Journal Article

Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study

Lee, Jinhee, Kronbichler, Andreas, Shin, Youn Ho, Yon, Dong Keon, Lee, Keum Hwa, Shin, Jae Il, Jacob, Louis, Ogino, Shuji, Jin, Hyun Young, Abou Ghayda, Ramy, Kim, Min Seo, Song, Mingyang, Lee, Dong Hoon, Kim, So Young, Smith, Lee, Lee, I-Min, Hong, Sung Hwi, Koyanagi, Ai, Yang, Jee Myung, Dragioti, Elena, Ekelund, Ulf, Giovannucci, Edward, Won, Hong-Hee, Moon, Sung Yong, Lee, Seung Won

2022

Overview

PurposeTo determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.MethodsData regarding 212 768 Korean adults (age ≥20 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.ResultsOut of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500–1000 MET min/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.ConclusionAdults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.

• Publisher: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Cardiovascular disease / Chronic illnesses / Clinical outcomes / Cohort analysis / Coronaviruses / COVID-19 / Diabetes / Disease transmission / Exercise / Health insurance / Hypertension / Hypotheses / Infections / Laboratories / Length of stay / Metabolism / Mortality / Original Research / Pandemics / Patients / physical activity / Physical fitness / Population / Respiratory diseases / Severe acute respiratory syndrome coronavirus 2