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
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Objective: To quantify the association between physical activity and risk of SARS-CoV-2 infection, COVID-19-associated hospitalisation, severe illness and death due to COVID-19 in adults. Design: A systematic review and meta-analysis. Data sources: Three databases were systematically searched through March 2022. Eligibility criteria for selecting studies: Peer-reviewed articles reporting the association between regular physical activity and at least one COVID-19 outcome in adults were included. Risk estimates (ORs, relative risk (RR) ratios or HRs) were extracted and pooled using a random-effects inverse-variance model. Results: Sixteen studies were included (n=1 853 610). Overall, those who engaged in regular physical activity had a lower risk of infection (RR=0.89; 95% CI 0.84 to 0.95; I 2 =0%), hospitalisation (RR=0.64; 95% CI 0.54 to 0.76; I 2 =48.01%), severe COVID-19 illness (RR=0.66; 95% CI 0.58 to 0.77; I 2 =50.93%) and COVID-19-related death (RR=0.57; 95% CI 0.46 to 0.71; I 2 =26.63%) as compared with their inactive peers. The results indicated a non-linear dose–response relationship between physical activity presented in metabolic equivalent of task (MET)-min per week and severe COVID-19 illness and death (p for non-linearity <0.001) with a flattening of the dose–response curve at around 500 MET-min per week. Conclusions: Regular physical activity seems to be related to a lower likelihood of 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. Given the heterogeneity and risk of publication bias, further studies with standardised methodology and outcome reporting are now needed. PROSPERO registration number: CRD42022313629.
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Physical activity and exercise benefits apply to conditions with very distinct pathophysiology, such as Alzheimer's disease, cancer, heart disease, and pneumonia/other infections.
“Physical activity and exercise benefits apply to conditions characterized by very distinct pathophysiology, such as Alzheimer’s disease [629], cancer [628], heart disease [630], and pneumonia/other infections [631,632].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [631]
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- Authors
- Ezzatvar, Y., Ramírez-Vélez, R., Izquierdo, M., & Garcia-Hermoso, A.
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2022-08-22
- Volume
- 56
- Issue
- 20
- Pages
- 1188-1193
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W4293081885
- Cited by
- 86
- References
- 60
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 22 · 2023: 34 · 2022: 11
- FWCI
- 2.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Spanish Ministry for Science and Innovation (2017-2020, PID2020-113098RB-I00)
- Instituto de Salud Carlos III (CP18/0150)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- physical activity, COVID-19 pandemic, COVID-19 hospitalization, severe COVID-19, COVID-19 mortality, dose-response relationship, metabolic equivalent of task, adults
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