Relationship between physical activity, healthy lifestyle and COVID-19 disease severity; a cross-sectional study
Zahra Tavakol, Shima Ghannadi, Mastaneh Rajabian Tabesh, Farzin Halabchi, Pardis Noormohammadpour, Samaneh Akbarpour, Zahra Alizadeh, Malihe Hassan Nezhad, Sahar Karimpour Reyhan
Journal of Public Health, doi:10.1007/s10389-020-01468-9
Aim The COVID-19 pandemic is a global health emergency, and therefore the prevention and treatment of this disease is an important priority of world health. In the present study, some risk factors, including unhealthy nutrition, obesity, and physical inactivity, were assessed in patients infected with SARS-CoV-2, and their effects on the severity and duration of disease were evaluated. Subject and methods The present study was a cross-sectional study. Data was collected from all patients who visited the respiratory emergency department from March 20, 2020 to April 24, 2020 in the University Hospital. The outcome measures were body mass index, diet quality that was evaluated with a 16-item food intake questionnaire, and physical activity level that was assessed by the global physical activity questionnaire. Results Two hundred and six patients' data was analyzed. The results investigated that patients with lower levels of physical activity or lower MET.min/week were affected by a more severe form of the disease (p = 0.05 and p = 0.03, respectively). We found that patients with a healthier dietary pattern were affected by lower severity of illness (p < 0.05). Conclusion It seems that increasing levels of physical activity may partly reduce the severity of COVID-19 disease. Some dietary patterns such as increasing fruit and poultry consumption as well as drinking less tea were correlated significantly with a less severe form of the disease. The results did not confirm previous concerns regarding a potentially harmful effect of smoking on the severity or duration of symptoms.
Author's contribution All authors contributed to the study conception and design. Material preparation was performed by Zahra Tavakol, Mastaneh Rajabian Tabesh, Malihe Hassan Nezhad, and Sahar Karimpour Reyhan. Data collection and analysis were performed by Zahra Alizadeh, Pardis Noormohammadpour, Samaneh Akbarpour, and Farzin Halabchi. The first draft of the manuscript was written by Shima Ghannadi and Zahra Alizadeh, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest. Ethics approval This study was approved by the ethical committee at Tehran University of Medical Sciences, Tehran, Iran (IRCTID: IR.TUMS.VCR.REC.1399.151). Informed consent Informed consent was obtained from all individual participants included in the study.
References
Ainsworth, Compendium of physical activities: an update of activity codes and MET intensities, Med Sci Sports Exerc
Baik, Curhan, Rimm, Bendich, Willett et al., A prospective study of age and lifestyle factors in relation to community-acquired pneumonia in US men and women, Arch Intern Med
Barrett, Meditation or exercise for preventing acute respiratory infection (MEPARI-2): a randomized controlled trial, PLoS One
Blair, Brodney, Bull, Maslin, Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues, Med Sci Sports Exerc
Calfee, Cigarette smoke exposure and the acute respiratory distress syndrome, Crit Care Med
Casas, Sacanella, Estruch, The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases, Endocr Metab Immune Disord
Cecchini, Sassi, Lauer, Lee, Guajardo-Barron et al., Chronic diseases: chronic diseases and development 3 tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness, Lancet
Chandra, Nutrition and the immune system: an introduction, Am J Clin Nutr
Charland, Buckeridge, Hoen, Berry, Elixhauser et al., Relationship between community prevalence of obesity and associated behavioral factors and community rates of influenza-related hospitalizations in the United States, Influenza Other Respir Viruses
Chierico, Vernocchi, Dallapiccola, Putignani, Mediterranean diet and health: food effects on gut microbiota and disease control, Int J Mol Sci
Chubak, Moderate-intensity exercise reduces the incidence of colds among postmenopausal women, Am J Med
Esteghamati, Khalilzadeh, Rashidi, Kamgar, Meysamie et al., Physical activity in Iran: results of the third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007), J Phys Act Health,
doi:10.1123/jpah.8.1.27Fattahi, Halabchi, Golsoorat-Pahlaviani, Abouzari, Sajedi-Monfared, Physical activity, sedentary behavior and correlates among students of Tehran University of Medical Sciences, Acta Med Iran
Furushima, Ide, Yamada, Effect of tea Catechins on influenza infection and the common cold with a focus on epidemiological/clinical studies, Molecules,
doi:10.3390/molecules23071795Furushima, Prevention of acute upper respiratory infections by consumption of Catechins in healthcare workers: a randomized, placebo-controlled trial, Nutrients,
doi:10.3390/nu12010004Gorbalenya, Baker, Baric, Groot, Drosten et al., The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2, Nat Microbiol
Gralinski, Menachery, Return of the coronavirus: 2019-nCoV, Viruses
Halabchi, Regular sports participation as a potential predictor of better clinical outcome in adult patients with COVID-19: a large cross-sectional study, J Phys Act Health,
doi:10.1123/jpah.2020-0392Hemiö, Pölönen, Ahonen, Kosola, Viitasalo et al., A simple tool for diet evaluation in primary health care: validation of a 16-item food intake questionnaire, Int J Environ Res Public Health
Huang, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Ide, Kawasaki, Akutagawa, Yamada, Effects of green tea gargling on the prevention of influenza infection: an analysis using Bayesian approaches, J Altern Complement Med,
doi:10.1089/acm.2016.0094Kant, Dietary patterns: biomarkers and chronic disease risk, Appl Physiol Nutr Metab
Klein, Wadden, Sugerman, AGA technical review on obesity, Gastroenterology
Kohl Hw 3rd, The pandemic of physical inactivity: global action for public health, Lancet
Kohut, Sim, Yu, Yoon, Loiacono, Chronic exercise reduces illness severity, decreases viral load, and results in greater anti-inflammatory effects than acute exercise during influenza infection, J Infect Dis
Kornum, Obesity and risk of subsequent hospitalisation with pneumonia, Eur Respir J
Laddu, Lavie, Phillips, Arena, Physical activity for immunity protection: inoculating populations with healthy living medicine in preparation for the next pandemic, Prog Cardiovasc Dis,
doi:10.1016/j.pcad.2020.04.006Lowder, Padgett, Woods, Moderate exercise early after influenza virus infection reduces the Th1 inflammatory response in lungs of mice, Exerc Immunol Rev
Lowder, Padgett, Woods, Moderate exercise protects mice from death due to influenza virus, Brain Behav Immun
Mark, Catharine, Batty, Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: a community-based cohort study of 387,109 adults in UK, Brain Behav Immun,
doi:10.1016/j.bbi.2020.05.059Murphy, Davis, Carmichael, Gangemi, Ghaffar et al., Exercise stress increases susceptibility to influenza infection, Brain Behav Immun
Neuman, Willett, Curhan, Physical activity and the risk of community-acquired pneumonia in US women, Am J Med
Nieman, Exercise effects on systemic immunity, Immunol Cell Biol
Nieman, Henson, Austin, Upper respiratory tract infection is reduced in physically fit and active adults, Br J Sports Med
Nieman, Immune function in female elite rowers and nonathletes, Br J Sports Med
Nieman, The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections, Int J Sports Med
Obasi, Advantage of meditation over exercise in reducing cold and flu illness is related to improved function and quality of life, Influenza Other Respir Viruses
Pietiläinen, Physical inactivity and obesity: a vicious circle, Obesity
Popkin, Adair, Ng, Global nutrition transition and the pandemic of obesity in developing countries, Nutr Rev
Pratt, Varela, Salvo, Kohl, Iii et al., Attacking the pandemic of physical inactivity: what is holding us back?, Br J Sport Med
Qingxian, Obesity and COVID-19 severity in a designated hospital in Shenzhen, China, Diabetes Care
Selk-Ghaffari, COVID-19 epidemic: exercise or not to exercise; that is the question! Asian, J Sports Med
Simonnet, High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation, Obesity
Swinburn, Sacks, Hall, Mcpherson, Finegood et al., The global obesity pandemic: shaped by global drivers and local environments, Lancet
Wang, Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, Jama
Warren, Exercise improves host response to influenza viral infection in obese and non-obese mice through different mechanisms, PLoS One
Weber, Zimmermann, Kieseier, Hartung, Hofstetter, Bacteria and their cell wall components uniformly co-activate interleukin-17-producing thymocytes
Yang, Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and metaanalysis
