Baseline physical activity is associated with reduced mortality and disease outcomes in COVID‐19: A systematic review and meta‐analysis
Masoud Rahmati, Mahdieh Molanouri Shamsi, Kayvan Khoramipour, Fatemeh Malakoutinia, Wongi Woo, Seoyeon Park, Dong Keon Yon, Seung Won Lee, Jae Il Shin, Lee Smith
Reviews in Medical Virology, doi:10.1002/rmv.2349
Among coronavirus disease 2019 (COVID-19) patients, physically active individuals may be at lower risk of fatal outcomes. However, to date, no meta-analysis has been carried out to investigate the relationship between physical activity (PA) and fatal outcomes in patients with COVID-19. Therefore, this meta-analysis aims to explore the hospitalisation, intensive care unit (ICU) admissions, and mortality rates of COVID-19 patients with a history of PA participation before the onset of the pandemic, and to evaluate the reliability of the evidence. A systematic search of MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and medRxiv was conducted for articles published up to January 2022. A random-effects meta-analysis was performed to compare disease severity and mortality rates of COVID-19 patients in physically active and inactive cases. Twelve studies involving 1,256,609 patients (991,268 physically active and 265,341 inactive cases) with COVID-19, were included in the pooled analysis. The overall metaanalysis compared with inactive controls showed significant associations between PA with reduction in COVID-19 hospitalisation (risk ratio (RR) = 0.58, 95% confidence intervals (CI) 0.46-0.73, P = 0.001), ICU admissions (RR = 0.65, 95% CI 0.52-0.81, P = 0.001) and mortality (RR = 0.47, 95% CI 0.38-0.59, P = 0.001). The protective effect of PA on COVID-19 hospitalisation and mortality could be attributable to the types of exercise such as resistance exercise (RR = 0.27, 95% CI 0.15-0.49, P = 0.001) and endurance exercise (RR = 0.41, 95% CI 0.23-0.74, P = 0.003), respectively. Physical activity is associated with decreased hospitalisation, ICU admissions, and mortality rates of patients with COVID-19. Moreover, COVID-19 patients with a history of resistance and endurance exercises experience a lower rate of hospitalisation and mortality, respectively. Further studies are warranted to determine the biological mechanisms underlying these findings.
P = 0.00001), and 0.41 (95% CI: 0.23, 0.72, P = 0.002), respectively (Figure 4b ). Subgroup analyses of PA-induced adaptation demonstrated a positive association between endurance exercise with reduction in COVID-19 mortality (RR = 0.41, 95% CI 0.23-0.74, P = 0.003). In addition, resistance exercise did not have a significant effect on reducing COVID-19 mortality (RR = 0.13, 95% CI 0.01-2.06, P = 0.15). The positive effect of combined training in reducing COVID-19 mortality, did not reach a statistically significant level (RR = 0.23, 95% CI 0.06-0.97, P = 0.05), (Figure 4c ). Subgroup analyses that stratified studies based on different PA levels in cohort and cross-sectional studies showed no difference between low and moderate-vigorous levels on the risk of COVID-19 mortality (in cohort studies: RR = 0.67, 95% CI 0.54-0.84, P = 0.0004 and RR = 0.56, 95% CI 0.49-0.64, P = 0.00001, respectively; in cross-sectional studies: RR = 0.42, 95% CI 0.24-0.75, P = 0.003 and RR = 0.34, 95% CI 0.21-0.54, P = 0.00001, respectively). By stratifying studies based on different PA levels, heterogeneity decreased to I 2 = 0% in both cohort (P = 0.43) and cross-sectional studies (P = 0.95, Figure 4d ).
| Sensitivity analysis and publication bias In sensitivity analyses, the overall pooled estimates of the respective outcomes obtained in each analysis closely resembled the preliminary associations. Further, funnel plots were checked for the included studies, which suggested no noticeable..
References
Ahmadi, Huang, Inan-Eroglu, Hamer, Stamatakis, older adults: evidence from a community-based cohort study in the United Kingdom
Brawner, Ehrman, Bole, Inverse relationship of maximal exercise capacity to hospitalization secondary to coronavirus disease, Mayo Clin Proc
Burtscher, Millet, Burtscher, Low cardiorespiratory and mitochondrial fitness as risk factors in viral infections: implications for COVID-19, Br J Sports Med
Chamorro-Viña, Fernandez-Del-Valle, Tacón, Excessive exercise and immunity: the J-shaped curve The Active Female
Cho, Lee, Physical activity and the risk of COVID-19 infection and mortality: a nationwide population-based case-control study, J Clin Med
Christensen, Arneja, Stk, Sturrock, Brooks, The association of estimated cardiorespiratory fitness with COVID-19 incidence and mortality: a cohort study, Plos one
Cochran, The combination of estimates from different experiments, Biometrics
Committee, Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ)-short and Long Forms
Da Silveira, Da, Fagundes, Bizuti, Starck et al., Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature, Clin Exp Med
De Souza, Motta-Santos, Soares, Association of physical activity levels and the prevalence of COVID-19-associated hospitalization, J Sci Med Sport
Dessie, Zewotir, Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients, BMC Infect Dis
Ekblom-Bak, Väisänen, Ekblom, Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study, Int J Behav Nutr Phys Activity
Elezkurtaj, Greuel, Ihlow, Causes of death and comorbidities in hospitalized patients with COVID-19, Sci Rep
Eriksen, Frandsen, The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review, J Med Libr Assoc JMLA
Fang, Li, Yu, Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and metaanalysis, Aging
Gao, Piernas, Astbury, Associations between bodymass index and COVID-19 severity in 6• 9 million people in England: a prospective, community-based, cohort study, Lancet Diabetes & Endocrinol
Halabchi, Mazaheri, Sabeti, Regular sports participation as a potential predictor of better clinical outcome in adult patients with COVID-19: a Large Cross-sectional Study, J Phys Activity Health
Hamer, Gale, Kivimäki, Batty, Overweight, obesity, and risk of hospitalization for COVID-19: a community-based cohort study of adults in the United Kingdom, Proc Natl Acad Sci
Hamer, Kivimäki, Gale, Batty, Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: a community-based cohort study of 387,109 adults in UK, Brain Behav Immun
Hamrouni, Roberts, Thackray, Stensel, Bishop, Associations of obesity, physical activity level, inflammation and cardiometabolic health with COVID-19 mortality: a prospective analysis of the UK Biobank cohort, BMJ Open
Higgins, Thomas, Chandler, Cochrane Handbook for Systematic Reviews of Interventions
Jee, Physical exercise for strengthening innate immunity during COVID-19 pandemic: 4th series of scientific evidence, J Exerc Rehabil
Karim, Karim, Omicron SARS-CoV-2 variant: a new chapter in the COVID-19 pandemic, Lancet
Khoramipour, Basereh, Hekmatikar, Castell, Ruhee et al., Physical activity and nutrition guidelines to help with the fight against COVID-19, J Sports Sci
Ko, Danielson, Town, Risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization: COVID-19-associated hospitalization surveillance network and behavioral risk factor surveillance system, Clin Infect Dis
Ledo, Schub, Ziller, Elite athletes on regular training show more pronounced induction of vaccine-specific T-cells and antibodies after tetravalent influenza vaccination than controls, Brain Behav Immun
Lee, Lee, Moon, 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
Lee, Shiroma, Lobelo, Puska, Blair et al., Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy, lancet
Luben, Hayat, Wareham, Pharoah, Khaw, Usual physical activity and subsequent hospital usage over 20 years in a general population: the EPIC-Norfolk cohort, BMC Geriatr
Maltagliati, Sieber, Sarrazin, Muscle strength explains the protective effect of physical activity against COVID-19 hospitalization among adults aged 50 years and older, J Sports Sci
Meyer, Mcdowell, Lansing, Changes in physical activity and sedentary behavior in response to COVID-19 and their associations with mental health in 3052 US adults, Int J Environ Res public health
Moher, Liberati, Tetzlaff, Altman, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Int J Surg
Nieman, Does Exercise Alter Immune Function and Respiratory Infections? President's Council on Physical Fitness and Sports, Research Digest
Nieman, Henson, Austin, Upper respiratory tract infection is reduced in physically fit and active adults, Br J Sports Med
Nieman, Wentz, The compelling link between physical activity and the body's defense system, J Sport Health Sci
Nobari, Fashi, Eskandari, Pérez-Gómez, Suzuki, Potential improvement in rehabilitation quality of 2019 novel coronavirus by isometric training system; Is there "muscle-lung cross-talk, Int J Environ Res Public Health
Nobari, Fashi, Eskandari, Villafaina, Murillo-Garcia et al., Effect of COVID-19 on health-related quality of life in adolescents and children: a systematic review, Int J Environ Res Public Health
Organization, Stay Physically Active during Self-Quarantine
Parodi, Liu, From containment to mitigation of COVID-19 in the US, JAMA
Piepoli, Hoes, Agewall, European Guidelines on cardiovascular disease prevention in clinical practice, Kardiologia Pol Pol Heart J
Rahmati, None
Ringseis, Eder, Mooren, Krüger, Metabolic signals and innate immune activation in obesity and exercise, Exerc Immunol Rev
Rivera-Brown, Frontera, Principles of exercise physiology: responses to acute exercise and long-term adaptations to training, Pm&r
Rogeri, Gasparini, Martins, Crosstalk between skeletal muscle and immune system: which roles do IL-6 and glutamine play?, Front Physiology
Roser, Ritchie, Ortiz-Ospina, Hasell, Coronavirus disease (COVID-19)-Statistics and research, Our World in data
Ryrsø, Faurholt-Jepsen, Ritz, The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial, Trials
Salgado-Aranda, Pérez-Castellano, Núñez-Gil, Influence of baseline physical activity as a modifying factor on COVID-19 mortality: a single-center, retrospective study, Infect Dis Ther
Sallis, Young, Tartof, Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients, Br J Sports Med
Shamsi, Chekachak, Soudi, Combined effect of aerobic interval training and selenium nanoparticles on expression of IL-15 and IL-10/TNF-α ratio in skeletal muscle of 4T1 breast cancer mice with cachexia, Cytokine
Shamsi, Chekachak, Soudi, Effects of exercise training and supplementation with selenium nanoparticle on T-helper 1 and 2 and cytokine levels in tumor tissue of mice bearing the 4 T1 mammary carcinoma, Nutrition
Shamsi, Hassan, Gharakhanlou, Exercise-induced chaperokine activity of hsp70: possible role in chronic diseases, Chaperokine Activity of Heat Shock Proteins
Stang, Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses, Eur J Epidemiol
Steffl, Bohannon, Sontakova, Tufano, Shiells et al., Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis, Clin Interventions aging
Tison, Avram, Kuhar, Worldwide effect of COVID-19 on physical activity: a descriptive study, Ann Intern Med
Turner, Brum, Does regular exercise counter T cell immunosenescence reducing the risk of developing cancer and promoting successful treatment of malignancies? Oxidative medicine and cellular longevity
Wu, Tang, Cheng, Diabetes increases the mortality of patients with COVID-19: a meta-analysis, Acta Diabetol
Young, Coleman, Ngor, Reynolds, Sidell et al., Associations between Physical Activity and Cardiometabolic Risk Factors Assessed in a Southern California Health Care System
Yuan, Huang, -Y, Chen, Does pre-existent physical inactivity have a role in the severity of COVID-19?, Ther Adv Respir Dis
Zhang, Zhang, Wang, Tao, Dou et al., Sarcopenia as a predictor of hospitalization among older people: a systematic review and meta-analysis, BMC Geriatr
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'Assessed in a Southern California Health Care System, 2010–2012',
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'author': 'Souza FR',
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'volume': '20',
'author': 'Luben R',
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'article-title': 'Physical exercise for strengthening innate immunity during COVID‐19 '
'pandemic: 4th series of scientific evidence',
'volume': '16',
'author': 'Jee Y‐S',
'year': '2020',
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{'key': 'e_1_2_11_46_1', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.bbi.2019.09.024'},
{ 'key': 'e_1_2_11_47_1',
'series-title': 'Does regular exercise counter T cell immunosenescence reducing the risk '
'of developing cancer and promoting successful treatment of malignancies? '
'Oxidative medicine and cellular longevity',
'author': 'Turner JE',
'year': '2017'},
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