Leisure Time Physical Activity and SARS-CoV-2 Infection among ELSA-Brasil Participants
Francisco José Gondim Pitanga, Maria Da Conceição Almeida, Bruce B Duncan, José Geraldo Mill, Luana Giatti, Maria Del Carmen B Molina, Maria De Jesus Mendes Da Fonseca, Maria Inês Schmidt, Rosane Harter Griep, Sandhi Maria Barreto, Sheila Maria Alvim De Matos
International Journal of Environmental Research and Public Health, doi:10.3390/ijerph192114155
The regular practice of physical activity (PA) can reduce the chance of aggravation of the disease and lower rates of hospitalization and mortality from COVID-19, but few studies have analyzed the association of PA with the risk of infection by SARS-CoV-2. The aim of the study was to analyze the association between PA and self-reported SARS-CoV-2 infection. A longitudinal study was conducted with data from 4476 ELSA-Brasil participants who had their PA analyzed twice, once in 2016-2018 and again in 2020. PA was identified using the IPAQ at both follow-up moments and categorized into four groups: (a) remained physically inactive (reference); (b) remained physically active; (c) became physically active in the second moment; and (d) became physically inactive in the second moment. The variables of age, sex, obesity, hypertension, diabetes and specific protective practices against COVID-19 were tested as possible confounders. Data were analyzed by logistic regression. A 95% confidence interval (CI) was used. Remaining physically active was associated with a 43% reduction in the risk of SARS-CoV-2 infection only among those who used specific practices to protect against COVID-19, OR = 0.57 and CI = 0.32-0.99. The results suggested that regular practice of PA can reduce the risk of SARS-CoV-2 infection, especially among those who have used specific practices to protect against COVID-19 during the pandemic.
Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.
References
Aquino, Barreto, Bensenor, Carvalho, Chor et al., Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and design, Am. J. Epidemiol, 
doi:10.1093/aje/kwr294Chastin, Abaraogu, Bourgois, Dall, Darnborough et al., Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis, Sports Med, 
doi:10.1007/s40279-021-01466-1Cho, Lee, Jae, Kim, Ha et al., Physical Activity and the Risk of COVID-19 Infection and Mortality: A Nationwide Population-Based Case-Control Study, J. Clin. Med, 
doi:10.3390/jcm10071539Cuervo, Grandvaux, ACE2: Evidence of role as entry receptor for SARS-CoV-2 and implications in comorbidities, Elife, 
doi:10.7554/eLife.61390Ezzatvar, Ramírez-Vélez, Izquierdo, Garcia-Hermoso, 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, Br. J. Sports Med, 
doi:10.1136/bjsports-2022-105733Hosmer, Lemeshow, Appled Logistic Regression
Klentrou, Cieslak, Macneil, Vintinner, Plyley, Effect of moderate exercise on salivary immunoglobulin A and infection risk in humans, Eur. J. Appl. Physiol, 
doi:10.1007/s00421-002-0609-1Kohut, Cooper, Nickolaus, Russell, Cunnick, Exercise and psychosocial factors modulate immunity to influenza vaccine in elderly individuals, J. Gerontol. Ser. A Biol. Sci. Med. Sci, 
doi:10.1093/gerona/57.9.M557Lee, Lee, Moon, Jin, Yang et al., 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, Br. J. Sports Med, 
doi:10.1136/bjsports-2021-104203Matsudo, Araújo, Matsudo, Questionário internacional de atividade física (IPAQ): Estudo de validade e reprodutibilidade no Brasil, Rev. Bras. Ativ. Fís. Saude, 
doi:10.12820/rbafs.v.6n2p5-18Pitanga, Beck, Pitanga, Pinho Cscortez, Guedes et al., Association between leisure time physical activity and mortality by COVID-19 in the brazilian capitals: An ecological analysis, Rev. Bras. Med. Esporte, 
doi:10.1590/1517-8692202127062021_0071Salgado-Aranda, Pérez-Castellano, Núñez-Gil, Orozco, Torres-Esquivel et al., Influence of Baseline Physical Activity as a Modifying Factor on COVID-19 Mortality: A Single-Center, Retrospective Study, Infect. Dis. Ther, 
doi:10.1007/s40121-021-00418-6Sallis, Young, Tartof, Sallis, Sall et al., Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: A study in 48 440 adult patients, Br. J. Sports Med, 
doi:10.1136/bjsports-2021-104080Schmidt, Griep, Passos, Luft, Goulart et al., Strategies and development of quality assurance and control in the ELSA-Brasil, Rev. Saude Publica, 
doi:10.1590/S0034-8910.2013047003889Shimizu, Kimura, Akimoto, Akama, Otsuki et al., Effects of exercise, age and gender on salivary secretory immunoglobulin A in elderly individuals, Exerc. Immunol. Rev
Talic, Shah, Wild, Gasevic, Maharaj et al., Effectiveness of public health measures in reducing the incidence of COVID-19, SARS-CoV-2 transmission, and COVID-19 mortality: Systematic review and meta-analysis, BMJ, 
doi:10.1136/bmj-2021-068302Zbinden-Foncea, Francaux, Deldicque, Hawley, Does High Cardiorespiratory Fitness Confer Some Protection against Proinflammatory Responses after Infection by SARS-CoV-2?, Obesity, 
doi:10.1002/oby.22849DOI record:
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