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  • 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

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Original research
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
  1. Seung Won Lee1,
  2. Jinhee Lee2,
  3. Sung Yong Moon1,
  4. Hyun Young Jin1,
  5. Jee Myung Yang3,
  6. Shuji Ogino4,5,
  7. Mingyang Song4,
  8. Sung Hwi Hong6,
  9. Ramy Abou Ghayda7,
  10. Andreas Kronbichler8,
  11. Ai Koyanagi9,10,
  12. Louis Jacob9,11,12,
  13. Elena Dragioti13,
  14. Lee Smith14,
  15. Edward Giovannucci4,15,16,
  16. I-Min Lee4,17,
  17. Dong Hoon Lee16,
  18. Keum Hwa Lee18,
  19. Youn Ho Shin19,
  20. So Young Kim20,
  21. Min Seo Kim21,
  22. Hong-Hee Won21,
  23. Ulf Ekelund22,23,
  24. Jae Il Shin18,
  25. Dong Keon Yon24
  1. 1 Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea (the Republic of)
  2. 2 Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea (the Republic of)
  3. 3 Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  4. 4 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  5. 5 Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  6. 6 Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  7. 7 Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
  8. 8 Deparment of Medicine, University of Cambridge, Cambridge, UK
  9. 9 Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona, Spain
  10. 10 Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
  11. 11 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
  12. 12 Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
  13. 13 Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
  14. 14 The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Chelmsford, UK
  15. 15 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  16. 16 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  17. 17 Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  18. 18 Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  19. 19 Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea (the Republic of)
  20. 20 Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (the Republic of)
  21. 21 Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Korea (the Republic of)
  22. 22 Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
  23. 23 Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
  24. 24 Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Dong Keon Yon, Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 08826, Korea (the Republic of); yonkkang{at}gmail.com; Professor Seung Won Lee, Department of Data Science, Sejong University College of Software Convergence, Seoul 03722, Korea (the Republic of); lsw2920{at}gmail.com; Professor Jae Il Shin, Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea (the Republic of); shinji{at}yuhs.ac

Abstract

Purpose To 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.

Methods Data 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.

Results Out 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.

Conclusion Adults 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.

  • COVID-19
  • physical activity

Data availability statement

Data are available on reasonable request. Study protocol, statistical code: available from DKYon (email: yonkkang@gmail.com). Data set: available from the National Health Insurance Service of Korea (NHIS-COVID-19 data) through a data use agreement.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bjsports-2021-104203

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    Data availability statement

    Data are available on reasonable request. Study protocol, statistical code: available from DKYon (email: yonkkang@gmail.com). Data set: available from the National Health Insurance Service of Korea (NHIS-COVID-19 data) through a data use agreement.

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    Footnotes

    • SWL and DKY are joint first authors.

    • Contributors DKY had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version before submission. Study concept and design: SWL, JIS and DKY; acquisition, analysis or interpretation of data: SWL, SYM, HYJ and DKY; drafting of the manuscript: SWL, JL, JIS and DKY; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: SWL and DKY; study supervision: SWL, JIS and DKY. DKY is guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (NRF2019R1G1A109977913).

    • Disclaimer The funders had no role in study design, data collection, data analysis, data interpretation or writing of the report.

    • Competing interests None declared.

    • 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.