Influence of Baseline Physical Activity as a Modifying Factor on COVID-19 Mortality: A Single-Center, Retrospective Study

The dose-response relationship between physical activity and the risk of death from pneumonia in middle-aged and older adults: A meta-analysis

BACKGROUND

Deaths from COVID-19 are concentrated in older adults, and studies have reported that physical activity (PA) can reduce the risk of death from pneumonia.

METHODS

Eight cohort studies and 2 case-control studies were included according to the inclusion and exclusion criteria established in this meta-analysis study followed the PRISMA guideline, 8 cohort studies and 2 case-control studies were finally included. Then, the research objects in these studies were classified to further study the dose-response relationship and non-dose-response relationship.

RESULTS

The highest dose of PA reduced the risk of death by 59% (risk ratio = 0.41; 95% confidence interval: 0.23-0.58) compared with the lowest dose of PA in middle-aged and elderly people. Furthermore, when the PA level was <10 m/wk, the risk of death from pneumonia was reduced by 6% every 4.5 MET-h/wk increase. At a PA level > 10 m/wk, the risk of death from pneumonia increased by 5% every 4.5 MET-h/wk increase. At a PA level > 30 m/wk, PA is a risk factor for pneumonia-related death in middle-aged and elderly people.

CONCLUSIONS

This meta-analysis showed that PA was associated with a reduced risk of dying from pneumonia in middle-aged and older adults, and that there was a significant nonlinear negative dose-response relationship between PA levels and the risk of dying from pneumonia. Therefore, moderate exercise was recommended.

Insights from Chilean NCDs Hospitalization Data during COVID-19

The COVID-19 pandemic has affected the lifestyles of people of all ages, conditions and occupations. Social distance, remote working, changes in diet and a lack of physical activity have directly and indirectly affected many aspects of mental and physical health, particularly in patients with many comorbidities and non-communicable diseases (NCDs). In our paper, we analyzed COVID-19 hospitalized and non-hospitalized cases according to comorbidities to assess the average monthly percentage change (AMPC) and monthly percentage change (MPC) using open access data from the Chilean Ministry of Science, Technology, Knowledge and Innovation. As expected, the infection mainly affected patients with comorbidities, including cardiovascular risk factors. The hospitalized cases with obesity and chronic lung disease increased throughout the period of June 2020-August 2021 (AMPC = ↑20.8 and ↑19.4%, respectively, p < 0.05), as did all the non-hospitalized cases with comorbidities throughout the period (AMPC = ↑15.6 to ↑30.3 [p < 0.05]). The increases in hospitalizations and non-hospitalizations with comorbidities may be associated with physical inactivity. A healthy lifestyle with regular physical activity may have had a protective effect on the COVID-19 severity and related events in the post-pandemic period, especially for the NCD population.

Higher level of physical activity reduces mental and neurological symptoms during and two years after COVID-19 infection in young women

Previous studies found that regular physical activity (PA) can lower the risk of SARS-CoV-2 (COVID-19) infection and post-COVID-19 condition (PCC), yet its specific effects in young women have not yet been investigated. Thus, we aimed to examine whether regular physical activity reduces the number of symptoms during and after COVID-19 infection among young women aged between 18 and 34 (N = 802), in which the confounding effect of other morbidities could be excluded. The average time since infection was 23.5 months. Participants were classified into low, moderate, and high PA categories based on the reported minutes per week of moderate and vigorous PA. Using the Post-COVID-19 Case Report Form, 50 different symptoms were assessed. Although regular PA did not decrease the prevalence of COVID-19 infection and PCC but significantly reduced the number of mental and neurological symptoms both in acute COVID-19 and PCC. Importantly, the high level of PA had a greater impact on health improvements. In addition, the rate of reinfection decreased with an increased level of PA. In conclusion, a higher level of regular PA can reduce the risk of reinfection and the number of mental and neurological symptoms in PCC underlying the importance of regular PA, even in this and likely other viral disease conditions.

[Long covid and disability]

Long covid is a health problem that will entail a high hidden cost attributable to the pandemic years after it because it affects the work capacity of many workers. Given the millions of covid-19 cases worldwide and current research showing that one in 7covid-19 patients remain symptomatic at 12 weeks, the number of long covid patients is likely to be substantial. Long covid is characterized by heterogeneous sequelae that often affect multiple systems, organs with an impact on the functioning and capacity of the worker. Workers with long covid symptoms can return to their occupation but this involves a complex individualized approach to the impact of symptoms on work, adjustments and modifications to the workplace. Patients with long covid typically report prolonged multisystem involvement and signicant disability. The psychological cost to the worker must also be addressed. A survey by the Community of Madrid (CCOO, SATSE, CSIF, AMYTS) in 2022 reveals that 24.5% of those affected by long covid were sick for more than 12 months; 30% of those affected by persistent covid need and adaption to their workplace. In Spain, more than 10million people infected with SARS-CoV-2 have been reported since the pandemic began, so it is estimated that there could be one million people with persistent covid. In 2021 alone there were more than 2.6 million sick leave due to covid-19 in Spain, the average duration of which was 10 days. One hundred million people around the world suffer from persistent covid, but few countries officially count them, nor do they help those affected with employment. In advanced countries, like the United States, long covid is treated as a disability,and the number of people with disabilities working or looking for work increased by 1.36 million, an increase of 23%, between January 2021 and January 2022. In the United Kingdom, some 200,000 people are not working or are not looking for work due to long-term health problems attributable to long covid, since the pandemic began.

Spatiotemporal trends of cardiovascular disease burden attributable to low physical activity during 1990-2019: an analysis of the Global Burden of Disease Study 2019

OBJECTIVES

The epidemiological trends of cardiovascular disease (CVD) burden attributed to low physical activity (LPA) across various regions and countries are poorly understood. Hence, we assessed the global, regional, and national spatiotemporal trends of LPA-related CVD from 1990 to 2019.

STUDY DESIGN

We conducted a secondary analysis of the Global Burden of Disease Study 2019. The data on LPA-related CVD were examined with regard to sex, age, year, and Socio-Demographic Index (SDI).

METHODS

We assessed the temporal changes in age-standardized mortality rate (ASMR) and age-standardized death rate (ASDR) using the estimated annual percentage change (EAPC) over a 30-year period.

RESULTS

There were a staggering 0.64 million deaths and 9.99 million disability-adjusted life-years globally attributed to LPA-related CVD in 2019. The majority of the LPA-related CVD burden was observed in the population aged ≥80 years. It also indicated a high disease burden of LPA-related CVD in Central Asia, Arabian Peninsula, and North Africa. Although there has been a decline in ASMR and ASDR associated with LPA-related CVD on a global scale, the countries experiencing the most substantial increase in LPA-related CVD burden are Uzbekistan, Tajikistan, and Azerbaijan. The ASMR and ASDR remained stable in regions with low, low-middle, and middle SDI levels. The EAPCs of ASMR and ASDR were negatively linked with SDI in 2019.

CONCLUSIONS

From 1990 to 2019, LPA led to a significant and escalating burden of CVD in certain regions, namely, Uzbekistan, Tajikistan, and Azerbaijan. It is imperative for governments and policymakers to implement regulatory measures and strategic interventions aimed at mitigating this burden.

COVID-19 vaccination produces exercise-responsive SARS-CoV-2 specific T-cells regardless of infection history

BACKGROUND

The mobilization and redistribution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific T-cells and neutralizing antibodies (nAbs) during exercise is purported to increase immune surveillance and protect against severe coronavirus disease 2019 (COVID-19). We sought to determine if COVID-19 vaccination would elicit exercise-responsive SARS-CoV-2 T-cells and transiently alter nAb titers.

METHODS

Eighteen healthy participants completed a 20-min bout of graded cycling exercise before and/or after receiving a COVID-19 vaccine. All major leukocyte subtypes were enumerated before, during, and after exercise by flow cytometry, and immune responses to SARS-CoV-2 were determined using whole blood peptide stimulation assays, T-cell receptor (TCR)-β sequencing, and SARS-CoV-2 nAb serology.

RESULTS

COVID-19 vaccination had no effect on the mobilization or egress of major leukocyte subsets in response to intensity-controlled graded exercise. However, non-infected participants had a significantly reduced mobilization of CD4+ and CD8+ naive T-cells, as well as CD4+ central memory T-cells, after vaccination (synthetic immunity group); this was not seen after vaccination in those with prior SARS-CoV-2 infection (hybrid immunity group). Acute exercise after vaccination robustly mobilized SARS-CoV-2 specific T-cells to blood in an intensity-dependent manner. Both groups mobilized T-cells that reacted to spike protein; however, only the hybrid immunity group mobilized T-cells that reacted to membrane and nucleocapsid antigens. nAbs increased significantly during exercise only in the hybrid immunity group.

CONCLUSION

These data indicate that acute exercise mobilizes SARS-CoV-2 specific T-cells that recognize spike protein and increases the redistribution of nAbs in individuals with hybrid immunity.

Beneficial role of healthy eating Index-2015 score & physical activity on COVID-19 outcomes

BACKGROUND

Nutritional status and physical activity are essential to maintain a strong immune system. No definite pharmacological strategies for Coronavirus disease 2019 treatment are presently available, so natural enhancement of the immune system is in need. Our goal was to assess the correlation of healthy diet and physical activity on COVID-19 disease outcome.

METHODS

This cohort study was conducted on 68 adult patients who contracted mild (38) or moderate [30] cases of COVID-19, recruited via a convenience sampling technique from the outpatient clinic, Kasr Al-Aini Faculty of Medicine, Cairo University Hospital. Patients' Healthy Eating Index (HEI) and degree of physical activity as measured by the Global Physical Activity Questionnaire were evaluated and linked with several inflammatory markers.

RESULTS

Most of patients with mild COVID-19 patients (92.1%) were physically active, compared to only 50% of moderate COVID-19. The total Metabolic Equivalent Task-min/week was positively correlated with the lymphocyte percentage. The median total HEI score was significantly higher in the patients with mild COVID-19 than with moderate COVID. Significant positive correlations observed among the lymphocyte count and total HEI-2015. There was approximately a 64% reduction in the probability of acquiring moderate COVID-19 illness for each unit rise in The HEI.

CONCLUSION

Healthier nutrition and Physical activity correlated with reduced COVID-19 disease severity.

TRIAL REGISTRATION

The study was registered on clinical trial.gov maintained by the US National Library of Medicine (CinicalTrials.gov identifier = NCT04447144; https://clinicaltrials.gov/ ) (25/06/2020).

Clinical and invasively-measured predictors of high exercise capacity in Fontan patients

INTRODUCTION

Fontan patients have variable exercise capacity. Contemporary understanding as to which factors predict high tolerance is limited.

METHODS

Records from the Ahmanson/University of California, Los Angeles Adult Congenital Heart Disease Center were reviewed for adult Fontan patients who underwent CPET. Patients were considered "high performers" if their maximum oxygen uptake (VO2 max/kg)-predicted was greater than 80%. Cross-sectional clinical, hemodynamic, and liver biopsy data was gathered. High-performers were compared to control patients across these parameters via associations and regression.

RESULTS

A total of 195 adult patients were included; 27 patients were considered "high performers". They had lower body mass indices (BMI, p < 0.001), mean Fontan pressures (p = 0.026), and cardiac outputs (p = 0.013). High performers also had higher activity levels (p < 0.001), serum albumin levels (p = 0.003), non-invasive and invasive systemic arterial oxygen saturations (p < 0.001 and p = 0.004), lower New York Heart Association (NYHA) heart failure class (p = 0.002), and were younger at Fontan completion (p = 0.011). High performers had less severe liver fibrosis (p = 0.015). Simple regression found Fontan pressure, non-invasive O2 saturation, albumin level, activity level, age at Fontan surgery, NYHA class, and BMI to predict significant changes in VO2 max/kg %-predicted. These associations persisted in multiple regression for non-invasive O2 saturation, NYHA class II, activity level, and BMI.

CONCLUSIONS

Thin Fontan patients who exercise more had better exercise capacity, Fontan hemodynamic profiles, and less liver fibrosis.

Association between physical activity and risk of COVID-19 infection or clinical outcomes of the patients with COVID-19: A systematic review and meta-analysis

Objective

The COVID-19 pandemic has caused serious consequences for global health and economy. The important question is whether the level of physical activity might influence the risk of COVID-19 incidence or clinical outcomes, including the severity or mortality of infected patients. The objective of this systematic review and meta-analysis is to evaluate the association between sufficient physical activity and incidence, hospitalization, severity, recovery, and mortality of COVID-19.

Methods

A systematic search of Web of Sciences, PubMed, and Scopus between December 2019 and November 2021 was conducted. Studies were screened based on the inclusion criteria, i.e. observational studies (case-control, prospective or retrospective longitudinal designs, and cross-sectional studies) which have determined the association of physical activity, exercise, sports participation, or sedentary behavior with COVID-19 incidence or outcomes, including mortality, severity, recovery and hospitalization in healthy population or population with any specific comorbidity.

Results

Based on eligibility criteria, 27 articles were finally included in the qualitative synthesis. The meta-analysis of five studies evaluating the association of physical activity and COVID-19 mortality showed a weighted OR of OR of 0.61 (CI 95%: 0.50-0.75) with heterogeneity (I2 = 45.8%, P < 0.001) and in seven studies regarding physical activity and COVID-19 hospitalization, weighted OR was 0.541 (CI 95%: 0.491-0.595) with heterogeneity (I2 = 81.7%, P < 0.001).

Conclusion

Participating in sufficient physical activity might decrease COVID-19 related COVID-19-related hospitalization and mortality. Developing programs to increase physical activity during the COVID-19 pandemic might be an appropriate health strategy.

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

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.

COVID-19: Insights into long-term manifestations and lockdown impacts

Coronaviruses are pathogens thought to primarily affect the respiratory tracts of humans. The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 was also marked mainly by its symptoms of respiratory illness, which were named coronavirus disease 2019 (COVID-19). Since its initial discovery, many other symptoms have been linked to acute SARS-CoV-2 infections as well as to the long-term outcomes of COVID-19 patients. Among these symptoms are different categories of cardiovascular diseases (CVDs), which continue to be the main cause of death worldwide. The World Health Organization estimates that 17.9 million people die from CVDs each year, accounting for ∼32% of all deaths globally. Physical inactivity is one of the most important behavioral risk factors for CVDs. The COVID-19 pandemic has affected CVDs as well as the physical activity in different ways. Here, we provide an overview of the current status as well as future challenges and possible solutions.

Baseline physical activity and the risk of severe illness and mortality from COVID-19: A dose-response meta-analysis

To provide a scientific basis for improved exercise-based immunity, a meta-analysis was used to explore the dose-response relationship between physical activity (PA) and the risk of severe illness and mortality related to COVID-19 (coronavirus disease 2019). To this end, we searched PubMed, Web of Science databases from January 2020 through April 2022. 14 observational studies met the criteria for inclusion in the meta-analysis, including 2840 cases of severe illness and death from COVID-19. Categorical dose-relationship analysis showed that the risks of severe illness and mortality from COVID-19 were, respectively, 46% (risk ratio (RR): 0.54; confidence intervals (CIs): 0.41-0.68) and 59% (RR = 0.41; 95%CI: 0.23-0.58) lower for the highest dose of PA compared with the lowest dose of PA. The results of the continuous dose-response analysis show an inverse nonlinear relationship (P_{non-linearity} < 0.05) between PA and both the risk of severe illness and mortality from COVID-19. For PA below 10 MET-h/week (MET-h/week: metabolic equivalent of task-hours/week), an increase of 4 MET-h/week (1 h of moderate-intensity or 0.5 h of high-intensity PA) was associated with 8% and 11% reductions in the risk of severe illness and mortality from COVID-19. PA above 10 MET-h/week lowered the risk of severe illness and mortality from COVID-19 by 7% and 9%, respectively, for each 4 MET-h/week increase. Doses of WHO-recommended PA levels (10 MET-h/week) may be required for more substantial reductions in the risk of severe illness and mortality from COVID-19.

Respiratory muscle strength and pulmonary function in unvaccinated athletes before and after COVID-19 infection: A prospective cohort study

PURPOSE

We investigated abnormalities and recovery in respiratory function after COVID-19 infection in an unvaccinated elite athlete population.

METHODS

Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF).

RESULTS

The most frequent reported symptoms were fatigue with 80% and muscle/joint pain and headache with 50%, whereas only 10% reported dyspnoea and 30% cough. During follow-up, MIP was up to 13% and MEP up to 8% lower following COVID-19 infection. Likewise, FEV₁ was up to 2% and FVC up to 5% lower. While MEP and FEV₁ rapidly normalised, MIP and FVC still remained abnormal after 52 days of COVID-19 infection, thereby leading to a restrictive ventilatory pattern. PEF seemed unaffected during follow-up.

CONCLUSIONS

COVID-19 decreases respiratory function in unvaccinated athletes despite reporting few respiratory symptoms and having mild disease. An initiative aimed at reducing the long-term adverse effects following COVID-19 infection seems warranted, which perhaps may be avoided through vaccination.

Sports entrepreneurship during COVID-19: Technology as an ally to maintain the competitiveness of small businesses

The sports sector, specifically the field of personal trainer entrepreneurship, has been severely affected by the COVID-19 crisis. However, there are still few empirical studies that analyze how the actions taken before and during this crisis can affect sports entrepreneurs' performance. This research aims to analyze which combinations of sports entrepreneurs' personal characteristics and actions performed have been most and least effective in minimizing the negative impact of COVID-19 on their businesses. A validated online questionnaire was administered to personal trainer entrepreneurs from May to June 2020 before they reopened their facilities. Fuzzy-set qualitative comparative analysis (fsQCA) was performed to assess the impacts. The results show that both post-COVID measures (adaptation of the business model) and previous strategic orientation seemed essential. Specifically, high levels of sports entrepreneurs' resilience and innovation/R&D when competing against their closest competitors before the COVID-19 pandemic and the increased use of technologies (sports services digitization) during the pandemic have been essential to maintaining the performance of the sports business. Thus, improvements in the digital competencies of personal trainers' sports entrepreneurs, the development of strategic plans and activities related to innovation/R&D and process improvements are important measures to maintain the competitiveness of small sports businesses during crises.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

Protective role of physical activity patterns prior to COVID-19 confinement with the severity/duration of respiratory pathologies consistent with COVID-19 symptoms in Spanish populations

The main purpose of the present study was to determine the association of physical activity (PA) patterns prior to COVID-19 confinement with severe respiratory distress consistent with COVID-19 symptoms. Participants were recruited by sending a survey through various social network channels via the snowball method. A voluntary sample of 420 individuals consisting of 199 men and 221 women from the Spanish national territory participated in this study. Some factors, such as being overweight and obese were related to the presence of a greater number of symptoms associated with COVID-19. Interestingly, it was observed that not performing moderate or vigorous PA increased the risk of COVID-19 symptoms. Consequently, when the effect of the practise of PA was evaluated in terms of the number of practises per week and in minutes per practise per week, a protective effect was observed, where moderate PA >150 min per week reported an inverse association with hospitalization for respiratory symptoms (RR: 95%CI: 0.24, 0.05-1.04, P = 0.05). Likewise, overweight (RR: 16.3, 95%CI: 1.93-137.9, P = 0.01), obesity (RR: 19.1, 95%CI: 1.63-222.5, P = 0.019) and non-performance of moderate PA (RR: 4.12, 95%CI; 0.95-17.76, P = 0.05) reported positive associations with hospitalization for respiratory symptoms. Thus, the practise of moderate PA (>150 min per week) is a protective factor against hospitalization for respiratory symptoms consistent with COVID-19 symptoms.

Being Physically Active Leads to Better Recovery Prognosis for People Diagnosed with COVID-19: A Cross-Sectional Study

The regular practice of physical activity helps in the prevention and control of several non-communicable diseases. However, evidence on the role of physical activity in mitigating worsening clinical outcomes in people with COVID-19 is still unclear. The aim of this study was to verify whether different levels of physical activity provide protection for clinical outcomes caused by SARS-CoV-2 infection. A cross-sectional study was conducted with 509 adults (43.8 ± 15.71 years; 61.1% female) with a positive diagnosis of COVID-19 residing in Ribeirão Preto, São Paulo, Brazil. Participants were interviewed by telephone to determine the severity of the infection and the physical activity performed. Binary logistic regression was used to indicate the odds ratio (OR) of active people reporting less harmful clinical outcomes from COVID-19. Active people had a lower chance of hospitalization, fewer hospitalization days, less respiratory difficulty and needed less oxygen support. The results suggest that active people, compared to sedentary people, have a lower frequency of hospitalization, length of stay, breathing difficulty and need for oxygen support. These results corroborate the importance of public policies to promote the practice of physical activity, in order to mitigate the severity of the clinical outcomes of COVID-19.

Effects of physical activity on the severity of illness and mortality in COVID-19 patients: A systematic review and meta-analysis

Purpose: This systematic review and meta-analysis investigated the association between Physical activity (PA) before Coronavirus Disease 2019 (COVID-19) infection and the severity of illness and mortality in COVID-19 patients.

Methods: A comprehensive search was undertaken to identify retrospective and nonrandomized controlled trial studies comparing the severity and mortality of COVID-19 infection among COVID-19 patients who had previously reported their participation in PA with those who had not. The databases searched were PubMed, Cochrane Library, Scopus, Science Direct, EMBASE, OPENGREY.EU, and ClinicalTrials.gov. The risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for determining pairwise meta-analyses. The protocol was registered with PROSPERO (CRD42021262548).

Results: Eighteen studies met the inclusion criteria (5 cross-sectional, 12 cohort, and 1 case-control studies). All 1 618 680 subjects were adults. PA significantly decreased the risk of death in COVID-19 patients (odds ratio [OR] 0.34; 95% confidence interval [CI], 0.19–0.62; p < 0.001) and the risk of severe outcomes (OR 0.60; 95% CI, 0.48–0.76; p < 0.001). Subgroup analysis showed that PA for ≥150 min/wk at a moderate intensity or ≥75 min/wk at a vigorous intensity reduced the risks of severity and mortality. Vigorous PA reduced mortality risk, whereas moderate to vigorous PA reduced the risks of severity and mortality.

Conclusion: PA before infection might reduce severity and mortality in COVID-19 patients, especially PA ≥ 150 min/wk of moderate activity or ≥75 min/wk of vigorous activity. However, careful interpretations should be considered due to the difference in PA patterns and severity definitions among included studies. This finding implies that engaging in regular PA, even in different patterns, has beneficial effects on the severity and mortality of COVID-19 patients.

Physical activity lowers the risk for acute respiratory infections: Time for recognition

Physical inactivity is a well-established risk factor for chronic diseases, such as cardiovascular disease, cancer, and diabetes mellitus. There is a growing awareness that physical inactivity should also be regarded as a risk factor for acute respiratory infections (ARIs). ARIs, such as the common cold, influenza, pneumonia, and coronavirus disease 2019 (COVID-19), are among the most pervasive diseases on earth and cause widespread morbidity and mortality. Evidence in support of the linkage between ARIs and physical inactivity has been strengthened during the COVID-19 pandemic because of increased scientific scrutiny. Large-scale studies have consistently reported that the risk for severe COVID-19 outcomes is elevated in cohorts with low physical activity and/or physical fitness, even after adjusting for other risk factors. The lowered risk for severe COVID-19 and other ARIs in physically active groups is attributed to exercise-induced immunoprotective effects, including enhanced surveillance of key immune cells and reduced chronic inflammation. Scientific consensus groups, including those who submitted the Physical Activity Guidelines for Americans, have not yet given this area of research the respect that is due. It is time to add "reduced risk for ARIs" to the "Exercise is Medicine" list of physical activity-related health benefits.

Leisure Time Physical Activity and SARS-CoV-2 Infection among ELSA-Brasil Participants

The regular practice of physical activity (PA) can reduce the chance of aggravation of the disease and lower rates of hospitalization and mortality from COVID-19, but few studies have analyzed the association of PA with the risk of infection by SARS-CoV-2. The aim of the study was to analyze the association between PA and self-reported SARS-CoV-2 infection. A longitudinal study was conducted with data from 4476 ELSA-Brasil participants who had their PA analyzed twice, once in 2016-2018 and again in 2020. PA was identified using the IPAQ at both follow-up moments and categorized into four groups: (a) remained physically inactive (reference); (b) remained physically active; (c) became physically active in the second moment; and (d) became physically inactive in the second moment. The variables of age, sex, obesity, hypertension, diabetes and specific protective practices against COVID-19 were tested as possible confounders. Data were analyzed by logistic regression. A 95% confidence interval (CI) was used. Remaining physically active was associated with a 43% reduction in the risk of SARS-CoV-2 infection only among those who used specific practices to protect against COVID-19, OR = 0.57 and CI = 0.32-0.99. The results suggested that regular practice of PA can reduce the risk of SARS-CoV-2 infection, especially among those who have used specific practices to protect against COVID-19 during the pandemic.

The role of physical activity in the clinical outcomes of people diagnosed with Covid-19: A systematic review

Objective

This review aimed to compile the evidence on PA and clinical outcomes of people receiving a positive diagnosis of covid-19.

Design

Systematic review.

Methods

The search was performed in five databases: EMBASE, MEDLINE via PubMed portal, Scopus, SPORTDiscus via EBSCO platform, and Web of Science. In addition, the "gray" literature was searched through Google Scholar and medRxiv published between January 2020 and July 2022. Studies were assessed for risk of bias, with the extraction of relevant data. Our search revealed a total of 10,028 studies.

Results

After applying the eligibility criteria 32 studies were included. Thirty-one studies were at low to moderate risk of bias. Physically active individuals, who were diagnosed with covid-19, presented attenuation of clinical outcomes, such as decreased risk of hospitalization, recovery time, number of symptoms, severity, and ICU and death when compared to individuals with low levels of PA or classified as sedentary.

Conclusions

Physically active individuals when diagnosed with covid-19 may have decreased risk of several clinical outcomes related to covid-19, including but not limited to hospitalization and number of symptoms. Public health authorities should develop strategies and initiatives that promote safe PA environments to improve the clinical prognosis of people diagnosed with covid-19.

Study registration

Open Science Framework (OSF), DOI registry 10.17605/OSF.IO/PV6NF. It can be consulted through the access link: https://doi.org/10.17605/OSF.IO/PV6NF, October 07, 2021.

Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis

Among coronavirus disease 2019 (COVID-19) patients, physically active individuals may be at lower risk of fatal outcomes. However, to date, no meta-analysis has been carried out to investigate the relationship between physical activity (PA) and fatal outcomes in patients with COVID-19. Therefore, this meta-analysis aims to explore the hospitalisation, intensive care unit (ICU) admissions, and mortality rates of COVID-19 patients with a history of PA participation before the onset of the pandemic, and to evaluate the reliability of the evidence. A systematic search of MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and medRxiv was conducted for articles published up to January 2022. A random-effects meta-analysis was performed to compare disease severity and mortality rates of COVID-19 patients in physically active and inactive cases. Twelve studies involving 1,256,609 patients (991,268 physically active and 265,341 inactive cases) with COVID-19, were included in the pooled analysis. The overall meta-analysis compared with inactive controls showed significant associations between PA with reduction in COVID-19 hospitalisation (risk ratio (RR) = 0.58, 95% confidence intervals (CI) 0.46-0.73, P = 0.001), ICU admissions (RR = 0.65, 95% CI 0.52-0.81, P = 0.001) and mortality (RR = 0.47, 95% CI 0.38-0.59, P = 0.001). The protective effect of PA on COVID-19 hospitalisation and mortality could be attributable to the types of exercise such as resistance exercise (RR = 0.27, 95% CI 0.15-0.49, P = 0.001) and endurance exercise (RR = 0.41, 95% CI 0.23-0.74, P = 0.003), respectively. Physical activity is associated with decreased hospitalisation, ICU admissions, and mortality rates of patients with COVID-19. Moreover, COVID-19 patients with a history of resistance and endurance exercises experience a lower rate of hospitalisation and mortality, respectively. Further studies are warranted to determine the biological mechanisms underlying these findings.

Estimated Oxygen Consumption with the Abbreviated Method and Its Association with Vaccination and PCR Tests for COVID-19 from Socio-Demographic, Anthropometric, Lifestyle, and Morbidity Outcomes in Chilean Adults

COVID-19 causes cardiovascular and lung problems that can be aggravated by confinement, but the practice of physical activity (PA) could lessen these effects. The objective of this study was to evaluate the association of maximum oxygen consumption (V˙O2max) with vaccination and PCR tests in apparently healthy Chilean adults. An observational and cross-sectional study was performed, in which 557 people from south-central Chile participated, who answered an online questionnaire on the control of COVID-19, demographic data, lifestyles, and diagnosis of non-communicable diseases. V˙O2max was estimated with an abbreviated method. With respect to the unvaccinated, those who received the first (OR:0.52 [CI:0.29;0.95], p = 0.019) and second vaccine (OR:0.33 [CI:0.18;0.59], p = 0.0001) were less likely to have an increased V˙O2max. The first vaccine was inversely associated with V˙O2max (mL/kg/min) (β:−1.68 [CI:−3.06; −0.3], p = 0.017), adjusted for BMI (β:−1.37 [CI:−2.71; −0.03], p = 0.044) and by demographic variables (β:−1.82 [CI:−3.18; −0.46], p = 0.009); similarly occur for the second vaccine (β: between −2.54 and −3.44, p < 0.001) on models with and without adjustment. Having taken a PCR test was not significantly associated with V˙O2max (mL/kg/min). It is concluded that vaccination significantly decreased V˙O2max, although it did not indicate cause and effect. There is little evidence of this interaction, although the results suggest an association, since V˙ O2max could prevent and attenuate the contagion symptoms and effects.

Resistance Training before, during, and after COVID-19 Infection: What Have We Learned So Far?

At the end of 2019, a severe acute respiratory syndrome caused by SARS-CoV-2 started a pandemic, leading to millions of deaths and many important political and social changes. Even in the absence of contamination, the mobility reduction, social distancing and closing of exercise facilities negatively affected physical activity and conditioning, which is associated with muscle atrophy, loss of muscle strength, and reductions in functional capacity. In cases of infection, it has been shown that increased physical capacity is associated with decreased hospitalization and mortality risk. Although millions of people have died from COVID-19, most contaminated individuals survived the infection, but carried different sequelae, such as the severe loss of physical function and a reduced quality of life. Among different physical exercise models that might help to prevent and treat COVID-19-related conditions, resistance training (RT) might be particularly relevant. Among its benefits, RT can be adapted to be performed in many different situations, even with limited space and equipment, and is easily adapted to an individual's characteristics and health status. The current narrative review aims to provide insights into how RT can be used in different scenarios to counteract the negative effects of COVID-19. By doing this, the authors expect to provide insights to help deal with the current pandemic and similar events the world may face in the future.

Lessons From COVID-19: Physical Exercise Can Improve and Optimize Health Status

The outbreak of Coronavirus Disease 2019 (COVID-19) has caused increasing challenges for healthcare systems globally. The disease spread rapidly from Wuhan to the rest of the world, involving more than 400 million individuals and including more than 5 million deaths. In dealing with the pandemic, China and other countries took protective measures such as promoting social distancing, canceling public gatherings, closing schools, quarantining, and imposing lockdowns. All these measures lead to physical inactivity. Being physically inactive has significant repercussions on the status of physical and mental wellbeing, and it is associated with anxiety, stress, increased chronic disease risk, and worsening of chronic conditions. In this sense, the relevance of maintaining a healthy lifestyle through physical exercise has been outlined by the World Health Organization (WHO). The aim of this mini review is to discuss the importance of physical activity in the context of the COVID-19 pandemic, highlighting the benefits of physical activity and exercise that could be potentially effective treatment strategies for comorbid chronic conditions, long covid syndrome (LCS), and symptoms such as depression and anxiety.

Physical activity and COVID-19. The basis for an efficient intervention in times of COVID-19 pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic has shocked world health authorities generating a global health crisis. The present study aimed to analyze the different factors associated with physical activity that could have an impact in the COVID-19, providing a practical recommendation based on actual scientific knowledge. We conducted a consensus critical review using primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages. The method was a narrative literature review of the available literature regarding physical activity and physical activity related factors during the COVID-19 pandemic. The main online database used in the present research were PubMed, SciELO, and Google Scholar. COVID-19 has negatively influenced motor behavior, levels of regular exercise practice, eating and nutritional patterns, and the psychological status of citizens. These factors feed into each other, worsening COVID-19 symptoms, the risk of death from SARS-CoV-2, and the symptoms and effectiveness of the vaccine. The characteristics and symptoms related with the actual COVID-19 pandemic made the physical activity interventions a valuable prevention and treatment factor. Physical activity improves body composition, the cardiorespiratory, metabolic, and mental health of patients and enhancing antibody responses in vaccination.

What Comes First, the Behavior or the Condition? In the COVID-19 Era, It May Go Both Ways

Which came first, the chicken or the egg? This causality dilemma was first proposed by the Greek biographer Plutarch in the 1st century CE. While the cause-effect relationship between lifestyle behaviors and chronic disease is not always a certainty, and genetic predisposition can independently lead to premature chronic disease, the likelihood of developing one or more chronic conditions is significantly higher in those who: (1) lead sedentary lifestyles; (2) consume unhealthy diets; (3) smoke; or (4) have excess body mass. Recently, the Royal College of General Practitioners issued an apology for the title of an online event that suggested the coronavirus disease 2019 (COVID-19) is a lifestyle disease. We feel that this was the correct course of action as leading an unhealthy lifestyle is certainly not the cause for an individual contracting COVID-19 (ie, effect). However, a body of evidence has demonstrated that unhealthy lifestyle behaviors and characteristics as well as being diagnosed with one or more chronic diseases does significantly increase the risk for a complicated medical course in individuals infected with COVID-19. Moreover, the cause-effect relationship between lifestyle behaviors and characteristics and COVID-19 may eventually prove to go both ways, as the pandemic may lead to a higher prevalence of unhealthy lifestyle behaviors and characteristics over the long term that eventually leads to a higher prevalence of chronic disease. As such, health living medicine must be widely practiced and prescribed to all individuals globally.

COVID-19 and Air Pollution: A Spatial Analysis of Particulate Matter Concentration and Pandemic-Associated Mortality in the US

In 2019, a novel coronavirus, SARS-CoV-2, was first reported in Wuhan, China. The virus causes the disease commonly known as COVID-19, and, since its emergence, it has infected over 252 million individuals globally and taken the lives of over 5 million in the same time span. Primary research on SARS-CoV-2 and COVID-19 focused on understanding the biomolecular composition of the virus. This research has led to the development of multiple vaccines with great efficacy and antiviral treatments for the disease. The development of biomedical interventions has been crucial to combating this pandemic; additionally, environmental confounding variables that could have exacerbated the pandemic need further assessment. In this research study, we conducted a spatial analysis of particulate matter (PM) concentration and its association with COVID-19 mortality in the United States. Results of this study demonstrate a significant positive correlation between PM concentration levels and COVID-19 mortality; however, this does not necessarily imply a causal relationship. These results are consistent with similar studies in Italy and China, where significant COVID-19 cases and corresponding deaths were exhibited. Furthermore, maps of the data demonstrate clustering of COVID-19 mortality which suggest further investigation into the social determinants of health impacting the pandemic.

An Evolving Approach to Assessing Cardiorespiratory Fitness, Muscle Function and Bone and Joint Health in the COVID-19 Era

Cardiorespiratory fitness (CRF) is now an established vital sign. CRF, along with muscle function and bone and joint health is related to functional independence and a higher quality of life. Wasserman and colleagues proposed a gear model illustrating the integrated role of the respiratory, cardiovascular, and skeletal muscle systems during aerobic exercise; in 2015, a revision to the original model was proposed. Our understanding of the effects and challenges associated with the coronavirus disease 2019 (COVID-19) are rapidly evolving. Initial evidence indicates higher levels of CRF, and muscle function protect individuals infected with COVID-19 from a complicated medical course. Moreover, for those individuals infected with COVID-19, there are initial signs of a reduction in CRF following the initial phase of recovery. We are also gaining an understanding of long COVID syndrome, where individuals who have recovered from the acute phase of viral infection present with lasting symptoms, which include but are not limited to reduced CRF, shortness of breath, and fatigue. Clearly, these individuals will require rehabilitation to restore and/or improve CRF, muscle function, bone and joint health, functional capacity (ie, the ability to perform activities of daily living), and quality of life. The importance of assessing the synergistic function of systems essential to performing activities that require physical exertion is a health care imperative. This graphical narrative provides an update to the gear model initially proposed by Wasserman and updated to a gear and circuit in 2015. External CRF, muscle function, and bone and joint health influencers and an approach to clinical assessment are also introduced.

Forest-bathing and physical activity as weapons against COVID-19: a review

Strengthening the immune system in order to better withstand the threat of COVID-19 is an important way to ensure the protection of our health against the current pandemic associated with SARS-CoV-2. There are many ways to achieve this, but with current circumstances, certain modalities stand out as being the most valid and are certainly worth greater consideration. Here we review the effects that particular immuno-strengthening activities can have on limiting the severity of COVID-19 disease as well as preventing virus infection. Physical activity, in particular, should not be discounted as an important method of prevention of viral diseases as it triggers many biological processes within the human body which in turn lead to heightened natural defences against viral infections. When exercise is performed in forested areas, these protective health benefits may be increased since many plant species emit biogenic volatile compounds (VOCs) which, when inhaled, have many protective properties. These VOCs have been shown in particular to have immunostimulatory effects on the human body and, thus, they could be of use in the prevention and/or treatment of COVID-19. Being amongst trees may also help to alleviate stress and anxiety, lowering cortisol levels and consequently helping the proper functioning of the immune system. In the following work, we have performed an analysis of the available scientific literature which looks at the effects of physical exercise as well as 'forest-bathing' on the immune system's ability to fight disease, especially of course as it relates to COVID-19. Our review aims at shedding light on the benefits of exercising outdoors in green areas and suggests reforestation as a protective measure against future outbreaks.

No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

BACKGROUND

Regular physical activity (PA) has been postulated to improve, or at least maintain, immunity across the life span. However, the link between physical (in)activity and coronavirus disease 2019 (COVID-19) remains to be established. This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19.

METHODS

Hospitalized patients with COVID-19 (mean age: 54.9 years) were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital) and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.

RESULTS

The median hospital length of stay was 7.0 ± 4.0 days, median ± IQR; 3.3% of patients died, 13.8% were admitted to the ICU, and 8.6% required mechanical ventilation. Adjusted linear regression models showed that PA indices were not associated with hospital length of stay (work index: β = -0.57 (95% confidence interval (95%CI): -1.80 to 0.65), p = 0.355; sport index: β = 0.43 (95%CI: -0.94 to 1.80), p = 0.536; leisure-time index: β = 1.18 (95%CI: -0.22 to 2.59), p = 0.099; and total activity index: β = 0.20 (95%CI: -0.48 to 0.87), p = 0.563). None of the PA indices were associated with mortality, admission to the ICU, or mechanical ventilation requirement (all p > 0.050).

CONCLUSION

Among hospitalized patients with COVID-19, PA did not independently associate with hospital length of stay or any other clinically relevant outcomes. These findings should be interpreted as meaning that, among already hospitalized patients with more severe forms of COVID-19, being active is a potential protective factor likely outweighed by a cluster of comorbidities (e.g., type 2 diabetes, hypertension, weight excess) and older age, suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.

Changes in Physical Activity Are Associated with Corresponding Changes in Psychological Well-Being: A Pandemic Case Study

Societal crises and personal challenges are often followed by substantial changes in physical activity. Is there a link between such changes and psychological well-being? Seeking to answer this question, we conducted a correlational study on a representative sample in Sweden during the first year of the COVID-19 pandemic (N = 1035). About 49% of the sample had decreased their physical activity compared to their self-reported activity level prior to the pandemic, whereas 32% had increased it. The results showed a positive and robust association between changes in daily activity level and corresponding changes in psychological well-being. Specifically, individuals who had reduced their physical activity over the last year reported lower life satisfaction than before, and individuals who had increased their physical activity reported higher life satisfaction than before. The amount of complete physical inactivity (sitting) showed a similar pattern as the exercise data, meaning that individuals who reported increasing inactivity per day also reported a greater decline in life satisfaction. Additional analyses showed that the association between daily activity level and life satisfaction was somewhat stronger for men than for women, but there was no difference when comparing individual versus organized activities. The current study was based on a cross-sectional design, measuring self-reported change over time. Recent work from other research teams have used longitudinal data and experience-sampling in different settings, finding similar results. We conclude that there is good reason to recommend physical exercise as a coping strategy in difficult times.

COVID-19 Infection Alters the Microbiome: Elite Athletes and Sedentary Patients Have Similar Bacterial Flora

Regular exercise can upgrade the efficiency of the immune system and beneficially alter the composition of the gastro-intestinal microbiome. We tested the hypothesis that active athletes have a more diverse microbiome than sedentary subjects, which could provide better protection against COVID-19 during infection. Twenty active competing athletes (CA) (16 male and 4 females of the national first and second leagues), aged 24.15 ± 4.7 years, and 20 sedentary subjects (SED) (15 male and 5 females), aged 27.75 ± 7.5 years, who had been diagnosed as positive for COVID-19 by a PCR test, served as subjects for the study. Fecal samples collected five to eight days after diagnosis and three weeks after a negative COVID-19 PCR test were used for microbiome analysis. Except for two individuals, all subjects reported very mild and/or mild symptoms of COVID-19 and stayed at home under quarantine. Significant differences were not found in the bacterial flora of trained and untrained subjects. On the other hand, during COVID-19 infection, at the phylum level, the relative abundance of Bacteroidetes was elevated during COVID-19 compared to the level measured three weeks after a negative PCR test (p < 0.05) when all subjects were included in the statistical analysis. Since it is known that Bacteroidetes can suppress toll-like receptor 4 and ACE2-dependent signaling, thus enhancing resistance against pro-inflammatory cytokines, it is suggested that Bacteroidetes provide protection against severe COVID-19 infection. There is no difference in the microbiome bacterial flora of trained and untrained subjects during and after a mild level of COVID-19 infection.

Effect of the COVID-19 pandemic on the physical and psychoaffective health of older adults in a physical exercise program

COVID-19 lockdowns restricted physical activity levels for individuals in many countries. In particular, older adults experienced limited access to their usual activities, including physical exercise programs. How such restrictions and interruptions in physical exercise programs might impact the physical and mental health of older adults has not yet been studied. We sought to analyse changes in the physical and mental health of older adults enrolled in a group-based multicomponent physical exercise (MPE) program that was interrupted due to the COVID-19 pandemic. We followed 17 participants of this program from October 2018 to October 2020, including the interruption of the program during the pandemic. The MPE program included strength, balance, and stretching exercises. We compared anthropometric and cardiovascular parameters, physical fitness, frailty, quality of life, and psychoaffective status of participants before and during the COVID-19 pandemic. Most parameters followed the same pattern, improving after 8 months of the first MPE season (Oct. 2018-Jun. 2019), worsening after 4 months of summer rest, improving from October 2019 to January 2020 in the second MPE season (Oct. 2019-Jan. 2020), and severely worsening after 7 months of program interruption. We show that an MPE program has clear benefits to the physical and psychoaffective health of older adults, and interruption of these programs could adversely impact participants. These results highlight the need to maintain physical exercise programs or facilitate engagement in physical activity and reduce sedentary behaviour in older adults, particularly in situations such as the COVID-19 pandemic.

Fitness, strength and severity of COVID-19: a prospective register study of 1 559 187 Swedish conscripts

OBJECTIVE

To investigate the possible connection between cardiorespiratory fitness (CRF) and muscle strength in early adulthood and severity of COVID-19 later in life.

DESIGN

Prospective registry-based cohort study.

PARTICIPANTS

1 559 187 Swedish men, undergoing military conscription between 1968 and 2005 at a mean age of 18.3 (SD 0.73) years.

MAIN OUTCOME MEASURES

Hospitalisation, intensive care or death due to COVID-19 from March to September 2020, in relation to CRF and muscle strength.

RESULTS

High CRF in late adolescence and early adulthood had a protective association with severe COVID-19 later in life with OR (95% CI) 0.76 (0.67 to 0.85) for hospitalisation (n=2 006), 0.61 (0.48 to 0.78) for intensive care (n=445) and 0.56 (0.37 to 0.85) for mortality (n=149), compared with the lowest category of CRF. The association remains unchanged when controlled for body mass index (BMI), blood pressure, chronic diseases and parental education level at baseline, and incident cardiovascular disease before 2020. Moreover, lower muscle strength in late adolescence showed a linear association with a higher risk of all three outcomes when controlled for BMI and height.

CONCLUSIONS

Physical fitness at a young age is associated with severity of COVID-19 many years later. This underscores the necessity to increase the general physical fitness of the population to offer protection against future viral pandemics.

Nutrition in the Actual COVID-19 Pandemic. A Narrative Review

The pandemic of Coronavirus Disease 2019 (COVID-19) has shocked world health authorities generating a global health crisis. The present study discusses the main finding in nutrition sciences associated with COVID-19 in the literature. We conducted a consensus critical review using primary sources, scientific articles, and secondary bibliographic indexes, databases, and web pages. The method was a narrative literature review of the available literature regarding nutrition interventions and nutrition-related factors during the COVID-19 pandemic. The main search engines used in the present research were PubMed, SciELO, and Google Scholar. We found how the COVID-19 lockdown promoted unhealthy dietary changes and increases in body weight of the population, showing obesity and low physical activity levels as increased risk factors of COVID-19 affection and physiopathology. In addition, hospitalized COVID-19 patients presented malnutrition and deficiencies in vitamin C, D, B12 selenium, iron, omega-3, and medium and long-chain fatty acids highlighting the potential health effect of vitamin C and D interventions. Further investigations are needed to show the complete role and implications of nutrition both in the prevention and in the treatment of patients with COVID-19.

Effect of COVID-19 confinement on physical activity patterns in relation to sociodemographic parameters in Spanish population

BACKGROUND

The main purpose of the present study was to determine the socio demographic parameters associated to physical activity (PA) patterns changes during the COVID-19 lockdown in the Spanish population.

METHODS

Participants were recruited by sending a survey through various social network channels via the snowball method. A voluntary sample of 2430 individuals consisting of 1,203 men and 1,227 women (aged between 18 to 73 years old) from the Spanish national territory participated in this study. An online survey was performed to collect the information, which was tested through ad hoc analysis with different socio-demographic variables. Participants were a median of 34 years old (18-73 years old) with a mean BMI of 23.6 kg/m2.

RESULTS

The risk factors associated with the change in PA hours during confinement showed that to do sports (β; -56.88, 95%CI; -79.35 to -34.40, P <0.001), male sex (β - 34.78, 95%CI;-54.02 to -15.52, P<0.001) and the educational level (i.e., elementary school category) (β; -54.21, 95%CI;-89.10 to -19.32, P= 0.002) reported negative changes with hours of PA during confinement. By the contrary, the employment status (passive work) and to be student reported positive association (i.e., increase PA hours per week).

CONCLUSIONS

The COVID-19 lockdown led to a reduction PA patterns in Spanish population. Mostly men showed a drastic decrease in hours of PA compared to the women's group. Likewise, the groups of people with elementary and high education showed a decrease in hours of weekly PA, as well as unemployed people.

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

Background: The COVID-19 pandemic has been characterized by wide variations in mortality across nations. Some of this variability may be explained by medical comorbidities such as obesity and depression, both of which are strongly correlated with dietary practices such as levels of sugar and seafood consumption. Methods: COVID-19 mortality indices for 156 countries were obtained from the Johns Hopkins University’s data aggregator. Correlations between these variables and (a) per capita consumption of sugar and seafood, and (b) country-wise prevalence of depression and obesity were examined. Results: Sugar consumption (r = 0.51, p < 0.001) and prevalence of obesity (r = 0.66, p < 0.001) and depression (r = 0.56, p < 0.001) were positively correlated with crude mortality rates, while seafood consumption was negatively correlated with the infection fatality rate (r = −0.28, p = 0.015). These effects were significant even after correcting for potential confounders. The associations with depression and obesity remained significant upon multivariate regression. Conclusions: Both obesity and depression, which are associated with inflammatory dysregulation, may be related to cross-national variations in COVID-19 mortality, while seafood consumption may be protective. These findings have implications in terms of protecting vulnerable individuals during the current pandemic.