COVID-19 And Physical Inactivity: Is There A Risk?
Vaccination is one of the most effective ways to protect against COVID-19. Vaccines are effective at preventing serious outcomes, such as severe illness, hospitalization and death due to COVID-19. The purpose of this article is to shed light on the overall importance of physical activity and not to downplay the long-term protection that COVID-19 vaccines provide .
Why Physical Activity
Physical activity and exercise have been ingrained into our early education as an imperative part of our day to day lives. It is well known by most that the positive effects of physical activity take months and years to reap and the positive effect that is usually highlighted within the media is weight loss. On our Tiktok Feeds and Instagram Timelines, weight loss and muscle mass take over the conversation. While the benefits of weight loss and lowering BMI are imperative to living a healthy lifestyle, physical activity has additional benefits that are often over looked. Specific efforts to identify an association between exercise and immunity are often times limited. Here at Enable Health we wanted to determine and share with our community how and why physical activity is so important, especially during a global pandemic.
With several reports on COVID affecting the elderly, and those with pre-existing health conditions such as hypertension, diabetes and respiratory conditions (Asthma, COPD, ILD), we thought we would explore the relationship between COVID outcomes and patients who were physically inactive. While physical inactivity is associated with the above health conditions, physical inactivity on its own is a condition that can and should be explored through reliable and consistent scientific methodology.
The Big Study Explained
The British Medical Journal (BMJ) recently published an article on the relationship between physical inactivity and COVID outcomes : “Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440
Below we will review the methodology and results of the study to ensure that the information provided can be clearly understood and analyzed.
The retrospective observational study was conducted in Southern California and 48,440 COVID-19 positive patients who met all inclusion criteria were included. Electronic health records of self-reported physical activity over three or more accounts were analyzed. Demographics such as age, race, prior health conditions and severe risk factors for COVID were controlled for.
Being consistently inactive increased the odds of hospitalization by 2.26 fold (CI 1.18-2.83) compared with consistently meeting the physical activity (PA) guidelines. 10.5% of inactive patients were hospitalized compared to 3.2% of active patients. A 1.2 odds ratio was observed when comparing inactive patients to those who were completing some sort of physical activity. Other than age, pregnancy and history of organ transplant, being inactive presented the highest odds for hospitalization with COVID-19. The odds of death from COVID-19 were 2.49 times greater for patients who were consistently inactive compared with patients who were consistently meeting (PA) guidelines.
Physical activity is an important, modifiable risk factor for severe COVID-19 outcomes and had an increased risk compared to the odds of smoking and all chronic diseases studied. Even activity levels that did not meet the physical activity guidelines reduced the odds of hospitalization and death from COVID-19. It is important to note that the study utilized self-reported physical activity and there was no measure of intensity which contributes to the limitations of this study. The potential for additional confounding variables could also pose limitations. Lastly, individuals with severe diseases that limit their ability to exercise may have contributed to the increase in hospitalization (reverse association).
The American physical activity guidelines used in this study were achieving more than 150min/week of Moderate - Vigorous Physical Activity (MVPA). Those who completed 0-10min/week of MVPA were considered physically inactive. These guidelines are comparable to that of the Canadian Physical Activity Guidelines which call for Canadian adults to accumulate at least 150 minutes of MVPA per week, in bouts of 10 minutes or more. MVPA include activities such as brisk walking, biking, heavy cleaning (vacuuming, shovelling) mowing the lawn and jogging.
16% of adults living in Canada achieved at least 150 minutes of weekly MVPA in bouts of 10 minutes or more in 2019 . While achieving 150 minutes every week is not doable and attainable for many Canadians, as per the BMJ study:
SOMETHING IS BETTER THAN NOTHING.
The mechanism behind the protectiveness of physical activity and COVID-19 has also been evaluated and several theories have arisen. It is well known that severe cases of COVID-19 are associated with an imbalance in antiviral immunity, a pro-inflammatory cytokine storm and hyperinflammatory host response . Physical activity is hypothesized to decreases pro-thrombotic states, improve immune competence, and reduce pro-inflammatory states [4,5].
Here at Enayble Health we hope to clarify how and why physical activity is so important by creating relatable and reliable content. We can do better as Canadians to improve our immune systems and response to COVID-19 and other illnesses alike. The Canadian government, healthcare workers and allies can help to educate their patient’s communities and families on the importance of maintaining physical activity. And as well can provide personalized resources to ensure that these targets can be met to create a society that Moves More and Lives Well.
Share this article and comment your thoughts. Stay tuned for our next post describing the detailed role physical activity plays in one’s immune response and how it can shape your immune system. Thank you and we hope that this article has motivated you to Move More and Live Well during the COVID-19 pandemic and beyond.
Being consistently inactive or achieving 0-10 min of Moderate-Vigorous Physical Activity/Week increased the odds of hospitalization 2.26 fold compared with consistently meeting the PA guidelines ( >150min MVPA/ week).
The odds of death from COVID-19 were 2.49 times greater for patients who were consistently inactive compared with patients who were consistently meeting physical activity guidelines.
Something is Better Than Nothing: A 1.2 odds ratio was observed when comparing inactive patients to those who were completing some sort of physical activity.
16% of adults living in Canada achieved at least 150 minutes of weekly MVPA in bouts of 10 minutes or more in 2019: We can do better as Canadians to improve our immune systems and response to COVID-19 and other illnesses alike.
The Canadian government, healthcare workers and allies can help to educate their patients and communities on the importance of maintaining physical activity and can provide resources to ensure that these targets can be met to create a society that Moves More and Lives Well.
Sallis R, Young DR, Tartof SY, et al Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients British Journal of Sports Medicine Published Online First: 13 April 2021. Doi : 10.1136/bjsports-2021-104080
Clarke, Janine & Colley, Rachel & Janssen, Ian & Tremblay, Mark. (2019). Accelerometer-measured moderate-to-vigorous physical activity of Canadian adults, 2007 to 2017. Health reports. 30. 3-10. 10.25318/82-003-x201900800001-eng.
Filgueira TO, Castoldi A, Santos LER, de Amorim GJ, de Sousa Fernandes MS, Anastácio WLDN, Campos EZ, Santos TM, Souto FO. The Relevance of a Physical Active Lifestyle and Physical Fitness on Immune Defense: Mitigating Disease Burden, With Focus on COVID-19 Consequences. Front Immunol. 2021 Feb 5;12:587146. doi: 10.3389/fimmu.2021.587146. PMID: 33613573; PMCID: PMC7892446.
Gleeson, M., Bishop, N., Stensel, D. et al. The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nat Rev Immunol 11, 607–615 (2011). https://doi.org/10.1038/nri3041
Vaccine Pic: https://health.clevelandclinic.org/should-i-get-the-vaccine-if-ive-already-had-covid-19-and-would-my-side-effects-be-worse/
Exercise Immunity Pic: https://www.ochd.org/wp-content/uploads/2020/03/Tips-to-Help-Boost-Your-Immune-System-1080x675.jpg
Heart Picture: https://www.sharp.com/health-news/images/Exercise-can-reverse-heart-age-HN1319-iStock-629320658-Sized.png
Physical Activity Guidelines: https://www.acsm.org/images/default-source/read-research/resource-library/pa-recommendations.jpg?sfvrsn=8226ea46_0