Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes
Steenkamp et al.
, Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with..
, British Journal of Sports Medicine, doi:10.1136/bjsports-2021-105159
Retrospective 65,361 COVID-19 patients in South Africa, showing significantly lower hospitalization, ICU admission, ventilation, and mortality with exercise.
risk of death, 42.0% lower, RR 0.58, p < 0.001, high activity levels 29,469, low activity levels 13,366, adjusted per study, high activity vs. low activity, poisson regression, multivariable.
risk of mechanical ventilation, 45.0% lower, RR 0.55, p < 0.001, high activity levels 29,469, low activity levels 13,366, adjusted per study, high activity vs. low activity, poisson regression, multivariable.
risk of ICU admission, 41.0% lower, RR 0.59, p < 0.001, high activity levels 29,469, low activity levels 13,366, adjusted per study, high activity vs. low activity, poisson regression, multivariable.
risk of hospitalization, 34.0% lower, RR 0.66, p < 0.001, high activity levels 29,469, low activity levels 13,366, adjusted per study, high activity vs. low activity, poisson regression, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Steenkamp et al., 9 Feb 2022, retrospective, South Africa, peer-reviewed, 10 authors, study period 19 March, 2020 - 30 June, 2021.
Abstract: Original research
Lizelle Steenkamp,1 Robin Terence Saggers ,2,3 Rossella Bandini,4
Saverio Stranges,5,6 Yun-Hee Choi,7 Jane S Thornton ,8 Simon Hendrie,9
Deepak Patel,1 Shannon Rabinowitz,9 Jon Patricios 2
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Professor Jon Patricios, Wits
Sport and Health (WiSH),
School of Clinical Medicine,
Faculty of Health Sciences,
University of the Witwatersrand,
South Africa; firstname.lastname@example.org o.za
Accepted 21 January 2022
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To cite: Steenkamp L,
Saggers RT, Bandini R, et al.
Br J Sports Med Epub ahead
of print: [please include Day
Month Year]. doi:10.1136/
Objective To determine the association between
directly measured physical activity and hospitalisation,
intensive care unit (ICU) admission, ventilation and
mortality rates in patients with a confirmed diagnosis of
Methods Directly measured physical activity data
from 65 361 adult patients with a COVID-19 diagnosis
from 19 March 2020 to 30 June 2021, were grouped
by activity level: low (<60 min/week), moderate
(60–149 min/week) and high activity (≥150 min/week).
The association of physical activity levels and the risk
of adverse outcomes was analysed using modified
Poisson regression. We accounted for demographics and
comorbidities including conditions known to influence
COVID-19 outcomes, as well as patient complexity as
measured by the Johns Hopkins Adjusted Clinical Group
system. The regression approach was further validated
with a Bayesian network model built off a directed
Results High physical activity was associated with
lower rates of hospitalisation (risk ratio, RR 0.66, 95%
CI 0.63 to 0.70), ICU admission (RR 0.59, 95% CI 0.52
to 0.66), ventilation (RR 0.55, 95% CI 0.47 to 0.64) and
death (RR 0.58, 95% CI 0.50 to 0.68) due to COVID-19
than those who engaged in low physical activity.
Moderate physical activity also was associated with
lower rates of hospitalisation (RR 0.87, 95% CI 0.82 to
0.91), admission to ICU (RR 0.80, 95% CI 0.71 to 0.89),
ventilation (RR 0.73, 95% CI 0.62 to 0.84) and death
(RR 0.79, 95% CI 0.69 to 0.91).
Conclusions Adults with high and moderate physical
activity levels had significantly better outcomes than
those with low activity when contracting COVID-19. The
apparent protective effects of regular physical activity
extended to those with concomitant chronic medical
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