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Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients
  1. Robert Sallis1,
  2. Deborah Rohm Young2,
  3. Sara Y Tartof2,
  4. James F Sallis3,
  5. Jeevan Sall1,
  6. Qiaowu Li2,
  7. Gary N Smith4,
  8. Deborah A Cohen2
  1. 1 Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, California, USA
  2. 2 Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA
  3. 3 University of California San Diego, La Jolla, California, USA
  4. 4 Economics Department, Pomona College, Claremont, California, USA
  1. Correspondence to Dr Robert Sallis, Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA 92335, USA; Robert.E.Sallis{at}


Objectives To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines.

Methods We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient’s self-reported physical activity category (consistently inactive=0–10 min/week, some activity=11–149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.

Results Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity.

Conclusions Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.

  • COVID-19
  • physical activity
  • exercise

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No data are available.

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  • Contributors RS, DRY and SYT gained funding for the study. RS, DRY, SYT, JFS, JS, GNS and DAC conceived the study idea and contributed to writing of the first draft of the manuscript. RS, DRY, SYT, JFS, JS, QL, GNS and DAC interpreted the data analysis, and conducted data validation and data visualisation. All authors contributed to revisions of the manuscript and approved the submitted version.

  • Funding This study was supported in part through funding from the Kaiser Permanente Community Benefits Funds.

  • Competing interests SYT reports grants from Roche/Genentech during the conduct of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.