Gymnastik- och idrottshögskolan, GIH

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Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study.
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.ORCID iD: 0000-0002-3901-7833
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.ORCID iD: 0000-0002-0958-0094
Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.ORCID iD: 0000-0002-4030-5437
Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.ORCID iD: 0000-0002-0079-124x
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2021 (English)In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 18, no 1, article id 135Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The impact of cardiorespiratory fitness (CRF) and other lifestyle-related factors on severe COVID-19 risk is understudied. The present study aims to investigate lifestyle-related and socioeconomic factors as possible predictors of COVID-19, with special focus on CRF, and to further study whether these factors may attenuate obesity- and hypertension-related risks, as well as mediate associations between socioeconomic factors and severe COVID-19 risk.

METHODS: Out of initially 407,131 participants who participated in nationwide occupational health service screening between 1992 and 2020, n = 857 cases (70% men, mean age 49.9 years) of severe COVID-19 were identified. CRF was estimated using a sub-maximum cycle test, and other lifestyle variables were self-reported. Analyses were performed including both unmatched, n = 278,598, and sex-and age-matched, n = 3426, controls. Severe COVID-19 included hospitalization, intensive care or death due to COVID-19.

RESULTS: Patients with more severe COVID-19 had significantly lower CRF, higher BMI, a greater presence of comorbidities and were more often daily smokers. In matched analyses, there was a graded decrease in odds for severe COVID-19 with each ml in CRF (OR = 0.98, 95% CI 0.970 to 0.998), and a two-fold increase in odds between the lowest and highest (< 32 vs. ≥ 46 ml·min-1·kg-1) CRF group. Higher BMI (per unit increase, OR = 1.09, 1.06 to 1.12), larger waist circumference (per cm, OR = 1.04, 1.02 to 1.06), daily smoking (OR = 0.60, 0.41 to 0.89) and high overall stress (OR = 1.36, 1.001 to 1.84) also remained significantly associated with severe COVID-19 risk. Obesity- and blood pressure-related risks were attenuated by adjustment for CRF and lifestyle variables. Mediation through CRF, BMI and smoking accounted for 9% to 54% of the associations between low education, low income and blue collar/low skilled occupations and severe COVID-19 risk. The results were consistent using either matched or unmatched controls.

CONCLUSIONS: Both lifestyle-related and socioeconomic factors were associated with risk of severe COVID-19. However, higher CRF attenuated the risk associated with obesity and high blood pressure, and mediated the risk associated with various socioeconomic factors. This emphasises the importance of interventions to maintain or increase CRF in the general population to strengthen the resilience to severe COVID-19, especially in high-risk individuals.

Place, publisher, year, edition, pages
BioMed Central, 2021. Vol. 18, no 1, article id 135
Keywords [en]
Cardiorespiratory fitness, Lifestyle, Obesity, Severe acute respiratory syndrome coronavirus 2, Socioeconomics
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medicine/Technology
Identifiers
URN: urn:nbn:se:gih:diva-6827DOI: 10.1186/s12966-021-01198-5ISI: 000708860700001PubMedID: 34666788OAI: oai:DiVA.org:gih-6827DiVA, id: diva2:1605220
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HPI-gruppenAvailable from: 2021-10-22 Created: 2021-10-22 Last updated: 2024-01-17

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Ekblom Bak, ElinVäisänen, DanielEkblom, BjörnBlom, VictoriaKallings, LenaHemmingsson, ErikSalier Eriksson, JaneHolmlund, TobiasLindwall, MagnusLönn, Amanda

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Ekblom Bak, ElinVäisänen, DanielEkblom, BjörnBlom, VictoriaKallings, LenaHemmingsson, ErikSalier Eriksson, JaneHolmlund, TobiasLindwall, MagnusLönn, Amanda
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Department of Physical Activity and HealthDepartment of Physiology, Nutrition and Biomechanics
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Public Health, Global Health, Social Medicine and Epidemiology

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