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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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          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.

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          Most cited references44

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          International physical activity questionnaire: 12-country reliability and validity.

          Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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            The Physical Activity Guidelines for Americans

            Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.
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              Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.

              Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non-communicable diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers, and shortens life expectancy. Because much of the world's population is inactive, this link presents a major public health issue. We aimed to quantify the eff ect of physical inactivity on these major non-communicable diseases by estimating how much disease could be averted if inactive people were to become active and to estimate gain in life expectancy at the population level. For our analysis of burden of disease, we calculated population attributable fractions (PAFs) associated with physical inactivity using conservative assumptions for each of the major non-communicable diseases, by country, to estimate how much disease could be averted if physical inactivity were eliminated. We used life-table analysis to estimate gains in life expectancy of the population. Worldwide, we estimate that physical inactivity causes 6% (ranging from 3·2% in southeast Asia to 7·8% in the eastern Mediterranean region) of the burden of disease from coronary heart disease, 7% (3·9-9·6) of type 2 diabetes, 10% (5·6-14·1) of breast cancer, and 10% (5·7-13·8) of colon cancer. Inactivity causes 9% (range 5·1-12·5) of premature mortality, or more than 5·3 million of the 57 million deaths that occurred worldwide in 2008. If inactivity were not eliminated, but decreased instead by 10% or 25%, more than 533 000 and more than 1·3 million deaths, respectively, could be averted every year. We estimated that elimination of physical inactivity would increase the life expectancy of the world's population by 0·68 (range 0·41-0·95) years. Physical inactivity has a major health eff ect worldwide. Decrease in or removal of this unhealthy behaviour could improve health substantially. None.
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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                July 2021
                21 July 2021
                21 July 2021
                : bjsports-2021-104203
                Affiliations
                [1 ]departmentDepartment of Data Science , Sejong University College of Software Convergence , Seoul, Korea (the Republic of)
                [2 ]departmentDepartment of Psychiatry , Yonsei University Wonju College of Medicine , Wonju, Korea (the Republic of)
                [3 ]departmentDepartment of Ophthalmology, Asan Medical Center , University of Ulsan College of Medicine , Seoul, Korea (the Republic of)
                [4 ]departmentDepartment of Epidemiology , Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
                [5 ]departmentProgram in MPE Molecular Pathological Epidemiology, Department of Pathology , Brigham and Women’s Hospital and Harvard Medical School , Boston, Massachusetts, USA
                [6 ]Yonsei University College of Medicine , Seoul, Korea (the Republic of)
                [7 ]departmentUrology Institute, University Hospitals , Case Western Reserve University , Cleveland, Ohio, USA
                [8 ]departmentDeparment of Medicine , University of Cambridge , Cambridge, UK
                [9 ]departmentResearch and Development Unit, Parc Sanitari Sant Joan de Deu , CIBERSAM , Barcelona, Spain
                [10 ]departmentCatalan Institution for Research and Advanced Studies (ICREA) , Pg. Lluis Companys , Barcelona, Spain
                [11 ]Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM) , Madrid, Spain
                [12 ]departmentFaculty of Medicine , University of Versailles Saint-Quentin-en-Yvelines , Montigny-le-Bretonneux, France
                [13 ]departmentPain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences , Linköping University , Linkoping, Sweden
                [14 ]departmentThe Cambridge Centre for Sport and Exercise Sciences , Anglia Ruskin University , Chelmsford, UK
                [15 ]departmentChanning Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts, USA
                [16 ]departmentDepartment of Nutrition , Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
                [17 ]departmentDivision of Preventive Medicine, Brigham and Women’s Hospital , Harvard Medical School , Boston, Massachusetts, USA
                [18 ]departmentDepartment of Pediatrics , Yonsei University College of Medicine , Seoul, Korea (the Republic of)
                [19 ]departmentDepartment of Pediatrics, CHA Gangnam Medical Center , CHA University School of Medicine , Seoul, Korea (the Republic of)
                [20 ]departmentDepartment of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center , CHA University School of Medicine , Seongnam, Korea (the Republic of)
                [21 ]departmentSamsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University , Samsung Medical Center , Seoul, Korea (the Republic of)
                [22 ]departmentDepartment of Sports Medicine , Norwegian School of Sports Sciences , Oslo, Norway
                [23 ]departmentDepartment of Chronic Diseases and Ageing , Norwegian Institute of Public Health , Oslo, Norway
                [24 ]departmentDepartment of Pediatrics, Seoul National University Hospital , Seoul National University College of Medicine , Seoul, Korea (the Republic of)
                Author notes
                [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@ 123456gmail.com ; Professor Seung Won Lee, Department of Data Science, Sejong University College of Software Convergence, Seoul 03722, Korea (the Republic of); lsw2920@ 123456gmail.com ; Professor Jae Il Shin, Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea (the Republic of); shinji@ 123456yuhs.ac

                SWL and DKY are joint first authors.

                Author information
                http://orcid.org/0000-0001-5632-5208
                http://orcid.org/0000-0002-1083-6907
                http://orcid.org/0000-0003-2115-7835
                http://orcid.org/0000-0003-1628-9948
                Article
                bjsports-2021-104203
                10.1136/bjsports-2021-104203
                8300550
                34301715
                f4944a93-b5cb-41aa-ae9b-9cc4333f4f77
                © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

                This article is made freely available for 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.

                History
                : 30 June 2021
                Funding
                Funded by: National Research Foundation of Korea (NRF);
                Award ID: NRF2019R1G1A109977913
                Categories
                Original Research
                2474
                2314
                Custom metadata
                free

                Sports medicine
                covid-19,physical activity
                Sports medicine
                covid-19, physical activity

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