Association Between Accelerometer-Assessed Physical Activity and Severity of COVID-19 in UK Biobank
Rowlands et al.
, Association Between Accelerometer-Assessed Physical Activity and Severity of COVID-19 in UK Biobank
, Mayo Clinic Proceedings: Innovations, Quality & Outcomes, doi:10.1016/j.mayocpiqo.2021.08.011
UK Biobank retrospective showing lower risk of severe COVID-19 with higher moderate to vigorous physical activity. Results are only provided for physical activity as a continuous variable.
Rowlands et al., 31 Dec 2021, retrospective, United Kingdom, peer-reviewed, 13 authors, study period 16 March, 2020 - 16 March, 2021.
Abstract: ORIGINAL ARTICLE
Association Between AccelerometerAssessed Physical Activity and Severity of
COVID-19 in UK Biobank
Alex V. Rowlands, PhD; Paddy C. Dempsey, PhD; Clare Gillies, PhD;
David E. Kloecker, MPhil; Cameron Razieh, PhD; Yogini Chudasama, PhD;
Nazrul Islam, PhD; Francesco Zaccardi, PhD; Claire Lawson, PhD;
Tom Norris, PhD; Melanie J. Davies, MD; Kamlesh Khunti, PhD;
and Tom Yates, PhD
Objective: To quantify the association between accelerometer-assessed physical activity and coronavirus
disease 2019 (COVID-19) outcomes.
Methods: Data from 82,253 UK Biobank participants with accelerometer data (measured 2013-2015),
complete covariate data, and linked COVID-19 data from March 16, 2020, to March 16, 2021, were
included. Two outcomes were investigated: severe COVID-19 (positive test result from in-hospital setting
or COVID-19 as primary cause of death) and nonsevere COVID-19 (positive test result from community
setting). Logistic regressions were used to assess associations with moderate to vigorous physical activity
(MVPA), total activity, and intensity gradient. A higher intensity gradient indicates a higher proportion of
Results: Average MVPA was 48.1 (32.7) min/d. Physical activity was associated with lower odds of severe
COVID-19 (adjusted odds ratio per standard deviation increase: MVPA, 0.75 [95% CI, 0.67 to 0.85]; total,
0.83 [0.74 to 0.92]; intensity, 0.77 [0.70 to 0.86]), with stronger associations in women (MVPA, 0.63
[0.52 to 0.77]; total, 0.76 [0.64 to 0.90]; intensity, 0.63 [0.53 to 0.74]) than in men (MVPA, 0.84 [0.73 to
0.97]; total, 0.88 [0.77 to 1.01]; intensity, 0.88 [0.77 to 1.00]). In contrast, when mutually adjusted, total
activity was associated with higher odds of a nonsevere infection (1.10 [1.04 to 1.16]), whereas the intensity gradient was associated with lower odds (0.91 [0.86 to 0.97]).
Conclusion: Odds of severe COVID-19 were approximately 25% lower per standard deviation (w30 min/
d) MVPA. A greater proportion of vigorous activity was associated with lower odds of severe and nonsevere infections. The association between total activity and higher odds of a nonsevere infection may be
through greater community engagement and thus more exposure to the virus. Results support calls for
public health messaging highlighting the potential of MVPA for reducing the odds of severe COVID-19.
ª 2021 THE AUTHORS. Published by Elsevier Inc on behalf of Mayo Foundation for Medical Education and Research. This is an open access article under
the CC BY license (http://creativecommons.org/licenses/by/4.0/) n Mayo Clin Proc Inn Qual Out 2021;5(6):997-1007
oor outcomes from coronavirus disease
2019 (COVID-19) are more likely in
people who are older,1 are more
deprived,2 have comorbidities,3 or are from
ethnic minority populations.4 As with chronic
disease, research suggests that risk factors
related to health behaviors, such as obesity5
and slow walking pace,6 also have a negative
impact on COVID-19 outcomes.
Physical activity is a modiﬁable health
behavior that may mitigate the risks of
COVID-19.7 This could occur through reductions in chronic inﬂammation8,9 or cardiometabolic risk factors,10 which are associated
with an increased risk of COVID-19,11 or
through enhanced immunity.7 In the early
months of the pandemic (up to July 2020),
we reported initial observations from Biobank
data,12 which was suggestive evidence for
lower odds (up to 20%) of severe COVID-19
per 30 minutes of daily..
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