Lifestyle Risk Factors and COVID-19 Hospitalization [COVID-19 and Physical Activity Series]

Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization by Dr. Hamer and co-authors is a prospective cohort study of 387,109 adults in the United Kingdom.  Physical activity, smoking, and alcohol intake were assessed by questionnaire, and baseline data collection took place between 2006 and 2010.  Specifically, physical activity was assessed using the International Physical Activity Questionnaire that measures duration and frequency of moderate-to-vigorous physical activity, and meeting physical activity guidelines was defined as ≥150 min/week moderate-to-vigorous physical activity or ≥75 min/week vigorous physical activity. Dr. Hamer and co-authors found a dose-dependent association between the risk of COVID-19 with worsening lifestyle scores, such that participants in the most adverse category had 4-fold higher risk (RR = 4.41; 95% CI, 2.52, 7.71) compared to people with the most optimal lifestyle.  Approximately 0.2% (N = 760) of the sample were hospitalized with a COVID-19 infection between March 16 and April 26, 2020, and their risk profile was characterized as being male, older age, smokers, physically inactive, less highly educated, non-white ethnicity, and higher prevalence of cardiometabolic comorbidities.  Based on risk factor prevalence estimates, unhealthy behaviors in combination accounted for 51.4% of the population attributable fraction of severe COVID-19.  Individually, smoking contributed to 13.3%, physical inactivity contributed to 8.6%, and overweight and obesity contributed to 29.5% of hospitalized cases of COVID-19.  After adjustment for age, sex and mutually for each lifestyle factor, physical inactivity (relative risk, 1.32; 95% confidence interval, 1.10, 1.58), smoking (1.42;1.12, 1.79) and obesity (2.05;1.68, 2.49)—but not heavy alcohol consumption (1.12; 0.93, 1.35)—were all related to COVID-19.  Protective associations of physical activity on COVID-19 were observed even at relatively low levels of activity below the current guidelines (i.e., < 150 min moderate to vigorous activity) and no dose-response effect was observed for higher levels. Dr. Hamer and co-authors concluded that adopting simple lifestyle changes could lower the risk of severe COVID-19 infection. 

Hamer, M., Kivimäki, M., Gale, C. R., & Batty, G. D. (2020). Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK. Brain, Behavior, and Immunity.