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CME / ABIM MOC / CE

Can Physical Activity Lower the Risk for COVID-19?

  • Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 10/7/2022
  • Valid for credit through: 10/7/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for infectious disease physicians, critical care physicians, allergists and clinical immunologists, family medicine and primary care physicians, internists, nurses, nurse practitioners, pharmacists, physician assistants, public health and prevention officials, sports medicine physicians, pulmonologists, and other members of the healthcare team for patients with or at risk for COVID-19.

The goal of this activity is for learners to be better able to describe the association between physical activity and risk for SARS-CoV-2 infection, COVID-19--associated hospitalization, and severe illness and death from COVID-19 in adults, according to a systematic review and meta-analysis.

Upon completion of this activity, participants will:

  • Describe the association between physical activity and risk for SARS-CoV-2 infection, COVID-19-associated hospitalization, and severe illness and death from COVID-19 in adults, according to a systematic review and meta-analysis
  • Determine clinical and public health implications of the association between physical activity and risk for SARS-CoV-2 infection, COVID-19-associated hospitalization, and severe illness and death from COVID-19 in adults, according to a systematic review and meta-analysis
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Megan Brooks

    Freelance writer, Medscape

    Disclosures

    Megan Brooks has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie Inc.

Editor/Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.


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In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

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    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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CME / ABIM MOC / CE

Can Physical Activity Lower the Risk for COVID-19?

Authors: News Author: Megan Brooks; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 10/7/2022

Valid for credit through: 10/7/2023

processing....

Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to the approved COVID-19 vaccines are provided in this activity in an effort to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.  

Clinical Context

Regular physical activity has many health benefits, including protection against respiratory infection severity and reducing risk factors for adverse COVID-19 outcomes, such as obesity, cardiovascular disease, and type 2 diabetes.

During the COVID-19 pandemic, physical activity appears to enhance immune defense and mitigate harmful effects of stress on immunity. The link between regular physical activity and COVID-19 outcomes is poorly understood but likely involves both metabolic and environmental factors. New research suggests that regular physical activity can help lower the risk for COVID-19 and its severity.

Study Synopsis and Perspective

According to a new study, a weekly tally of 150 minutes of moderate or 75 minutes of vigorous physical activity may afford the best protection against adverse COVID-19 outcomes.

"Our findings highlight the protective effects of engaging in sufficient physical activity as a public health strategy, with potential benefits to reduce the risk of severe COVID-19," said Antonio García-Hermoso, PhD, Public University of Navarra, Pamplona, Spain, and colleagues.

"Regular physical activity seemed to be related to a lower risk of COVID-19 infection, García-Hermosa told Medscape Medical News. "There is evidence that regular physical activity might contribute to a more effective immune response, providing enhanced protective immunity to infections, which could explain the relationship between exercise consistency with COVID-19 infection."

Regular exercise may also help to boost the body's anti-inflammatory responses, as well as cardiorespiratory and muscular fitness, all of which may explain its beneficial effects on COVID-19 severity, the researchers said.

The study was published August 22 in the British Journal of Sports Medicine.

Strong Protection From COVID?

A growing body of evidence suggests that increased physical activity may modulate the course of COVID-19 and reduce the risk for poor outcomes. The new analysis is the first to systematically evaluate and pool data on the effect of regular physical activity on COVID-19 outcomes.

The findings are based on data from 16 studies with more than 1.8 million adults (53% women; mean age 53 years).

Individuals who included regular physical activity in their weekly routine had an 11% lower risk for infection with SARS-CoV-2 (HR 0.89 [95% CI: 0.84, 0.95]) compared with inactive peers.

The physically active adults also had a 36% (HR 0.64 [95% CI: 0.54, 0.76]) lower risk of being hospitalized, a 44% (HR 0.66 [95% CI: 0.58, 0.77]) lower risk for severe COVID-19 illness, and a 43% (HR 0.57 [95% CI: 0.46, 0.71]) lower risk of dying from COVID-19 than their inactive peers.

The greatest protective effect occurs with achieving at least 500 metabolic equivalent of task (MET) minutes per week of physical activity -- equivalent to 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week with no added benefit beyond this level.

The researchers cautioned that the analysis included observational studies, differing study designs, subjective assessments of physical activity levels, and concerned only the Beta and Delta variants of SARS-CoV-2, not Omicron.

Despite these limitations, the researchers said their findings "may help guide physicians and healthcare policymakers in making recommendations and developing guidelines with respect to the degree of physical activity that can help reduce the risk of infectivity, hospitalization, severity, and mortality of COVID-19 at both the individual and the population level, especially in high-risk patients."

Helpful, but Not a Panacea

Reached for comment, Sean Heffron, MD, a preventive cardiologist and assistant professor of medicine at New York University (NYU) Langone Health in New York, New York, said the study "supports the well-established nonlinear association of increasing physical activity with adverse outcomes from a diverse array of diseases, including infectious diseases, such as COVID-19."

The observation is not particularly surprising, he told Medscape Medical News

"It is as I would suspect. They compiled data from a large number of studies published over the past several years that all had consistent findings," Heffron said.

"The take-away from a public health standpoint is that being physically active improves health in myriad ways. That being said, it is not a panacea, so additional measures (masking, vaccinations, etc.) are important for everyone," he said.

Also weighing in, Joseph Herrera, DO, chair of the department of rehabilitation for Mount Sinai Health System in New York, New York, said, "If you are physically fit, your body is more resilient and better prepared to handle the stressors of COVID or any other disease process."

For now, however, the question of whether physical fitness is actually protective against COVID-19 remains unclear.

"I'm just not sure right now," Herrera told Medscape Medical News.

He said he has treated athletes in professional sports, including the National Football League and Major League Baseball, and some of them have had long COVID-19 and have not returned to play.

"These are athletes at the peak of fitness and their career," he added.

Nonetheless, Herrera said a good public health message in general is to stay fit or get fit.

"That's something I preach all the time," he told Medscape Medical News.

García-Hermosa agreed: "In contrast to the vast majority of drugs, exercise is free of adverse effects. It's time to consider exercise as medicine. It's never too late to start being physically active."

The study had no specific funding. García-Hermoso, Heffron, and Herrera have reported no relevant financial relationships.

Br J Sports Med. Published online August 22, 2022.[1]

Study Highlights

  • Investigators systematically searched 3 databases through March 2022 for peer-reviewed articles reporting the association between regular physical activity and ≥ 1 COVID-19 outcome in adults (16 studies; N = 1,853,610; 53% women; mean age, 53.2 years).
  • A random-effects inverse-variance model allowed pooling of risk estimates.
  • GRADE assessment showed that overall quality of evidence for the association between physical activity and SARS-CoV-2 infection and COVID-19 hospitalization was low and for physical activity and severe COVID-19 illness and death was moderate.
  • Compared with their inactive peers, persons participating in regular physical activity had lower risks for infection (11% lower; RR 0.89 [95% CI: 0.84, 0.95]), hospitalization (36% [RR 0.64 (95% CI: 0.54, 0.76)]), severe COVID-19 (34% [RR 0.66 (95% CI: 0.58, 0.77)]) and COVID-19--related death (43% [RR 0.57 (95% CI: 0.46, 0.71)]).
  • There was a nonlinear dose-response relationship between physical activity (MET min/wk) with severe COVID-19 illness and death (P nonlinearity < .001), but not with infection or hospitalization, with a flattening of the dose-response curve at ~ 500 MET min/week.
  • Sensitivity analyses showed stability of overall findings once each study was individually excluded.
  • The investigators concluded that regular physical activity seemed to be related to lower likelihood for adverse COVID-19 outcomes (infectivity, hospitalization, severity, and mortality).
  • Greatest benefit is from ≥ 500 MET min/wk of physical activity, equivalent to 150 min/wk of moderate-intensity or 75 min/wk of vigorous-intensity physical activity, with no additional benefit from further MET min/wk.
  • Physical fitness improves overall resilience to the stressors of COVID-19 or any other disease process.
  • These benefits of exercise on COVID-19 severity may result from more effective immune response, improved anti-inflammatory responses, and cardiorespiratory and muscular fitness.
  • In healthy humans, physical activity has been linked to reduced systemic inflammation, enhanced natural killer cell cytolytic activity, increased T-cell proliferative capacity, lower circulating levels of inflammatory cytokines, and increased neutrophil phagocytic activity, which can all enhance viral control.
  • The findings highlight the protective effects of engaging in sufficient physical activity as a public health strategy, with potential benefits to lower risk for severe COVID-19, as well as of other chronic and acute diseases.
  • To ensure better health outcomes for all, equitable access to physical activity is needed for all socioeconomic and income groups.
  • The findings may help guide physicians and healthcare policymakers in making recommendations and developing guidelines regarding the extent of physical activity that can help lower risk for adverse COVID-19 at both the individual and population level, especially in high-risk patients.
  • Nonetheless, such measures do not obviate the need for additional preventive measures, such as masking and vaccinations.
  • Study limitations of heterogeneity, observational designs, subjective tools to assess physical activity, and risk for publication bias warrant caution in interpreting the results and further studies with standardized methodology and outcome reporting.
  • In addition, studies were conducted when only Beta and Delta SARS-CoV-2 variants, not Omicron, were circulating.
  • More epidemiologic studies with detailed quantification of physical activity and greater sample size will help establish more precise information regarding the observed association.

Clinical Implications

  • Regular physical activity seemed to be related to lower likelihood for adverse COVID-19 outcomes.
  • The findings may inform guidelines regarding the extent of physical activity that can help lower risk for adverse COVID-19 outcomes.
  • Implications for the Healthcare Team: While potentially helpful, sufficient exercise alone does not protect against COVID-19. The healthcare team should continue to educate patients on the need for additional preventive measures, such as masking and vaccinations.

 

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