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Baseline physical activity and the risk of severe illness and mortality from COVID-19: A dose-response meta-analysis.

ABSTRACT: To provide a scientific basis for improved exercise-based immunity, a meta-analysis was used to explore the dose-response relationship between physical activity (PA) and the risk of severe illness and mortality related to COVID-19 (coronavirus disease 2019). To this end, we searched PubMed, Web of Science databases from January 2020 through April 2022. 14 observational studies met the criteria for inclusion in the meta-analysis, including 2840 cases of severe illness and death from COVID-19. Categorical dose-relationship analysis showed that the risks of severe illness and mortality from COVID-19 were, respectively, 46% (risk ratio (RR): 0.54; confidence intervals (CIs): 0.41-0.68) and 59% (RR = 0.41; 95%CI: 0.23-0.58) lower for the highest dose of PA compared with the lowest dose of PA. The results of the continuous dose-response analysis show an inverse nonlinear relationship (P_{non-linearity} < 0.05) between PA and both the risk of severe illness and mortality from COVID-19. For PA below 10 MET-h/week (MET-h/week: metabolic equivalent of task-hours/week), an increase of 4 MET-h/week (1 h of moderate-intensity or 0.5 h of high-intensity PA) was associated with 8% and 11% reductions in the risk of severe illness and mortality from COVID-19. PA above 10 MET-h/week lowered the risk of severe illness and mortality from COVID-19 by 7% and 9%, respectively, for each 4 MET-h/week increase. Doses of WHO-recommended PA levels (10 MET-h/week) may be required for more substantial reductions in the risk of severe illness and mortality from COVID-19.

SUBMITTER: Liu J

PROVIDER: S-EPMC9905049 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Baseline physical activity and the risk of severe illness and mortality from COVID-19: A dose-response meta-analysis.

Liu Junjie J Guo Zhiguang Z Lu Songtao S

Preventive medicine reports 20230208

To provide a scientific basis for improved exercise-based immunity, a <i>meta</i>-analysis was used to explore the dose-response relationship between physical activity (PA) and the risk of severe illness and mortality related to COVID-19 (coronavirus disease 2019). To this end, we searched PubMed, Web of Science databases from January 2020 through April 2022. 14 observational studies met the criteria for inclusion in the <i>meta</i>-analysis, including 2840 cases of severe illness and death from ...[more]

PMID: 36778629

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Project description: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.

Project description:BackgroundAlthough electrolyte abnormalities are common among patients with COVID-19, very little has been reported on magnesium homeostasis in these patients. Here we report the incidence of hypermagnesemia, and its association with outcomes among patients admitted with COVID-19.MethodsWe retrospectively identified all patients with a positive test result for SARS-CoV-2 who were admitted to a large quaternary care center in New York City in spring 2020. Details of the patients' demographics and hospital course were obtained retrospectively from medical records. Patients were defined as having hypermagnesemia if their median magnesium over the course of their hospitalization was >2.4 mg/dl.ResultsA total of 1685 patients hospitalized with COVID-19 had their magnesium levels checked during their hospitalization, and were included in the final study cohort, among whom 355 (21%) had hypermagnesemia. Patients who were hypermagnesemic had a higher incidence of shock requiring pressors (35% vs 27%, P<0.01), respiratory failure requiring mechanical ventilation (28% vs 21%, P=0.01), AKI (65% vs 50%, P<0.001), and AKI severe enough to require renal replacement therapy (18% vs 5%, P<0.001). In an adjusted multivariable model, hypermagnesemia was observed more commonly with increasing age, male sex, AKI requiring RRT, hyperkalemia, and higher CPK. Survival probability at 30 days was 34% for the patients with hypermagnesemia, compared with 65% for patients without hypermagnesemia. An adjusted multivariable time to event analysis identified an increased risk of mortality with older age, need for vasopressors, higher C-reactive protein levels, and hypermagnesemia (HR, 2.03; 95% CI, 1.63 to 2.54, P<0.001).ConclusionsIn conclusion, we identified an association between hypermagnesemia among patients hospitalized with COVID-19 and increased mortality. Although the exact mechanism of this relationship remains unclear, hypermagnesemia potentially represents increased cell turnover and higher severity of illness, which is frequently associated with more severe forms of AKI.

Project description:ObjectiveTo examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.DesignSystematic review and harmonised meta-analysis.Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.Eligibility criteriaProspective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.Data extraction and analysisGuidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.Main outcome measureAll cause mortality.Results39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).ConclusionHigher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.Systematic review registrationPROSPERO CRD42018091808.

Project description:ImportanceThe 2008 Physical Activity Guidelines for Americans recommended a minimum of 75 vigorous-intensity or 150 moderate-intensity minutes per week (7.5 metabolic-equivalent hours per week) of aerobic activity for substantial health benefit and suggested additional benefits by doing more than double this amount. However, the upper limit of longevity benefit or possible harm with more physical activity is unclear.ObjectiveTo quantify the dose-response association between leisure time physical activity and mortality and define the upper limit of benefit or harm associated with increased levels of physical activity.Design, setting, and participantsWe pooled data from 6 studies in the National Cancer Institute Cohort Consortium (baseline 1992-2003). Population-based prospective cohorts in the United States and Europe with self-reported physical activity were analyzed in 2014. A total of 661,137 men and women (median age, 62 years; range, 21-98 years) and 116,686 deaths were included. We used Cox proportional hazards regression with cohort stratification to generate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Median follow-up time was 14.2 years.ExposuresLeisure time moderate- to vigorous-intensity physical activity.Main outcomes and measuresThe upper limit of mortality benefit from high levels of leisure time physical activity.ResultsCompared with individuals reporting no leisure time physical activity, we observed a 20% lower mortality risk among those performing less than the recommended minimum of 7.5 metabolic-equivalent hours per week (HR, 0.80 [95% CI, 0.78-0.82]), a 31% lower risk at 1 to 2 times the recommended minimum (HR, 0.69 [95% CI, 0.67-0.70]), and a 37% lower risk at 2 to 3 times the minimum (HR, 0.63 [95% CI, 0.62-0.65]). An upper threshold for mortality benefit occurred at 3 to 5 times the physical activity recommendation (HR, 0.61 [95% CI, 0.59-0.62]); however, compared with the recommended minimum, the additional benefit was modest (31% vs 39%). There was no evidence of harm at 10 or more times the recommended minimum (HR, 0.69 [95% CI, 0.59-0.78]). A similar dose-response relationship was observed for mortality due to cardiovascular disease and to cancer.Conclusions and relevanceMeeting the 2008 Physical Activity Guidelines for Americans minimum by either moderate- or vigorous-intensity activities was associated with nearly the maximum longevity benefit. We observed a benefit threshold at approximately 3 to 5 times the recommended leisure time physical activity minimum and no excess risk at 10 or more times the minimum. In regard to mortality, health care professionals should encourage inactive adults to perform leisure time physical activity and do not need to discourage adults who already participate in high-activity levels.

Project description:Rationale: Coronavirus disease (COVID-19) is a global threat to health. Its inflammatory characteristics are incompletely understood.Objectives: To define the cytokine profile of COVID-19 and to identify evidence of immunometabolic alterations in those with severe illness.Methods: Levels of IL-1β, IL-6, IL-8, IL-10, and sTNFR1 (soluble tumor necrosis factor receptor 1) were assessed in plasma from healthy volunteers, hospitalized but stable patients with COVID-19 (COVIDstable patients), patients with COVID-19 requiring ICU admission (COVIDICU patients), and patients with severe community-acquired pneumonia requiring ICU support (CAPICU patients). Immunometabolic markers were measured in circulating neutrophils from patients with severe COVID-19. The acute phase response of AAT (alpha-1 antitrypsin) to COVID-19 was also evaluated.Measurements and Main Results: IL-1β, IL-6, IL-8, and sTNFR1 were all increased in patients with COVID-19. COVIDICU patients could be clearly differentiated from COVIDstable patients, and demonstrated higher levels of IL-1β, IL-6, and sTNFR1 but lower IL-10 than CAPICU patients. COVID-19 neutrophils displayed altered immunometabolism, with increased cytosolic PKM2 (pyruvate kinase M2), phosphorylated PKM2, HIF-1α (hypoxia-inducible factor-1α), and lactate. The production and sialylation of AAT increased in COVID-19, but this antiinflammatory response was overwhelmed in severe illness, with the IL-6:AAT ratio markedly higher in patients requiring ICU admission (P < 0.0001). In critically unwell patients with COVID-19, increases in IL-6:AAT predicted prolonged ICU stay and mortality, whereas improvement in IL-6:AAT was associated with clinical resolution (P < 0.0001).Conclusions: The COVID-19 cytokinemia is distinct from that of other types of pneumonia, leading to organ failure and ICU need. Neutrophils undergo immunometabolic reprogramming in severe COVID-19 illness. Cytokine ratios may predict outcomes in this population.

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Baseline physical activity and the risk of severe illness and mortality from COVID-19: A dose-response meta-analysis.

Publications

Baseline physical activity and the risk of severe illness and mortality from COVID-19: A dose-response meta-analysis.

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