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0 0.5 1 1.5 2+ Mortality 59% Improvement Relative Risk ICU admission 42% Hospitalization 53% Exercise for COVID-19  Sallis et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective 10,102 patients in the USA Lower mortality (p=0.0047) and ICU admission (p=0.0056) Sallis et al., British J. Sports Medic.., Apr 2021 Favors exercise Favors inactivity

Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients

Sallis et al., British Journal of Sports Medicine, doi:10.1136/bjsports-2021-104080
Apr 2021  
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Exercise for COVID-19
9th treatment shown to reduce risk in October 2020
*, now known with p < 0.00000000001 from 66 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Retrospective 48,440 COVID-19 patients in the USA, showing significantly lower mortality, ICU admission, and hospitalization with exercise.
risk of death, 59.2% lower, RR 0.41, p = 0.005, high activity levels 11 of 3,118 (0.4%), low activity levels 170 of 6,984 (2.4%), adjusted per study, inverted to make RR<1 favor high activity levels, odds ratio converted to relative risk, consistently active vs. consistently inactive, multivariable.
risk of ICU admission, 41.5% lower, RR 0.58, p = 0.006, high activity levels 32 of 3,118 (1.0%), low activity levels 195 of 6,984 (2.8%), adjusted per study, inverted to make RR<1 favor high activity levels, odds ratio converted to relative risk, consistently active vs. consistently inactive, multivariable.
risk of hospitalization, 53.0% lower, RR 0.47, p < 0.001, high activity levels 99 of 3,118 (3.2%), low activity levels 732 of 6,984 (10.5%), adjusted per study, inverted to make RR<1 favor high activity levels, odds ratio converted to relative risk, consistently active vs. consistently inactive, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sallis et al., 13 Apr 2021, retrospective, USA, peer-reviewed, 8 authors.
This PaperExerciseAll
Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients
Dr Robert Sallis, Deborah Rohm Young, Sara Y Tartof, James F Sallis, Jeevan Sall, Qiaowu Li, Gary N Smith, Deborah A Cohen
British Journal of Sports Medicine, doi:10.1136/bjsports-2021-104080
Objectives To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines. Methods We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient's self-reported physical activity category (consistently inactive=0-10 min/ week, some activity=11-149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes. Results Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity. Conclusions Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care. This is a retrospective observational study in which PA was documented in the EHR in the 2 years preceding the March 2020 pandemic lockdown.
Competing interests SYT reports grants from Roche/Genentech during the conduct of the study. Patient consent for publication Not required. Ethics approval This study was approved by the Kaiser Permanente Southern California Institutional Review Board. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. Summary box What are the findings? ► Patients with COVID-19 who were consistently inactive during the 2 years preceding the pandemic were more likely to be hospitalised, admitted to the intensive care unit and die than patients who were consistently meeting physical activity guidelines. ► Other than advanced age and a history of organ transplant, physical inactivity was the strongest risk factor for..
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