Association of physical activity and the risk of COVID-19 hospitalization: A dose–response meta-analysis

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 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/wk) 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 interval [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 (P(non-linearity) < .05) between PA and the risk of COVID-19 hospitalization. When total PA was < or >10 Met-h/wk, an increase of 4 Met-h/wk 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 the World Health Organization may be required for more substantial reductions in the COVID-19 hospitalization risk.