Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis

Masoud Rahmati; Mahdieh Molanouri Shamsi; Kayvan Khoramipour; Fatemeh Malakoutinia; Wongi Woo; Seoyeon Park; Dong Keon Yon; Seung Won Lee; Jae Il Shin; Lee Smith

doi:10.1002/rmv.2349

Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis

Rev Med Virol. 2022 Sep;32(5):e2349. doi: 10.1002/rmv.2349. Epub 2022 Apr 13.

Authors

Affiliations

¹ Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran.
² Department of Physical Education & Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.
³ Department of Physiology and Pharmacology, Neuroscience Research Center, Institute of Neuropharmacology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
⁴ Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
⁵ Yonsei University College of Medicine, Seoul, Korea.
⁶ Department of Pediatrics, Kyung HeeUniversity Hospital, Kyung HeeUniversity College of Medicine, Seoul, Korea.
⁷ Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea.
⁸ Sungkyunkwan University School of Medicine, Suwon, Korea.
⁹ Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
¹⁰ Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK.

Abstract

Among coronavirus disease 2019 (COVID-19) patients, physically active individuals may be at lower risk of fatal outcomes. However, to date, no meta-analysis has been carried out to investigate the relationship between physical activity (PA) and fatal outcomes in patients with COVID-19. Therefore, this meta-analysis aims to explore the hospitalisation, intensive care unit (ICU) admissions, and mortality rates of COVID-19 patients with a history of PA participation before the onset of the pandemic, and to evaluate the reliability of the evidence. A systematic search of MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and medRxiv was conducted for articles published up to January 2022. A random-effects meta-analysis was performed to compare disease severity and mortality rates of COVID-19 patients in physically active and inactive cases. Twelve studies involving 1,256,609 patients (991,268 physically active and 265,341 inactive cases) with COVID-19, were included in the pooled analysis. The overall meta-analysis compared with inactive controls showed significant associations between PA with reduction in COVID-19 hospitalisation (risk ratio (RR) = 0.58, 95% confidence intervals (CI) 0.46-0.73, P = 0.001), ICU admissions (RR = 0.65, 95% CI 0.52-0.81, P = 0.001) and mortality (RR = 0.47, 95% CI 0.38-0.59, P = 0.001). The protective effect of PA on COVID-19 hospitalisation and mortality could be attributable to the types of exercise such as resistance exercise (RR = 0.27, 95% CI 0.15-0.49, P = 0.001) and endurance exercise (RR = 0.41, 95% CI 0.23-0.74, P = 0.003), respectively. Physical activity is associated with decreased hospitalisation, ICU admissions, and mortality rates of patients with COVID-19. Moreover, COVID-19 patients with a history of resistance and endurance exercises experience a lower rate of hospitalisation and mortality, respectively. Further studies are warranted to determine the biological mechanisms underlying these findings.

Keywords: COVID-19; exercise; meta-analysis; physical activity.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / therapy
Exercise
Hospitalization
Humans
Pandemics
Reproducibility of Results