Physical activity and risk of infection, severity, and mortality of COVID-19: Being physically active may be associated with better COVID-19 outcomes.

Keywords: Physical activity, COVID-19, morbi-mortality


Dr. Yasmin Ezzatvar, University of Valencia, Spain.
Dr. Robinson Ramírez-Vélez, Public University of Navarra, Spain.
Dr. Mikel Izquierdo, Public University of Navarra, Spain.
Dr. Antonio García-Hermoso, Navarrabiomed, Spain.

In this blog, we will explain the results of our recent study published in BJSM, on the importance of regular physical activity in reducing the risk of infection, hospitalisation, severe illness, and mortality due to COVID-19. This study was carried out by researchers from the University of Valencia, the Public University of Navarra and Navarrabiomed in Spain (1).


Why is this study important?

The COVID-19 pandemic has had a significant human cost, and its economic and social effects have spread globally. Some of the factors for increased severity have already been identified; some of them are non-modifiable (e.g., age, sex, ethnic/racial group) and others have some potential to be modified, like the presence of certain health conditions such as obesity, diabetes, hypertension or respiratory diseases. One of the best tools to prevent its onset, for its management and/or to clinically improve these conditions is, without a doubt, physical activity.


How did the study go about this?

Being physically active is probably one of the best decisions a person can make to stay healthy. Physical activity contributes to preventing and managing many diseases, including the prevention and protection against respiratory infections such as COVID-19. Among its many beneficial effects, some that could be especially relevant for this disease are its immunological benefits, its ability to mitigate the effects of stress on immunity, or the reduction of risk factors for a worse prognosis of COVID-19, such as obesity or hypertension. For this reason, our research team sought to quantify the link between regular physical activity and COVID-19 outcomes.


What did the study find?

We searched for studies reporting the association between regular physical activity and at least one COVID-19 outcome in adults, and we finally included 16 studies encompassing more than 1.8 million participants. Our analysis revealed that, compared to inactive individuals, those who engaged in regular physical activity had an 11% lower risk of COVID-19 infection, a 36% lower risk of hospitalisation, a 34% lower risk of severe COVID-19 illness, and the most surprising result: almost half the risk of death related to COVID-19 was reduced in individuals who engaged in regular physical activity compared to their inactive peers! Our findings also indicated a nonlinear dose–response relationship between physical activity and severe COVID-19 illness and death with a flattening of the dose–response curve at around 500 MET-min per week. 



What are the key take home points?

Regular physical activity seems to be related to a lower likelihood of adverse COVID-19 outcomes. We observed that the greatest benefit for lowering the risk of COVID-19 outcomes is obtained by achieving at least 500 MET-minutes per week of physical activity, equivalent to current physical activity guidelines for adults (2) (i.e., 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity or an equivalent combination of moderate- and vigorous-intensity activity throughout the week). Our findings highlight the protective effects of engaging in sufficient physical activity as a public health strategy, with potential benefits in reducing the risk of severe COVID-19 illness and mortality. This means that by following general physical activity guidelines, people can improve their health and reduce the risk of COVID-19 adverse outcomes. Therefore, our results support recommendations to increase the level of physical activity in the general population.


Watch the below video to learn more:


  1. Ezzatvar Y, Ramírez-Vélez R, Izquierdo M, et al Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults. 
  2. Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54:1451–62. doi:10.1136/BJSPORTS-2020-102955

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