full',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2023, 2, 14]],
'date-time': '2023-02-14T16:56:19Z',
'timestamp': 1676393779000},
'score': 1,
'resource': {'primary': {'URL': 'https://www.frontiersin.org/articles/10.3389/fpubh.2023.1072198/full'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2023, 2, 14]]},
'references-count': 26,
'alternative-id': ['10.3389/fpubh.2023.1072198'],
'URL': 'http://dx.doi.org/10.3389/fpubh.2023.1072198',
'relation': {},
'ISSN': ['2296-2565'],
'subject': ['Public Health, Environmental and Occupational Health'],
'container-title-short': 'Front. Public Health',
'published': {'date-parts': [[2023, 2, 14]]}}