Loading...
36 exercise COVID-19 controlled studies
40% improvement, RR
0.60
[0.53-0.67]
https://c19early.com/exmeta.html
0
0.5
1
1.5+
All studies
40%
36
1,464,894
Improvement, Studies, Patients
Relative Risk
Mortality
44%
13
1,437,929
Ventilation
46%
2
43,773
ICU admission
41%
4
708,149
Hospitalization
38%
9
666,393
Recovery
57%
2
66
Cases
20%
14
77,841
Peer-reviewed
40%
35
1,464,894
Prophylaxis
40%
36
1,464,894
Exercise for COVID-19
c19early.com/ex Aug 2022
Favors exercise
Favors inactivity
after exclusions
• Results are robust — in exclusion sensitivity analysis 31 of 36
studies must be excluded to avoid finding statistically significant efficacy
in pooled analysis.
• Results are consistent with the overall risk of all cause mortality based on cardiorespiratory fitness —
[Laukkanen ] show RR 0.55 [0.50-0.61] for the top vs. bottom tertiles.
0
0.5
1
1.5+
All studies
40%
36
1,464,894
Improvement, Studies, Patients
Relative Risk
Mortality
44%
13
1,437,929
Ventilation
46%
2
43,773
ICU admission
41%
4
708,149
Hospitalization
38%
9
666,393
Recovery
57%
2
66
Cases
20%
14
77,841
Peer-reviewed
40%
35
1,464,894
Prophylaxis
40%
36
1,464,894
Exercise for COVID-19
c19early.com/ex Aug 2022
Favors exercise
Favors inactivity
after exclusions
• Studies analyze exercise/physical activity levels before infection, comparing regular/moderate exercise vs. lower/no exercise. Note that risk may increase with more extreme activity levels.
• No treatment, vaccine, or intervention is 100%
available and effective for all variants. All practical, effective, and safe
means should be used.
Denying the efficacy of treatments increases mortality, morbidity, collateral
damage, and endemic risk.
• All data to reproduce this paper and
sources are in the
appendix .
Other meta analyses for exercise can be found in
[Li , Rahmati ] , showing significant improvements for mortality, ICU admission, and hospitalization.
Highlights
We show traditional outcome specific analyses and combined
evidence from all studies.
A
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Hamer
28%
0.72 [0.61-0.87]
hosp.
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Brawner
74%
0.26 [0.11-0.58]
hosp.
n/a
n/a
Zhang
26%
0.74 [0.48-1.14]
death
n/a
n/a
Tavakol
69%
0.31 [0.10-1.02]
severe case
3/64
19/124
Yates
45%
0.55 [0.38-0.79]
death
72/163,912
62/30,119
Holt
17%
0.83 [0.63-1.09]
cases
n/a
n/a
Cho
53%
0.47 [0.26-0.87]
death
case control
Sallis
59%
0.41 [0.22-0.76]
death
11/3,118
170/6,984
Christensen
63%
0.37 [0.16-0.85]
death
543 (n)
529 (n)
Latorre-Román
76%
0.24 [0.05-1.04]
hosp.
n/a
n/a
Marcus
42%
0.58 [0.48-0.71]
symp. case
240/10,627
134/3,708
Yuan
91%
0.09 [0.01-1.65]
death
0/61
6/103
Brandenburg
-6%
1.06 [0.23-4.79]
hosp.
102 (n)
39 (n)
Bielik
30%
0.70 [0.40-1.21]
mod. case
775 (n)
365 (n)
af Geijerstam
50%
0.50 [0.31-0.81]
death
318,902 (n)
336,271 (n)
Lee
74%
0.26 [0.07-0.99]
death
2/11,072
32/41,293
Maltagliati
52%
0.48 [0.25-0.87]
hosp.
n/a
n/a
Baynouna AlKetbi
98%
0.01 [0.00-0.44]
death
n/a
n/a
Ahmadi
30%
0.70 [0.54-0.89]
death
160/232,613
112/95,221
Nguyen
20%
0.80 [0.72-0.88]
symp. case
904/2,836
483/1,111
Lin
47%
0.53 [0.12-2.33]
cases
n/a
n/a
de Souza
73%
0.27 [0.07-1.06]
ventilation
3/611
6/327
Mohsin
19%
0.81 [0.66-0.99]
severe case
86/258
224/544
Ekblom-Bak
48%
0.52 [0.30-0.92]
severe case
n/a
n/a
Lengelé
74%
0.26 [0.07-0.80]
cases
23/229
4/12
Saadeh
9%
0.91 [0.56-1.43]
symp. case
362 (n)
225 (n)
Hamrouni
29%
0.71 [0.55-0.92]
death
138/106,006
109/47,827
Huang
47%
0.53 [0.23-1.22]
severe case
7/74
16/90
Steenkamp
42%
0.58 [0.50-0.68]
death
29,469 (n)
13,366 (n)
Gilley
-42%
1.42 [0.60-3.35]
cases
172/1,917
5/79
Beydoun
43%
0.57 [0.32-1.01]
cases
1,710 (n)
448 (n)
Salgado-Aranda
83%
0.17 [0.05-0.56]
death
4/223
41/297
Paul
38%
0.62 [0.30-1.20]
no recov.
n/a
n/a
Kontopoulou
66%
0.34 [0.24-0.47]
recov. time
42 (n)
24 (n)
Malisoux
63%
0.37 [0.14-0.98]
progression
115 (n)
108 (n)
Antunes
80%
0.20 [0.03-1.41]
ICU
1/14
9/25
Tau2 = 0.06, I2 = 67.5%, p < 0.0001
Prophylaxis
40%
0.60 [0.53-0.67]
1,826/885,655
1,432/579,239
40% improvement
All studies
40%
0.60 [0.53-0.67]
1,826/885,655
1,432/579,239
40% improvement
36 exercise COVID-19 studies
c19early.com/ex Aug 2022
Tau2 = 0.06, I2 = 67.5%, p < 0.0001
Effect extraction pre-specified (most serious outcome, see appendix)
Favors exercise
Favors inactivity
B
C
Figure 1. A. Random effects
meta-analysis. This plot shows pooled effects, discussion can be found in the heterogeneity section,
and results for specific outcomes can be found in the individual outcome analyses.
Effect extraction is pre-specified, using the most serious outcome reported.
For details of effect extraction see the
appendix .
B. Scatter plot showing the
distribution of effects reported in studies.
C. History of all reported
effects (chronological within treatment stages).
Introduction
We analyze all significant studies
reporting COVID-19 outcomes as a function of physical activity levels.
Search methods, inclusion criteria, effect
extraction criteria (more serious outcomes have priority), all individual
study data, PRISMA answers, and statistical methods are detailed in
Appendix 1 . We present random effects meta-analysis results for all
studies, for studies within each treatment stage, for individual outcomes, for
peer-reviewed studies, for Randomized Controlled Trials (RCTs), and after
exclusions.
Physical Inactivity
Insufficient physical activity is a risk factor for many
diseases and is common around the world
[Guthold ] , as shown in
Figure 2 .
[Guthold ] found that prevalence in high-income
countries was over twice as high, and has increased over time.
Figure 2. Prevalence of insufficient
physical activity around the world as of 2016, from
[Guthold ] (top: female,
bottom: male).
For upper respiratory tract infections, research shows lower risk
for moderate activity vs. a sedentary lifestyle, however risk increases with more
extreme activity levels
[Nieman ] .
Figure 2. Risk may increase with more
extreme activity levels, as seen with upper respiratory tract infections
[Nieman ] .
Results
Figure 3 shows a visual overview of the results, with details in
Table 1 and
Table 2 .
Figure
4 ,
5 ,
6 ,
7 ,
8 ,
9 ,
10 ,
11 , and
12
show forest plots for a random effects meta-analysis of
all studies with pooled effects, mortality results, ventilation, ICU admission, hospitalization, progression, recovery, cases, and peer reviewed studies.
0
0.5
1
1.5+
ALL STUDIES
MORTALITY
VENTILATION
ICU ADMISSION
HOSPITALIZATION
RECOVERY
CASES
PEER-REVIEWED
After Exclusions
ALL STUDIES
All
Prophylaxis
Exercise for COVID-19
C19EARLY.COM/EX AUG 2022
Treatment time Number of studies reporting positive effects
Total number of studies Percentage of studies reporting positive effects
Random effects meta-analysis results
Prophylaxis
34
36
94.4%
40% improvement
RR 0.60 [0.53‑0.67]
p < 0.0001
All studies
34
36
94.4%
40% improvement
RR 0.60 [0.53‑0.67]
p < 0.0001
Table 1. Results by treatment stage.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Hamer
28%
0.72 [0.61-0.87]
hosp.
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Brawner
74%
0.26 [0.11-0.58]
hosp.
n/a
n/a
Zhang
26%
0.74 [0.48-1.14]
death
n/a
n/a
Tavakol
69%
0.31 [0.10-1.02]
severe case
3/64
19/124
Yates
45%
0.55 [0.38-0.79]
death
72/163,912
62/30,119
Holt
17%
0.83 [0.63-1.09]
cases
n/a
n/a
Cho
53%
0.47 [0.26-0.87]
death
case control
Sallis
59%
0.41 [0.22-0.76]
death
11/3,118
170/6,984
Christensen
63%
0.37 [0.16-0.85]
death
543 (n)
529 (n)
Latorre-Román
76%
0.24 [0.05-1.04]
hosp.
n/a
n/a
Marcus
42%
0.58 [0.48-0.71]
symp. case
240/10,627
134/3,708
Yuan
91%
0.09 [0.01-1.65]
death
0/61
6/103
Brandenburg
-6%
1.06 [0.23-4.79]
hosp.
102 (n)
39 (n)
Bielik
30%
0.70 [0.40-1.21]
mod. case
775 (n)
365 (n)
af Geijerstam
50%
0.50 [0.31-0.81]
death
318,902 (n)
336,271 (n)
Lee
74%
0.26 [0.07-0.99]
death
2/11,072
32/41,293
Maltagliati
52%
0.48 [0.25-0.87]
hosp.
n/a
n/a
Baynouna AlKetbi
98%
0.01 [0.00-0.44]
death
n/a
n/a
Ahmadi
30%
0.70 [0.54-0.89]
death
160/232,613
112/95,221
Nguyen
20%
0.80 [0.72-0.88]
symp. case
904/2,836
483/1,111
Lin
47%
0.53 [0.12-2.33]
cases
n/a
n/a
de Souza
73%
0.27 [0.07-1.06]
ventilation
3/611
6/327
Mohsin
19%
0.81 [0.66-0.99]
severe case
86/258
224/544
Ekblom-Bak
48%
0.52 [0.30-0.92]
severe case
n/a
n/a
Lengelé
74%
0.26 [0.07-0.80]
cases
23/229
4/12
Saadeh
9%
0.91 [0.56-1.43]
symp. case
362 (n)
225 (n)
Hamrouni
29%
0.71 [0.55-0.92]
death
138/106,006
109/47,827
Huang
47%
0.53 [0.23-1.22]
severe case
7/74
16/90
Steenkamp
42%
0.58 [0.50-0.68]
death
29,469 (n)
13,366 (n)
Gilley
-42%
1.42 [0.60-3.35]
cases
172/1,917
5/79
Beydoun
43%
0.57 [0.32-1.01]
cases
1,710 (n)
448 (n)
Salgado-Aranda
83%
0.17 [0.05-0.56]
death
4/223
41/297
Paul
38%
0.62 [0.30-1.20]
no recov.
n/a
n/a
Kontopoulou
66%
0.34 [0.24-0.47]
recov. time
42 (n)
24 (n)
Malisoux
63%
0.37 [0.14-0.98]
progression
115 (n)
108 (n)
Antunes
80%
0.20 [0.03-1.41]
ICU
1/14
9/25
Tau2 = 0.06, I2 = 67.5%, p < 0.0001
Prophylaxis
40%
0.60 [0.53-0.67]
1,826/885,655
1,432/579,239
40% improvement
All studies
40%
0.60 [0.53-0.67]
1,826/885,655
1,432/579,239
40% improvement
36 exercise COVID-19 studies
c19early.com/ex Aug 2022
Tau2 = 0.06, I2 = 67.5%, p < 0.0001
Effect extraction pre-specified (most serious outcome, see appendix)
Favors exercise
Favors inactivity
Figure 4. Random effects meta-analysis for all studies with pooled effects.
This plot shows pooled effects, discussion can be found in the heterogeneity section,
and results for specific outcomes can be found in the individual outcome analyses.
Effect extraction is pre-specified, using the most serious outcome reported.
For details of effect extraction see the
appendix .
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Zhang
26%
0.74 [0.48-1.14]
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Yates
45%
0.55 [0.38-0.79]
72/163,912
62/30,119
Cho
53%
0.47 [0.26-0.87]
case control
Sallis
59%
0.41 [0.22-0.76]
11/3,118
170/6,984
Christensen
63%
0.37 [0.16-0.85]
543 (n)
529 (n)
Yuan
91%
0.09 [0.01-1.65]
0/61
6/103
af Geijerstam
50%
0.50 [0.31-0.81]
318,902 (n)
336,271 (n)
Lee
74%
0.26 [0.07-0.99]
2/11,072
32/41,293
Baynouna AlKetbi
98%
0.01 [0.00-0.44]
n/a
n/a
Ahmadi
30%
0.70 [0.54-0.89]
160/232,613
112/95,221
Hamrouni
29%
0.71 [0.55-0.92]
138/106,006
109/47,827
Steenkamp
42%
0.58 [0.50-0.68]
29,469 (n)
13,366 (n)
Salgado-Aranda
83%
0.17 [0.05-0.56]
4/223
41/297
Tau2 = 0.03, I2 = 41.7%, p < 0.0001
Prophylaxis
44%
0.56 [0.48-0.66]
387/865,919
532/572,010
44% improvement
All studies
44%
0.56 [0.48-0.66]
387/865,919
532/572,010
44% improvement
13 exercise COVID-19 mortality results
c19early.com/ex Aug 2022
Tau2 = 0.03, I2 = 41.7%, p < 0.0001
Favors exercise
Favors inactivity
Figure 5. Random effects meta-analysis for mortality results.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
de Souza
73%
0.27 [0.07-1.06]
3/611
6/327
Improvement, RR [CI]
Treatment
Control
Steenkamp
45%
0.55 [0.47-0.64]
29,469 (n)
13,366 (n)
Tau2 = 0.01, I2 = 3.4%, p < 0.0001
Prophylaxis
46%
0.54 [0.43-0.68]
3/30,080
6/13,693
46% improvement
All studies
46%
0.54 [0.43-0.68]
3/30,080
6/13,693
46% improvement
2 exercise COVID-19 mechanical ventilation results
c19early.com/ex Aug 2022
Tau2 = 0.01, I2 = 3.4%, p < 0.0001
Favors exercise
Favors inactivity
Figure 6. Random effects meta-analysis for ventilation.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Sallis
42%
0.58 [0.40-0.85]
32/3,118
195/6,984
Improvement, RR [CI]
Treatment
Control
af Geijerstam
40%
0.60 [0.46-0.80]
318,902 (n)
336,271 (n)
Steenkamp
41%
0.59 [0.52-0.66]
29,469 (n)
13,366 (n)
Antunes
80%
0.20 [0.03-1.41]
1/14
9/25
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Prophylaxis
41%
0.59 [0.53-0.65]
33/351,503
204/356,646
41% improvement
All studies
41%
0.59 [0.53-0.65]
33/351,503
204/356,646
41% improvement
4 exercise COVID-19 ICU results
c19early.com/ex Aug 2022
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Favors exercise
Favors inactivity
Figure 7. Random effects meta-analysis for ICU admission.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Hamer
28%
0.72 [0.61-0.87]
hosp.
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Brawner
74%
0.26 [0.11-0.58]
hosp.
n/a
n/a
Sallis
53%
0.47 [0.38-0.58]
hosp.
99/3,118
732/6,984
Latorre-Román
76%
0.24 [0.05-1.04]
hosp.
n/a
n/a
Brandenburg
-6%
1.06 [0.23-4.79]
hosp.
102 (n)
39 (n)
af Geijerstam
27%
0.73 [0.64-0.83]
hosp.
318,902 (n)
336,271 (n)
Maltagliati
52%
0.48 [0.25-0.87]
hosp.
n/a
n/a
de Souza
34%
0.66 [0.43-0.99]
hosp.
49/611
42/327
Antunes
43%
0.57 [0.34-0.95]
hosp. time
14 (n)
25 (n)
Tau2 = 0.07, I2 = 80.0%, p < 0.0001
Prophylaxis
38%
0.62 [0.50-0.78]
148/322,747
774/343,646
38% improvement
All studies
38%
0.62 [0.50-0.78]
148/322,747
774/343,646
38% improvement
9 exercise COVID-19 hospitalization results
c19early.com/ex Aug 2022
Tau2 = 0.07, I2 = 80.0%, p < 0.0001
Favors exercise
Favors inactivity
Figure 8. Random effects meta-analysis for hospitalization.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Malisoux
63%
0.37 [0.14-0.98]
115 (n)
108 (n)
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.045
Prophylaxis
63%
0.37 [0.14-0.98]
0/115
0/108
63% improvement
All studies
63%
0.37 [0.14-0.98]
0/115
0/108
63% improvement
1 exercise COVID-19 progression result
c19early.com/ex Aug 2022
Tau2 = 0.00, I2 = 0.0%, p = 0.045
Favors exercise
Favors inactivity
Figure 9. Random effects meta-analysis for progression.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Paul
38%
0.62 [0.30-1.20]
no recov.
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Kontopoulou
66%
0.34 [0.24-0.47]
recov. time
42 (n)
24 (n)
Tau2 = 0.11, I2 = 60.7%, p = 0.0036
Prophylaxis
57%
0.43 [0.24-0.76]
0/42
0/24
57% improvement
All studies
57%
0.43 [0.24-0.76]
0/42
0/24
57% improvement
2 exercise COVID-19 recovery results
c19early.com/ex Aug 2022
Tau2 = 0.11, I2 = 60.7%, p = 0.0036
Favors exercise
Favors inactivity
Figure 10. Random effects meta-analysis for recovery.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Zhang
18%
0.82 [0.69-0.96]
cases
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Holt
17%
0.83 [0.63-1.09]
cases
n/a
n/a
Cho
10%
0.90 [0.86-0.95]
cases
case control
Christensen
23%
0.77 [0.52-1.15]
cases
55/543
77/529
Marcus
42%
0.58 [0.48-0.71]
symp. case
240/10,627
134/3,708
Bielik
-9%
1.09 [0.69-1.73]
cases
775 (n)
365 (n)
Lee
16%
0.84 [0.73-0.98]
cases
291/11,072
1,293/41,293
Nguyen
20%
0.80 [0.72-0.88]
symp. case
904/2,836
483/1,111
Lin
47%
0.53 [0.12-2.33]
cases
n/a
n/a
Lengelé
74%
0.26 [0.07-0.80]
cases
23/229
4/12
Saadeh
9%
0.91 [0.56-1.43]
symp. case
362 (n)
225 (n)
Huang
66%
0.34 [0.17-0.70]
cases
n/a
n/a
Gilley
-42%
1.42 [0.60-3.35]
cases
172/1,917
5/79
Beydoun
43%
0.57 [0.32-1.01]
cases
1,710 (n)
448 (n)
Tau2 = 0.02, I2 = 69.4%, p < 0.0001
Prophylaxis
20%
0.80 [0.72-0.89]
1,685/30,071
1,996/47,770
20% improvement
All studies
20%
0.80 [0.72-0.89]
1,685/30,071
1,996/47,770
20% improvement
14 exercise COVID-19 case results
c19early.com/ex Aug 2022
Tau2 = 0.02, I2 = 69.4%, p < 0.0001
Favors exercise
Favors inactivity
Figure 11. Random effects meta-analysis for cases.
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
Hamer
28%
0.72 [0.61-0.87]
hosp.
n/a
n/a
Improvement, RR [CI]
Treatment
Control
Brawner
74%
0.26 [0.11-0.58]
hosp.
n/a
n/a
Zhang
26%
0.74 [0.48-1.14]
death
n/a
n/a
Tavakol
69%
0.31 [0.10-1.02]
severe case