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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