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Associations of Physical Inactivity and COVID-19 Outcomes Among Subgroups

Young et al., American Journal of Preventive Medicine, doi:10.1016/j.amepre.2022.10.007
Dec 2022  
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Mortality 74% Improvement Relative Risk Mortality (b) 65% Mortality (c) 48% Mortality (d) 35% Hospitalization 48% Hospitalization (b) 42% Hospitalization (c) 30% Hospitalization (d) 20% Exercise for COVID-19  Young et al.  Prophylaxis Does physical activity reduce risk for COVID-19? Retrospective 94,731 patients in the USA (January 2020 - May 2021) Lower mortality (p<0.0001) and hospitalization (p<0.0001) c19early.org Young et al., American J. Preventive M.., Dec 2022 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 66 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Retrospective 194,191 COVID-19 patients in the USA, showing lower risk of hospitalization and mortality with physical activity, with a dose response relationship.
risk of death, 74.4% lower, OR 0.26, p < 0.001, high activity levels 11,279, low activity levels 29,099, inverted to make OR<1 favor high activity levels, always active vs. always inactive, RR approximated with OR.
risk of death, 65.3% lower, OR 0.35, p < 0.001, high activity levels 11,279, low activity levels 83,452, inverted to make OR<1 favor high activity levels, always active vs. mostly inactive, RR approximated with OR.
risk of death, 47.9% lower, OR 0.52, p < 0.001, high activity levels 11,279, low activity levels 42,490, inverted to make OR<1 favor high activity levels, always active vs. some activity, RR approximated with OR.
risk of death, 35.5% lower, OR 0.65, p = 0.002, high activity levels 11,279, low activity levels 27,871, inverted to make OR<1 favor high activity levels, always active vs. consistently active, RR approximated with OR.
risk of hospitalization, 47.6% lower, OR 0.52, p < 0.001, high activity levels 11,279, low activity levels 29,099, inverted to make OR<1 favor high activity levels, always active vs. always inactive, RR approximated with OR.
risk of hospitalization, 41.9% lower, OR 0.58, p < 0.001, high activity levels 11,279, low activity levels 83,452, inverted to make OR<1 favor high activity levels, always active vs. mostly inactive, RR approximated with OR.
risk of hospitalization, 30.1% lower, OR 0.70, p < 0.001, high activity levels 11,279, low activity levels 42,490, inverted to make OR<1 favor high activity levels, always active vs. some activity, RR approximated with OR.
risk of hospitalization, 20.0% lower, OR 0.80, p < 0.001, high activity levels 11,279, low activity levels 27,871, inverted to make OR<1 favor high activity levels, always active vs. consistently active, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Young et al., 14 Dec 2022, retrospective, USA, peer-reviewed, 7 authors, study period 1 January, 2020 - 31 May, 2021. Contact: young@kp.org.
This PaperExerciseAll
Associations of Physical Inactivity and COVID-19 Outcomes Among Subgroups
Deborah Rohm Young, PhD James F Sallis, PhD Aileen Baecker, MD, MPH Deborah A Cohen, PhD Claudia L Nau, PhD Gary N Smith, MD Robert E Sallis
American Journal of Preventive Medicine, doi:10.1016/j.amepre.2022.10.007
Introduction: Physical activity before COVID-19 infection is associated with less severe outcomes. The study determined whether a dose-response association was observed and whether the associations were consistent across demographic subgroups and chronic conditions. Methods: A retrospective cohort study of Kaiser Permanente Southern California adult patients who had a positive COVID-19 diagnosis between January 1, 2020 and May 31, 2021 was created. The exposure was the median of at least 3 physical activity self-reports before diagnosis. Patients were categorized as follows: always inactive, all assessments at 10 minutes/week or less; mostly inactive, median of 0−60 minutes per week; some activity, median of 60−150 minutes per week; consistently active, median>150 minutes per week; and always active, all assessments>150 minutes per week. Outcomes were hospitalization, deterioration event, or death 90 days after a COVID-19 diagnosis. Data were analyzed in 2022. Results: Of 194,191 adults with COVID-19 infection, 6.3% were hospitalized, 3.1% experienced a deterioration event, and 2.8% died within 90 days. Dose-response effects were strong; for example, patients in the some activity category had higher odds of hospitalization (OR=1.43; 95% CI=1.26, 1.63), deterioration (OR=1.83; 95% CI=1.49, 2.25), and death (OR=1.92; 95% CI=1.48, 2.49) than those in the always active category. Results were generally consistent across sex, race and ethnicity, age, and BMI categories and for patients with cardiovascular disease or hypertension. Conclusions: There were protective associations of physical activity for adverse COVID-19 outcomes across demographic and clinical characteristics. Public health leaders should add physical activity to pandemic control strategies.
ACKNOWLEDGMENTS The authors thank the patients of Kaiser Permanente for helping to improve care through the use of information collected through our electronic health record systems. This study was supported in part by funding from the Kaiser Permanente Community Health Funds. No financial disclosures were reported by the authors of this paper. CREDIT AUTHOR STATEMENT SUPPLEMENTAL MATERIAL Supplemental materials associated with this article can be found in the online version at https://doi.org/10.1016/j. amepre.2022.10.007.
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