Physical activity and COVID-19: an observational and Mendelian randomisation study
Xiaomeng Zhang, Xue Li, Ziwen Sun, Yazhou He, Wei Xu, Harry Campbell, Malcolm G Dunlop, Maria Timofeeva, Evropi Theodoratou
Journal of Global Health, doi:10.7189/jogh.10.020514
Background Physical activity (PA) is known to be a protective lifestyle factor against several non-communicable diseases while its impact on infectious diseases, including Coronavirus Disease 2019 (COVID-19) is not as clear.
Methods We performed univariate and multivariate logistic regression to identify associations between both objectively and subjectively measured PA collected prospectively and COVID-19 related outcomes in the UK Biobank cohort. Subsequently, we tested causality by using Mendelian randomisation (MR) analyses.
Results In the multivariable model, the increased acceleration vector magnitude PA (AMPA) is associated with a decreased probability of overall and outpatient COVID-19 with an odds ratio (OR) and 95% confidence interval (CI) of 0.80 (0.69, 0.93) and 0.74 (0.58, 0.95), respectively. No association is found between self-reported moderate-to-vigorous PA (MVPA) and COVID-19 related outcomes. No association is found by MR analyses.
Conclusions Our results indicate a protective effect of objectively measured PA and COVID-19 outcomes (outpatient COVID-19 and overall COVID-19) independent of age, sex, measures of obesity, and smoking status. Although the MR analyses do not support a causal association, that may be due to limited power. We conclude that policies to encourage and facilitate exercise at a population level during the pandemic should be considered.
Authors' contributions: MGD, MT, and ET conceived this study. XZ, XL, MT and ET designed the methodology. XZ conducted data analysis and drafted the manuscript. XZ conducted data interpretation with ET, MT, and MGD. XL, ZS, YH, WX, HC, MGD, MT, and ET contributed to the manuscript drafting and revision. Competing interests: Harry Campbell is the Co-Editor in Chief of the Journal of Global Health. To ensure that any possible conflict of interest relevant to the journal has been addressed, this article was reviewed according to best practice guidelines of international editorial organisations. The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no conflicts of interest.
Additional material Online Supplementary Document VIEWPOINTS RESEARCH THEME 1: COVID-19 PANDEMIC
References
Biobank, Records of COVID-19 test results
Bowden, Smith, Burgess, Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression, Int J Epidemiol,
doi:10.1093/ije/dyv080Burgess, Scott, Timpson, Smith, Thompson, Consortium E-I. Using published data in Mendelian randomization: a blueprint for efficient identification of causal risk factors, Eur J Epidemiol,
doi:10.1007/s10654-015-0011-zBycroft, Freeman, Petkova, Band, Elliott et al., The UK Biobank resource with deep phenotyping and genomic data, Nature,
doi:10.1038/s41586-018-0579-zCraig, Marshall, Sjostrom, Bauman, Booth et al., International physical activity questionnaire: 12-country reliability and validity, Med Sci Sports Exerc,
doi:10.1249/01.MSS.0000078924.61453.FBDoherty, Jackson, Hammerla, Plotz, Olivier et al., Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study, PLoS One,
doi:10.1371/journal.pone.0169649Doherty, Smith-Byrne, Ferreira, Holmes, Holmes et al., GWAS identifies 14 loci for device-measured physical activity and sleep duration, Nat Commun,
doi:10.1038/s41467-018-07743-4Dyrstad, Hansen, Holme, Anderssen, Comparison of self-reported versus accelerometer-measured physical activity, Med Sci Sports Exerc,
doi:10.1249/MSS.0b013e3182a0595fGroeniger, Kamphuis, Mackenbach, Beenackers, Van Lenthe, Are socio-economic inequalities in diet and physical activity a matter of social distinction? A cross-sectional study, Int J Public Health,
doi:10.1007/s00038-019-01268-3Jakobsson, Malm, Furberg, Ekelund, Svensson, Physical Activity During the Coronavirus (COVID-19) Pandemic: Prevention of a Decline in Metabolic and Immunological Functions, Front Sports Act Living
Klimentidis, Raichlen, Garcia, Wineinger, Mandarino, Genome-wide association study of habitual physical activity in over 377,000 UK Biobank participants identifies multiple variants including CADM2 and APOE, Int J Obes (Lond),
doi:10.1038/s41366-018-0120-3Leong, Cole, Brenner, Meigs, Florez et al., Cardiometabolic Risk Factors for COVID-19 Susceptibility and Severity: A Mendelian Randomization Analysis,
doi:10.1101/2020.08.26.20182709v1Lesser, Nienhuis, The Impact of COVID-19 on Physical Activity Behavior and Well-Being of Canadians, Int J Environ Res Public Health,
doi:10.3390/ijerph17113899Locke, Kahali, Berndt, Justice, Pers et al., Genetic studies of body mass index yield new insights for obesity biology, Nature,
doi:10.1038/nature14177Meng, Li, Timofeeva, He, Spiliopoulou et al., Phenome-wide Mendelian-randomization study of genetically determined vitamin D on multiple health outcomes using the UK Biobank study, Int J Epidemiol,
doi:10.1093/ije/dyz182Popkin, Du, Green, Beck, Algaith et al., Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships, Obes Rev,
doi:10.1111/obr.13128Rezende, Sa, Markozannes, Rey-Lopez, Lee et al., Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases, Br J Sports Med,
doi:10.1136/bjsports-2017-098391Sellami, Gasmi, Denham, Hayes, Stratton et al., Effects of Acute and Chronic Exercise on Immunological Parameters in the Elderly Aged: Can Physical Activity Counteract the Effects of Aging?, Front Immunol,
doi:10.3389/fimmu.2018.02187Vasankari, Husu, Vaha-Ypya, Suni, Tokola et al., Association of objectively measured sedentary behaviour and physical activity with cardiovascular disease risk, Eur J Prev Cardiol,
doi:10.1177/2047487317711048White, Babic, Parker, Lubans, Astell-Burt et al., Domain-Specific Physical Activity and Mental Health: A Meta-analysis, Am J Prev Med,
doi:10.1016/j.amepre.2016.12.008Who, Coronavirus disease (COVID-2019) situation reports
