Association of physical activity and the risk of COVID-19 hospitalization: a dose-response meta-analysis (preprint)

ABSTRACT

Background: Many people have experienced a high burden due to the spread of the coronavirus disease (COVID-19) and its serious consequences for health and everyday life. Prior studies have reported that physical activity (PA) may lower the risk of COVID-19 hospitalization. The present meta-analysis (PROSPERO registration number CRD42022339672) explored the dose-response relationship between PA and the risk of COVID-19 hospitalization. Methods: Epidemiological observational studies on the relationship between PA and the risk of COVID-19 hospitalization were included. Categorical dose-response relationships between PA and the risk of COVID-19 hospitalization were assessed using random effect models. Robust error meta-regression models assessed the continuous relationship between PA (metabolic equivalent [MET]-h/week) and COVID-19 hospitalization risk across studies reporting quantitative PA estimates. Results: Seventeen observational studies (cohort\case-control\cross-section) met the criteria for inclusion in the meta-analysis. Categorical dose-relationship analysis showed a 40% (risk ratio (RR) 0.60, 95% confidence intervals (CI) 0.48-0.71) reduction in the risk of COVID-19 hospitalization compared to the lowest dose of PA. The results of the continuous dose-response relationship showed a non-linear inverse relationship (Pnon-linearity < 0.05) between PA and the risk of COVID-19 hospitalization. When total PA was less than or greater than 10 Met-h/week, an increase of 4 Met-h/week was associated with a 14% (RR = 0.83, 95%CI 0.85-0.87) and 11% (RR = 0.89, 95%CI 0.87-0.90) reduction in the risk of COVID-19 hospitalization, respectively. Conclusions: There was an inverse non-linear dose-response relationship between PA level and the risk of COVID-19 hospitalization. Doses of the guideline-recommended minimum PA levels by WTO may be required for more substantial reductions in the COVID-19 hospitalization risk.