RT Journal Article
SR Electronic
T1 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
JF British Journal of Sports Medicine
JO Br J Sports Med
FD BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
SP bjsports-2021-104203
DO 10.1136/bjsports-2021-104203
A1 Seung Won Lee
A1 Jinhee Lee
A1 Sung Yong Moon
A1 Hyun Young Jin
A1 Jee Myung Yang
A1 Shuji Ogino
A1 Mingyang Song
A1 Sung Hwi Hong
A1 Ramy Abou Ghayda
A1 Andreas Kronbichler
A1 Ai Koyanagi
A1 Louis Jacob
A1 Elena Dragioti
A1 Lee Smith
A1 Edward Giovannucci
A1 I-Min Lee
A1 Dong Hoon Lee
A1 Keum Hwa Lee
A1 Youn Ho Shin
A1 So Young Kim
A1 Min Seo Kim
A1 Hong-Hee Won
A1 Ulf Ekelund
A1 Jae Il Shin
A1 Dong Keon Yon
YR 2021
UL http://bjsm.bmj.com/content/early/2021/07/21/bjsports-2021-104203.abstract
AB 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.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.