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0 0.5 1 1.5 2+ Mortality 42% Improvement Relative Risk Ventilation 45% ICU admission 41% Hospitalization 34% Exercise for COVID-19  Steenkamp et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective 42,835 patients in South Africa (Mar 2020 - Jun 2021) Lower mortality (p<0.0001) and ventilation (p<0.0001) Steenkamp et al., British J. Sports Me.., Feb 2022 Favors exercise Favors inactivity

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., British Journal of Sports Medicine, doi:10.1136/bjsports-2021-105159
Feb 2022  
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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.
4,100+ studies for 60+ treatments.
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.
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Small steps, strong shield: directly measured, moderate physical activity in 65 361 adults is associated with significant protective effects from severe COVID-19 outcomes
Lizelle Steenkamp, Robin Terence Saggers, Rossella Bandini, Saverio Stranges, Yun-Hee Choi, Jane S Thornton, Simon Hendrie, Deepak Patel, Shannon Rabinowitz, Professor Jon Patricios
British Journal of Sports Medicine, doi:10.1136/bjsports-2021-105159
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 COVID-19. 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 acyclic graph. 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 conditions.
Competing interests LS, DP, SR and SH are employed by Discovery Health; JP and JST are editors of BJSM. Patient consent for publication Not applicable. Ethics approval Permission for use of DHMS anonymised medical and physical activity data was obtained from the Research Governance Committee of Discovery Health. Ethical approval was obtained from the Human Research Ethics Committee of the University of the Witwatersrand, Johannesburg (clearance certificate number M210725.) Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Not applicable. 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. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits..
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