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Cited by 789COVID-19 Clinical Research StudiesPhysical Activity and HealthCOVID-19 epidemiological studies

Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients

Sallis, Robert, Young, Deborah Rohm, Tartof, Sara Y, Sallis, James F, Sall, Jeevan, Li, Qiaowu, Smith, Gary N, Cohen, Deborah A·2021·British Journal of Sports Medicine
DOI 10.1136/bjsports-2021-104080
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Abstract

Objectives: To compare hospitalisation rates, intensive care unit (ICU) admissions and mortality for patients with COVID-19 who were consistently inactive, doing some activity or consistently meeting physical activity guidelines. Methods: We identified 48 440 adult patients with a COVID-19 diagnosis from 1 January 2020 to 21 October 2020, with at least three exercise vital sign measurements from 19 March 2018 to 18 March 2020. We linked each patient’s self-reported physical activity category (consistently inactive=0–10 min/week, some activity=11–149 min/week, consistently meeting guidelines=150+ min/week) to the risk of hospitalisation, ICU admission and death after COVID-19 diagnosis. We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes. Results: Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines. Patients who were consistently inactive also had a greater risk of hospitalisation (OR 1.20; 95% CI 1.10 to 1.32), admission to the ICU (OR 1.10; 95% CI 0.93 to 1.29) and death (OR 1.32; 95% CI 1.09 to 1.60) due to COVID-19 than patients who were doing some physical activity. Conclusions: Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults. We recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care.

AI snapshot

Written from the paper’s full text.

TL;DR

In 48,440 adults with COVID-19, consistently meeting physical activity guidelines before diagnosis was associated with lower odds of hospitalization, ICU admission, and death compared with being consistently inactive. Physical inactivity was a stronger risk factor for severe COVID-19 outcomes than most chronic conditions and modifiable risk factors studied, except age and organ transplant history.

Key findings

  • Among the cohort, 8.6% were hospitalized, 2.4% were admitted to the ICU, and 1.6% died after COVID-19 diagnosis.
  • Compared with consistently meeting physical activity guidelines, consistently inactive patients had higher adjusted odds of hospitalization (OR 2.26; 95% CI 1.81 to 2.83), ICU admission (OR 1.73; 95% CI 1.18 to 2.55), and death (OR 2.49; 95% CI 1.33 to 4.67).
  • Compared with patients doing some activity, consistently inactive patients also had higher adjusted odds of hospitalization (OR 1.20; 95% CI 1.10 to 1.32) and death (OR 1.32; 95% CI 1.09 to 1.60); ICU admission was not statistically significant (OR 1.10; 95% CI 0.93 to 1.29).
  • Doing some activity was associated with higher odds of severe outcomes than consistently meeting guidelines: hospitalization OR 1.89 (95% CI 1.53 to 2.33), ICU admission OR 1.58 (95% CI 1.10 to 2.27), and death OR 1.88 (95% CI 1.02 to 3.47).

Methods

  • Retrospective observational study at Kaiser Permanente Southern California among 48,440 adults aged 18 years and older with a positive COVID-19 test or diagnosis from 1 January 2020 to 21 October 2020, continuously enrolled for at least 6 months before diagnosis, and with at least three outpatient exercise vital sign (EVS) measurements from 19 March 2018 to 19 March 2020.
  • Physical activity categories were based on EVS: consistently inactive (0–10 min/week at all assessments), some activity (11–149 min/week or variable measures), and consistently meeting guidelines (150+ min/week at all assessments).
  • Multivariable logistic regression estimated odds ratios for hospitalization, ICU admission, and death, adjusting for demographics and CDC-defined risk factors/comorbidities including age, sex, race/ethnicity, obesity, diabetes, cardiovascular disease, COPD, renal disease, cancer, smoking, hypertension, pregnancy, and recent emergency or inpatient encounters.

Limitations

  • The paper states that physical activity was self-reported and did not measure exercise intensity beyond the threshold of “moderate to strenuous exercise (like a brisk walk).”
  • The paper states that the observational design precludes definitive causal conclusions; associations could be in reverse, and residual confounding, unmeasured confounders, or measurement error may remain.
  • The paper notes potential sparse data in some variables, such as the 80+ age category in the death model (OR 27.31; 95% CI 20.50 to 36.38), and that some confounders are time-varying and may not continuously reflect information recorded during patient interviews.
  • Evident from the text: the study was conducted in a single integrated healthcare system in Southern California, and physical activity was assessed only before the pandemic/diagnosis, so generalizability and the role of activity changes during the pandemic are not established by these data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bjsports-2021-104080

Cites

28 of 28 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Outcomes and adjusted analyses · p. 5

    Among COVID-19 patients, doing some physical activity was associated with higher odds of ICU admission compared with consistently meeting physical activity guidelines (OR 1.58; 95% CI 1.10 to 2.27).

    “Patients who were doing some activity had 1.58 greater odds for ICU admission (95% CI 1.10 to 2.27) than those who were consistently meeting PA guidelines.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Outcomes and adjusted analyses · p. 6

    Consistently inactive patients had 2.49 times greater odds of death from COVID-19 compared with patients consistently meeting physical activity guidelines (OR 2.49, 95% CI 1.33 to 4.67).

    “The odds of death were 2.49 times greater (95% CI 1.33 to 4.67) for patients who were consistently inactive compared with patients who were consistently meeting PA guidelines.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Outcomes and adjusted analyses · p. 6

    Consistently inactive patients had greater risk of death than patients doing some physical activity (OR 1.32, 95% CI 1.09 to 1.60).

    “Patients who were consistently inactive also had a greater risk of death (OR 1.32; 95% CI 1.09 to 1.60) than patients who were only doing some activity.”
    Quote in the paperSubstantial claim
  • Findingown data
    § ABSTRACT · p. 2

    Among COVID-19 patients, being consistently inactive was associated with higher odds of hospitalisation compared with consistently meeting physical activity guidelines (OR 2.26; 95% CI 1.81 to 2.83).

    “Patients with COVID-19 who were consistently inactive had a greater risk of hospitalisation (OR 2.26; 95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 than patients who were consistently meeting physical activity guidelines.”
    Quote in the paperSubstantial claim
  • Findingown data
    § DISCUSSION Main findings · p. 6

    Doing only some physical activity provided substantially higher odds for all COVID-19 adverse outcomes than consistently meeting physical activity guidelines.

    “However, doing only some activity provided substantially higher odds for all COVID-19 adverse outcomes than consistently meeting PA guidelines.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 11

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § RESULTS · p. 3

    The majority of patients (61.2%) in the cohort had five or more exercise vital sign measures in the 2-year time frame.

    “The majority of patients (61.2%) in our cohort had five or more EVS measures in that 2-­ year time frame (see online supplemental table).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Demographics · p. 4

    Among all patients with COVID-19, 8.6% were hospitalised, 2.4% were admitted to the ICU, and 1.6% died.

    “Among all patients with COVID-19, 8.6% were hospitalised, 2.4% were admitted to the ICU and 1.6% died (table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given
    § DISCUSSION Main findings · p. 6

    Pregnant patients with COVID-19 had a much lower risk of death.

    “In fact, pregnant patients with COVID-19 had a much lower risk of death.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Outcomes and adjusted analyses · p. 6

    The odds of death for consistently inactive patients was robust and in most instances higher than the odds of other COVID-19 risk factors.

    “Odds of death for consistently inactive patients was robust, and in most instances was higher than the odds of other COVID-19 risk factors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § INTRODUCTION · p. 2

    The US Centers for Disease Control and Prevention (CDC) has identified risk factors for severe COVID-19, including advanced age, male sex, and underlying comorbidities such as diabetes, obesity, and cardiovascular disease.

    “The US Centers for Disease Control and Prevention (CDC) has identified risk factors for severe COVID19, including advanced age, sex (male) and the presence of underlying comorbidities, such as diabetes, obesity and cardiovascular disease. 1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Centers for Disease Control and Prevention . COVID-19 people of any age with underlying medical conditions. Available: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html [Accessed 20 Dec 2020].

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § DISCUSSION Main findings · p. 6

    The elevated hospitalisation rate for pregnant patients is due to all being admitted to hospital to deliver their baby and likely does not suggest an increased risk for severe COVID-19-related hospitalisations.

    “It should be noted that the elevated hospitalisation rate for pregnant patients is due to the fact that all are admitted to the hospital to deliver their baby, and likely does not suggest an increased risk for severe COVID-19-­ related hospitalisations.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: All pregnant patients are admitted to hospital to deliver their baby, so the elevated hospitalisation rate for pregnant patients does not indicate increased risk for severe COVID-19-related hospitalisations.

  • Classified as probably not a substantial claim.

    Premisecitation
    § INTRODUCTION · p. 2

    A lack of physical activity is a well-documented underlying risk factor for multiple chronic diseases, including those associated with severe COVID-19.

    “a lack of PA is a well-­ documented underlying risk factor for multiple chronic diseases, including those associated with severe COVID-19. 1 2”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 1 2

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning
    § Study cohort · p. 3

    Requiring at least three outpatient exercise vital sign measurements between 19 March 2018 and 19 March 2020 increased the likelihood that the assessment captured regular physical activity habits.

    “We required patients to have at least three outpatient visits with an exercise vital sign (EVS) measure between 19 March 2018 and 19 March 2020 to increase the likelihood that the assessment captured regular PA habits.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § PA goals · p. 7

    The US Physical Activity Guidelines established a goal of 150 minutes per week of moderate-to-vigorous physical activity to maximise health benefits.

    “The US Physical Activity Guidelines established a goal of 150 min/ week of MVPA (like a brisk walk) to maximise health benefits. 3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § INTRODUCTION · p. 2

    Regular physical activity reduces the risk of systemic inflammation, which is a main contributor to lung damage caused by COVID-19.

    “Regular PA reduces the risk of systemic inflammation, which is a main contributor to lung damage caused by COVID-19. 10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Sallis, 2020, An international physical activity and public health research agenda to inform coronavirus disease-2019 policies and practices, J Sport Health Sci source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § ABSTRACT · p. 2

    The analysis used multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.

    “We conducted multivariable logistic regression controlling for demographics and known risk factors to assess whether inactivity was associated with COVID-19 outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Original research · p. 3

    Kaiser Permanente Southern California's racial/ethnic make-up, neighbourhood education and household income are generally similar to the area population.

    “Racial/ethnic make-­ up, neighbourhood education and household income are generally similar to the area population. 17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Exercise vital sign · p. 3

    The exercise vital sign has been shown to have good face and discriminant validity.

    “The EVS has been shown to have good face and discriminant validity. 18 19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 18 19

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § Data analysis · p. 3

    Covariates included age, sex, race, and underlying medical conditions associated with increased risk for severe COVID-19 as defined by the CDC.

    “Covariates included age, sex and race, along with underlying medical conditions associated with increased risk for severe illness from COVID-19 as defined by the CDC. 2”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention . About chronic diseases. Available: https://www.cdc.gov/chronicdisease/about/index.htm [Accessed 20 Dec 2020].

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § INTRODUCTION · p. 2

    The US Physical Activity Guidelines call for all adults to engage in at least 150 min/week of moderate to vigorous physical activity.

    “The US Physical Activity Guidelines call for all adults to engage in at least 150 min/week of moderate to vigorous physical activity (MVPA). 3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § INTRODUCTION · p. 2

    Regularly active individuals have a lower incidence, symptom intensity, and mortality from various viral infections.

    “It is well known that immune function improves with regular PA, and those who are regularly active have a lower incidence, intensity of symptoms and mortality from various viral infections. 7-9”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [7] Nieman, 2019, The compelling link between physical activity and the body's defense system, J Sport Health Sci source

      Not checked in the free run.

    • cites [8] da Silveira, 2021, Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature, Clin Exp Med source

      Not checked in the free run.

    • cites [9] Burtscher J , Millet GP , Burtscher M . Low cardiorespiratory and mitochondrial fitness as risk factors in viral infections: implications for COVID-19. British Journal of sports medicine (Published Online First: 24 November 2020). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § DISCUSSION Main findings · p. 7

    The reported odds ratios for physical inactivity are likely conservative, and the association of physical activity with negative COVID-19 outcomes may be larger than indicated by the estimates.

    “The reported ORs for physical inactivity are strong but likely conservative, because the models are adjusted for several chronic conditions that benefit from PA and increase the risk for severe COVID-19.”
    • Also stated in: § DISCUSSION Main findings · p. 7 · hedged
      “For instance, because physical inactivity is associated with higher BMI and greater risk of diabetes, both comorbidities associated with severe COVID-19 outcomes, the association of PA with negative COVID-19 outcomes may be larger than indicated by our estimates.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Physical inactivity is associated with higher BMI and greater risk of diabetes, and both comorbidities are associated with severe COVID-19 outcomes.

  • Classified as probably not a substantial claim.

    Study design and conductnone given
    § Strengths and limitations · p. 7

    The study's main strength is the large number of patients with COVID-19 with serial assessment of prediagnosis physical activity levels.

    “The study's main strength is the large number of patients with COVID-19 with serial assessment of prediagnosis PA levels.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § DISCUSSION Main findings · p. 7

    A UK study found that adults with chronic conditions were most likely to report reducing their physical activity due to the COVID-19 lockdown.

    “Although data on PA during the COVID-19 pandemic are scarce, a study from the UK found adults with chronic conditions were most likely to report reducing their PA due to the COVID-19 lockdown. 20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Rogers, 2020, Behavioral change towards reduced intensity physical activity is disproportionately prevalent among adults with serious health issues or Self-Perception of high risk during the UK COVID-19 Lockdown, Front Public Health source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Strengths and limitations · p. 8

    Other limitations include the potential for sparse data in some of the variables.

    “Other limitations include the potential for sparse data in some of the variables.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Strengths and limitations · p. 8

    The odds ratio for physical activity and death outcomes in the highest age category resulted in high odds ratios and wider confidence intervals.

    “For example, the OR for PA and death outcomes in the highest age category resulted in high ORs and wider CIs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Strengths and limitations · p. 7

    Another important strength is the ability to adjust for a wide range of demographic and health variables included in the EHR system.

    “Another important strength is the ability to adjust for a wide range of demographic and health variables that are included in the EHR system.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Strengths and limitations · p. 8

    Some of the confounders are time varying and may not continuously reflect the information recorded during patient interviews.

    “In addition, some of the confounders are time varying and may not continuously reflect the information recorded during patient interviews.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductnone given
    § Strengths and limitations · p. 7

    A final strength is that the COVID-19 outcomes measured were objective and indicative of COVID-19 severity.

    “A final strength is the COVID-19 outcomes measured were objective and indicative of COVID-19 severity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given
    § Strengths and limitations · p. 7

    The main limitations of this study are that the measure of physical activity was self-reported and there was no measure of exercise intensity beyond the threshold of moderate to strenuous exercise.

    “The main limitations of this study are that the measure of PA was self-­ reported and there was no measure of the intensity of exercise beyond the threshold of 'moderate to strenuous exercise (like a brisk walk)'.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Strengths and limitations · p. 7

    There is also the potential issue of residual confounding due to unmeasured confounders or measurement error.

    “There is also the potential issue of residual confounding due to unmeasured confounders or measurement error.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation
    § Strengths and limitations · p. 7

    Many studies have demonstrated numerous strong benefits from physical activity, especially among those who suffer from a variety of chronic diseases.

    “However, many studies have demonstrated numerous strong benefits from PA, especially among those who suffer from a variety of chronic diseases. 25-28”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [25] Pedersen, 2015, Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases, Scand J Med Sci Sports source

      Not checked in the free run.

    • cites [26] source

      Not checked in the free run.

    • cites [27] source

      Not checked in the free run.

    • cites [28] Katzmarzyk, 2021, Physical inactivity and non-communicable disease burden in low-income, middle-income and high-income countries, Br J Sports Med

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Strengths and limitations · p. 8

    The 80+ age confounder variable in the death regression has an OR of 27.31 and a wide CI (20.50 to 36.38), suggesting a sparse data problem.

    “The 80+ age confounder variable in the death regression has an OR of 27.31 and a wide CI (20.50 to 36.38), suggesting that there may be a sparse data problem (and perhaps for other confounding variables).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § PA goals · p. 7

    On average, Americans have at least 4-6 hours each day of leisure time, the majority of which is devoted to sedentary activities, particularly electronic media.

    “Other studies have shown that on average, Americans have at least 4-6 hours each day of leisure time, the majority of which is devoted to sedentary activities, particularly electronic media. 21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Sturm, 2019, Free time and physical activity among Americans 15 years or older: cross-sectional analysis of the American time use survey, Prev Chronic Dis source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning
    § Strengths and limitations · p. 7

    The observed associations could potentially be in reverse, with those who have more significant underlying illness being less likely to include physical activity in their daily routine or lacking the capacity to do so.

    “These associations could potentially be in reverse; that is, those who have more significant underlying illness may be less likely to include PA in their daily routine or lack the capacity to do so.”
    Quote in the paperNot a substantial claim
30 of 30

  • The paper relies on this without support.

    There are no data regarding the effect of regular physical activity on COVID-19 outcomes.

    “However, there are no data regarding the effect of regular physical activity (PA) on COVID-19 outcomes, even though a lack of PA is a well-­ documented underlying risk factor for multiple chronic diseases, including those associated with severe COVID-19. 1 2”

  • The paper relies on this without support.

    Physical inactivity is associated with higher BMI and greater risk of diabetes, and both comorbidities are associated with severe COVID-19 outcomes.

    “For instance, because physical inactivity is associated with higher BMI and greater risk of diabetes, both comorbidities associated with severe COVID-19 outcomes, the association of PA with negative COVID-19 outcomes may be larger than indicated by our estimates.”

  • The paper relies on this without support.

    All pregnant patients are admitted to hospital to deliver their baby, so the elevated hospitalisation rate for pregnant patients does not indicate increased risk for severe COVID-19-related hospitalisations.

    “It should be noted that the elevated hospitalisation rate for pregnant patients is due to the fact that all are admitted to the hospital to deliver their baby, and likely does not suggest an increased risk for severe COVID-19-­ related hospitalisations.”

  • The paper relies on this without support.

    Use of three or more EVS measures allows for improved estimates of physical activity and identification of patients with consistently high and low physical activity patterns.

    “However, this assessment of PA has previously been validated, 18 19 and the use of three or more EVS measures allowed for improved estimates of PA and the identification of patients with consistently high and low PA patterns.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • ICU admission percentage differs from the reported count

    Minor

    The stated 2.4% ICU admission rate does not match table 2: 1199 of 48 440 patients is about 2.5% to one decimal place.

    Reported 2.4 · recomputed 2.475227

  • Hospitalisation percentage differs from the reported count

    Minor

    The stated 8.6% hospitalisation rate does not match table 2: 4236 of 48 440 patients is about 8.7% to one decimal place.

    Reported 8.6 · recomputed 8.744839

  • ICU comparison is called significant despite a nonsignificant interval

    Minor

    The results say inactivity produced significantly higher odds for all three outcomes relative to doing some activity. Later, they explicitly say the ICU comparison was not statistically significant; its reported 95% CI is 0.93 to 1.29.

  • Hospitalisation confidence interval has two different lower bounds

    Minor

    The results text gives a lower 95% confidence bound of 1.18 for the inactivity-hospitalisation odds ratio, whereas the abstract gives 1.81 for the same estimate.

  • The activity-guideline cutoff excludes exactly 150 minutes in one definition

    Minor

    The abstract includes 150 min/week in the consistently meeting-guidelines category, but the methods specify greater than 150 min/week. These definitions classify someone reporting exactly 150 min/week differently.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. World Health Organization . World Health organization 2020 guidelines on physical activity and sedentary behavior, 2020. Available: https://bjsm.bmj.com/content/54/24/1451

Cited by

Sorted by citations

Related

Authors
Sallis, R., Young, D. R., Tartof, S. Y., Sallis, J. F., Sall, J., Li, Q., Smith, G. N., & Cohen, D. A.
Affiliations
  • Kaiser Permanente (US)
  • University of California San Diego (US)
  • Kaiser Permanente Fontana Medical Center (US)
  • Pomona College (US)
Corresponding author
Sallis, Robert
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2021-04-13
Volume
55
Issue
19
Pages
1099-1105
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2021-104080
OpenAlex
W3156459939
Semantic Scholar
1052835e1caf26032fc0bd997259cd3f584259c7
Cited by
789
References
28
Citations by year
2026: 31 · 2025: 55 · 2024: 98 · 2023: 203 · 2022: 257 · 2021: 145
FWCI
55.77
Type
journal article
Language
en
Open access
closed
Licence
bmj.com/coronavirus/usage (tdm)
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
Kaiser Permanente
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
Keywords
physical inactivity, COVID-19 pandemic, physical activity guidelines, hospitalization, intensive care unit admission, COVID-19 mortality, physical activity promotion, severe COVID-19 outcomes
MeSH terms
COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Intensive Care Units, Male, Middle Aged, Sedentary Behavior

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