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Obesity, walking pace and risk of severe COVID-19 and mortality: analysis of UK Biobank

Yates et al., International Journal of Obesity, doi:10.1038/s41366-021-00771-z
Feb 2021  
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Mortality 45% Improvement Relative Risk Severe case 47% Exercise for COVID-19  Yates et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective 194,031 patients in the United Kingdom Lower mortality (p=0.0015) and severe cases (p<0.0001) c19early.org Yates et al., Int. J. Obesity, February 2021 Favorsexercise Favorsinactivity 0 0.5 1 1.5 2+
Exercise for COVID-19
9th treatment shown to reduce risk in October 2020, now with p < 0.00000000001 from 68 studies.
No treatment is 100% effective. Protocols combine treatments.
5,300+ studies for 116 treatments. c19early.org
UK Biobank retrospective 412,596 people, showing severe COVID-19 and COVID-19 mortality inversely associated with self-reported walking pace.
Standard of Care (SOC): SOC for COVID-19 in the study country, the United Kingdom, is poor with low average efficacy for approved treatments1. The United Kingdom focused on expensive high-profit treatments, approving only one low-cost treatment, which required a prescription and had limited adoption. The high-cost prescription treatment strategy reduces the probability of treatment—especially early—due to access and cost barriers, and eliminates complementary and synergistic benefits seen with many low-cost treatments.
risk of death, 45.3% lower, RR 0.55, p = 0.001, high activity levels 72 of 163,912 (0.0%), low activity levels 62 of 30,119 (0.2%), adjusted per study, inverted to make RR<1 favor high activity levels, odds ratio converted to relative risk, multivariable.
risk of severe case, 46.7% lower, RR 0.53, p < 0.001, high activity levels 291 of 163,912 (0.2%), low activity levels 180 of 30,119 (0.6%), adjusted per study, inverted to make RR<1 favor high activity levels, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Yates et al., 26 Feb 2021, retrospective, United Kingdom, peer-reviewed, 7 authors.
This PaperExerciseAll
Obesity, walking pace and risk of severe COVID-19 and mortality: analysis of UK Biobank
Thomas Yates, Cameron Razieh, Francesco Zaccardi, Alex V Rowlands, Samuel Seidu, Melanie J Davies, Kamlesh Khunti
International Journal of Obesity, doi:10.1038/s41366-021-00771-z
Obesity is an emerging risk factor for coronavirus disease-2019 (COVID-19). Simple measures of physical fitness, such as self-reported walking pace, may also be important risk markers. This analysis includes 412,596 UK Biobank participants with linked COVID-19 data (median age at linkage = 68 years, obese = 24%, median number of comorbidities = 1). As of August 24th 2020, there were 1001 cases of severe (in-hospital) disease and 336 COVID-19 deaths. Compared to normal weight individuals, the adjusted odds ratio (OR) of severe COVID-19 in overweight and obese individuals was 1.
Author contributions Concept and design: TY, CR, FZ, KK, Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: TY. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: TY. Statistical support: FZ. Compliance with ethical standards Conflict of interest Prof. Kamlesh Khunti is Chair of the UK SAGE subgroup on ethnicity and COVID-19. No other conflicts have been declared. Financial support This research was supported by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, the NIHR Applied Research Collaboration -East Midlands, and a grant from the UKRI-DHSC COVID-19 Rapid Response Rolling Call (MR/V020536/1). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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Armstrong, Rudkin, Allen, Crook, Wilson et al., Dynamic linkage of COVID-19 test results between Public Health England's Second Generation Surveillance System and UK Biobank, Microbial Genomics Online
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Kruglikov, Scherer, The role of adipocytes and adipocytelike cells in the severity of COVID-19 infections, Obesity
Lighter, Phillips, Hochman, Sterling, Johnson et al., Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission, Clin Infect Dis
Maltese, Corsonello, Rosa, Soraci, Vitale et al., Frailty and COVID-19: a systematic scoping review, J Clin Med
Mertens, Clarys, Mullie, Lefevre, Charlier et al., Stability of physical activity, fitness components and diet quality indices, Eur J Clin Nutr
Michalakis, Ilias, SARS-CoV-2 infection and obesity: common inflammatory and metabolic aspects, Diabetes Metab Syndr
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Simonnet, Chetboun, Poissy, Raverdy, Noulette et al., High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation, Obesity
Stamatakis, Kelly, Strain, Murtagh, Ding et al., Self-rated walking pace and all-cause, cardiovascular disease and cancer mortality: individual participant pooled analysis of 50,225 walkers from 11 population British cohorts, Br J Sports Med
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Yates, Zaccardi, Dhalwani, Davies, Bakrania et al., Association of walking pace and handgrip strength with all-cause, cardiovascular, and cancer mortality: a UK Biobank observational study, Eur Heart J
Yates, Zaccardi, Razieh, Gillies, Rowlands et al., Framework to aid analysis and interpretation of ongoing COVID-19 research, Welcome Open Res
Zaccardi, Davies, Khunti, Yates, Comparative relevance of physical fitness and adiposity on life expectancy: a UK biobank observational study, Mayo Clin Proc
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