Lack of Physical Activity Associated with Higher Rates of Severe COVID-19 Outcomes

Background: Of the studies examining risk factors for severe COVID-19 outcomes, none have examined inadequate physical activity (PA). We compared hospitalization rates, intensive care unit (ICU) admissions and mortality for COVID-19 patients who were inactive, inconsistently active, or regularly physically active.Methods: This retrospective observational study was done at Kaiser Permanente in Southern California. We identified 48,440 adult patients with a COVID-19 diagnosis from January 1, 2020 to October 21, 2020, with at least two Exercise Vital Sign (EVS) measurements from March 19, 2018 to March 18, 2020. We linked each patient's self-reported PA category (consistently inactive = 0-10 min/week, inconsistently active = 11-149 min/week, consistently active = 150+ min/week) to risk of hospitalization, ICU admission and death after COVID-19 diagnosis. We conducted multivariate logistic regression controlling for known risk factors to assess whether regular PA was associated with COIVD -19 outcomes.Findings: COVID-19 patients who were consistently inactive were more likely to be hospitalized (OR 2.26; 95% CI: 1.81, 2.83), admitted to the ICU (OR= 1.73; 95% CI: 1.18, 2.55) and die (OR 2.49; 95% CI: 1.33, 4.67) than patients who were consistently active. Patients who were inconsistently active were more likely to be hospitalized (OR 1.89; 95% CI: 1.53, 2.33), admitted to the ICU (OR 1.58; 95% CI: 1.10, 2.27) and die (OR 1.88; 95% CI: 1.02, 3.47) compared to those who were consistently active. Patients who were consistently inactive had a greater risk of being hospitalized (OR= 1.20; 95% CI: 1.10, 1.32), admitted to the ICU (OR 1.10; 95% CI: 0.93, 1.29) and death (OR 1.32; 95% CI: 1.09, 1.60) than patients who were inconsistently active.Interpretations: Regular PA is a strong, modifiable independent risk factor for protecting against severe COVID-19 outcomes. Pandemic control measures should prioritize supporting regular PA to lessen COVID-19 morbidity and mortality.Funding Statement: This study was in part supported through funding from the Kaiser Permanente Community Benefits Funds.Declaration of Interests: The authors report no conflict of interest except Dr. Tartof reports grants from Roche/Genentech, Inc., during the conduct of the study.Ethics Approval Statement: The study was approved by the KPSC Institutional Review Board.