Muscle Strength Explains the Protective Effect of Physical Activity against COVID-19 Hospitalization among Adults aged 50 Years and Older
Silvio Maltagliati, Stephen Sieber, Philippe Sarrazin, Stéphane Cullati, Aïna Chalabaev, Grégoire P Millet, Matthieu P Boisgontier, Boris Cheval
doi:10.1101/2021.02.25.21252451
Objectives. Physical activity has been proposed as a protective factor for COVID-19 hospitalization. However, the mechanisms underlying this association are unclear. Here, we examined the association between physical activity and COVID-19 hospitalization and whether this relationship was explained by other risk factors for severe COVID-19. Method. We used data from adults aged 50 years and older from the Survey of Health, Ageing and Retirement in Europe. The outcome was self-reported hospitalization due to COVID-19 measured before August 2020. The main exposure was usual physical activity, self-reported between 2004 and 2017. Data were analyzed using logistic regression models. Results. Among the 3139 participants included in the study (69.3 ± 8.5 years, 1763 women), 266 were tested positive for COVID-19 and 66 were hospitalized. Results showed that individuals who engaged in physical activity more than once a week had lower odds of COVID-19 hospitalization than individuals who hardly ever or never engaged in physical activity (odds ratios = 0.41, 95% confidence interval = 0.22-0.74, p = .004). This association between physical activity and COVID-19 hospitalization was explained by muscle strength, but not by other risk factors.
Conclusion. These findings suggest that, after 50 years of age, engaging in physical activity more than once a week is associated with lower odds of COVID-19 hospitalization. The protective effect of physical activity on COVID-19 hospitalization is explained by muscle strength.
Supplementary material Table S1 . Results of the general logistic models testing the associations of low-to-moderate physical activity and other risk factors with COVID-19 hospitalizations. Table S2 . Results of the general logistic models testing the associations of vigorous physical activity and other risk factors with COVID-19 hospitalizations. Table S3 . Results based on the rare-events logistic regression with a tau parameter of 84/100,000. . Table S3 . Results based on the rare-events logistic regression with a tau parameter of 84/100,000.
Model
References
Batty, Deary, Luciano, Altschul, Kivimäki et al., Psychosocial factors and hospitalisations for COVID-19: Prospective cohort study based on a community sample, Brain, Behavior, and Immunity,
doi:10.1016/j.bbi.2020.06.021
Brawner, Ehrman, Bole, Kerrigan, Parikh et al., Maximal exercise capacity is inversely related to hospitalization secondary to coronavirus disease, Mayo Clinic Proceedings,
doi:10.1016/j.mayocp.2020.10.003
Burtscher, Burtscher, Millet, Indoor) isolation, stress, and physical inactivity: Vicious circles accelerated by COVID-19?, Scandinavian Journal of Medicine & Science in Sports,
doi:10.1111/sms.13706
Burtscher, Millet, Burtscher, Low cardiorespiratory and mitochondrial fitness as risk factors in viral infections: implications for COVID-19, British Journal of Sports Medicine,
doi:10.1136/bjsports-2020-103572
Cheval, Maltagliati, Sieber, Beran, Chalabaev et al., Why are individuals with diabetes less active? The mediating role of physical, emotional, and cognitive factors, Annals of Behavioral Medicine,
doi:10.1093/abm/kaaa120
Cheval, Orsholits, Sieber, Courvoisier, Cullati et al., Relationship between decline in cognitive resources and physical activity, Health Psychology,
doi:10.1037/hea0000857
Cheval, Sieber, Guessous, Orsholits, Courvoisier et al., Effect of early-and adult-life socioeconomic circumstances on physical inactivity, Medicine & Science in Sports & Exercise,
doi:10.1249/MSS.0000000000001472
Cheval, Sieber, Maltagliati, Millet, Formánek et al., Muscle strength is associated with COVID-19 hospitalization in adults 50 years of age and older, MedRxiv,
doi:10.1101/2021.02.02.21250909
Cheval, Sivaramakrishnan, Maltagliati, Fessler, Forestier et al., Relationships between changes in self-reported physical activity, sedentary behaviour and health during the coronavirus (COVID-19) pandemic in France and Switzerland, Journal of Sports Sciences,
doi:10.1080/02640414.2020.1841396
Choirat, Gandrud, Honaker, Imai, King, relogit: rare events logistic regression for dichotomous dependent variables
Dodds, Kuh, Sayer, Cooper, Physical activity levels across adult life and grip strength in early old age: updating findings from a British birth cohort, Age and Ageing,
doi:10.1093/ageing/aft124
Dong, Dai, Wei, Zhang, Zheng et al., A systematic review of SARS-CoV-2 vaccine candidates, Signal Transduction and Targeted Therapy,
doi:10.1038/s41392-020-00352-y
Dunton, Wang, Do, Courtney, Early effects of the COVID-19 pandemic on physical activity locations and behaviors in adults living in the United States, Preventive Medicine Reports,
doi:10.1016/j.pmedr.2020.101241
Gleeson, Bishop, Stensel, Lindley, Mastana et al., The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease, Nature Reviews Immunology,
doi:10.1038/nri3041
Guthold, Stevens, Riley, Bull, Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 populationbased surveys with 1•9 million participants, The Lancet Global Health,
doi:10.1016/S2214-109X(18)30357-7
Halabchi, Mazaheri, Sabeti, Yunesian, Alizadeh et al., Regular sports participation as a potential predictor of better clinical outcome in adult patients with COVID-19: A Large Cross-sectional Study, Journal of Physical Activity and Health,
doi:10.1123/jpah.2020-0392
Hamer, Kivimäki, Gale, Batty, Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK, Brain, Behavior, and Immunity,
doi:10.1016/j.bbi.2020.05.059
Li, Xu, Yu, Wang, Tao et al., Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan, Journal of Allergy and Clinical Immunology,
doi:10.1016/j.jaci.2020.04.006
Nieman, Wentz, The compelling link between physical activity and the body's defense system, Journal of Sport and Health Science,
doi:10.1016/j.jshs.2018.09.009
Tavakol, Ghannadi, Tabesh, Halabchi, Noormohammadpour et al., Relationship between physical activity, healthy lifestyle and COVID-19 disease severity; a cross-sectional study, Journal of Public Health,
doi:10.1007/s10389-020-01468-9
Warburton, Health benefits of physical activity: the evidence, Canadian Medical Association Journal,
doi:10.1503/cmaj.051351
Wearing, Konings, Stokes, De Bruin, Handgrip strength in old and oldest old Swiss adults -a cross-sectional study, BMC Geriatrics,
doi:10.1186/s12877-018-0959-0
Woods, Hutchinson, Powers, Roberts, Gomez-Cabrera et al., The COVID-19 pandemic and physical activity, Sports Medicine and Health Science,
doi:10.1016/j.smhs.2020.05.006
Zbinden-Foncea, Francaux, Deldicque, Hawley, Does high cardiorespiratory fitness confer some protection against proinflammatory responses after infection by SARS-CoV-2?, Obesity,
doi:10.1002/oby.22849