Physical Activity, Sedentary Behavior, and Risk of Coronavirus Disease 2019

Abstract

Introduction: Data on the associations of prepandemic physical activity and sedentary behavior with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) severity, particularly milder illness, have been limited.

Methods: We used data from 43,913 participants within the Nurses' Health Study II and Health Professionals Follow-Up Study who responded to periodic COVID-related surveys from May 2020 through March 2021. History of physical activity from the prepandemic period was assessed as the metabolic equivalents of task (MET)-hours per week of various activities of different intensity and sedentary behavior assessed from reports of time spent sitting from questionnaires completed 2016-2017. Multivariable logistic regression models were fitted to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for risk of SARS-CoV-2 infection and COVID-19 severity, as well as predicted COVID-19 defined using a validated symptom-based algorithm.

Results: Higher levels of prepandemic physical activity were associated with a lower risk for SARS-CoV-2 infection. Compared to participants with <3 MET-hours per week, the multivariable-adjusted OR was 0.86 (95% CI: 0.74, 0.99; P trend =.07) for those with ≥27 MET-hours per week. Higher physical activity levels were also associated with lower risk of symptomatic SARS-CoV-2 infection (OR: 0.84; 95% CI: 0.72, 0.99; P trend = .05) and predicted COVID-19 (OR: 0.87; 95% CI: 0.78, 0.97; P trend = .01). Longer time sitting at home watching TV (OR: 0.85; 95% CI: 0.73, 0.97) or for other tasks (OR: 0.78; 95% CI: 0.66, 0.92) was associated with a lower risk of SARS-CoV-2 infection.

Conclusions: Our findings support a protective association between prepandemic physical activity and lower risk and severity of COVID-19.

Keywords: COVID-19; Physical activity; SARS-CoV-2 infection; Sedentary behavior.

Figure 1

Total physical activity and risk of COVID-19 severity. Logistic regression models were used in the analysis. The number of participants was 17,390 for those who were asymptomatic and tested negative; 312 for asymptomatic SARS-CoV-2 infection; 2259 for symptomatic SARS-CoV-2 infection; and 139 for hospitalization. MV models were adjusted for white race, smoking pack-years (0, 0.1-10.0, 10.1-20.0, >20.0), the Alternate Healthy Eating Index (quintiles), body mass index (<22.5, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30-34.9, ≥35.0 kg/m²), alcohol intake (0, 0.1-5.0, 5.1-10.0, >10 g/d), 2010 census tract median income (quintiles), being a frontline health care worker, interaction with people with documented/presumed COVID-19 (none, interaction with people with presumed COVID-19, interaction with people with documented COVID-19), receipt of a COVID-19 vaccine, use of N95 masks at work (always, sometimes, never, not applicable), use of surgical masks at work (always, sometimes, never, not applicable), hypertension, hypercholesterolemia, diabetes, heart disease, and cancer. COVID-19 = coronavirus disease 2019; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Figure 2

Total physical activity and risk of SARS-CoV-2 infection in subgroups. Logistic regression models were used in the analysis. Values represented the odds ratios of SARS-CoV-2 infection comparing participants with ≥27 MET-hours per week to those with <3 MET-hours per week. MV models were adjusted for white race, smoking pack-years (0, 0.1-10.0, 10.1-20.0, >20.0), the Alternate Healthy Eating Index (quintiles), body mass index (<22.5, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30-34.9, ≥35.0 kg/m²), alcohol intake (0, 0.1-5.0, 5.1-10.0, >10 g/d), 2010 census tract median income (quintiles), being a frontline health care worker, interaction with people with documented/presumed COVID-19 (none, interaction with people with presumed COVID-19, interaction with people with documented COVID-19), receipt of a COVID-19 vaccine, use of N95 masks at work (always, sometimes, never, not applicable), use of surgical masks at work (always, sometimes, never, not applicable), hypertension, hypercholesterolemia, diabetes, heart disease, and cancer. COVID-19 = coronavirus disease 2019; MET = metabolic equivalent of task; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

Supplementary Figure 1

Flowchart of the study.

Supplementary Figure 2

Restricted cubic spline of total physical activity and risk of symptomatic SARS-CoV-2 infection (A) and predicted COVID-19 (B). Models were adjusted for age, sex, white race, smoking pack-years (0, 0.1-10.0, 10.1-20.0, >20.0), the Alternate Healthy Eating Index (quintiles), body mass index (<22.5, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30-34.9, ≥35.0 kg/m²), alcohol intake (0, 0.1-5.0, 5.1-10.0, >10 g/d), 2010 census tract median income (quintiles), being a frontline health care worker, interaction with people with documented/presumed COVID-19 (none, interaction with people with presumed COVID-19, interaction with people with documented COVID-19), receipt of a COVID-19 vaccine, use of N95 masks at work (always, sometimes, never, not applicable), use of surgical masks at work (always, sometimes, never, not applicable), hypertension, hypercholesterolemia, diabetes, heart disease, and cancer. There is no evidence for nonlinearity (P for nonlinearity > .05 for each). COVID-19 = coronavirus disease 2019; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.