What is the relationship between regular physical activity and vaccination against COVID-19 in healthcare workers?

In a recently published study in the British Journal of Sports MedicineResearchers examined the association between daily physical activity (PA) and vaccination against Coronavirus disease 2019 (COVID-19) in HCWs (health care workers).

Study: Association between regular physical activity and the protective effect of vaccination against SARS-CoV-2 in a South African case-control study. Credit: YanLev/Shutterstock


COVID-19 has resulted in significant morbidity and mortality worldwide. Studies have reported that both PA and vaccinations independently reduce the risk of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection consequences such as hospitalizations, intensive care unit (ICU) admissions and deaths.

About the study

In the present case-control study with a negative test result, the researchers examined the connection between PA and vaccination against SARS-CoV-2.

The retrospective study was conducted between February 16, 2021 and October 30, 2021 and used anonymized data from adult Discovery Health and Vitality (DHV) clients relating to demographics, chronic conditions, operational information and pathological exam reports. The team obtained COVID-19 data from Discovery Health’s preauthorization records.

PA records were obtained from Vitality data, including measured PA information from wearable health devices (PA minutes, heart rate, and step count), mass events, and timed gym sessions. The frequency, duration, and type of PA were recorded as part of Vitality Health’s behavior modification program.

COVID-19 polymerase chain reaction (PCR) reports from 258,293 DHV members between February 15 and October 31, 2021 were analyzed. The team excluded test reports from non-Ad26.COV2.S-COVID-19 vaccinees, indeterminate results and SARS-CoV-2 negative results within three weeks of SARS-CoV-2 positive results.

The team estimated SARS-CoV-2-associated hospitalization risks in unvaccinated individuals compared to individuals fully vaccinated with Ad26.COV2.S vaccine doses more than 28 days apart. One hundred ninety-six thousand four hundred and forty-four test participants were divided into three groups based on their PA as high (≥150 minutes of moderate or high-intensity PA weekly), moderate (60 to 149 minutes of moderate or high-intensity PA weekly), or low (<1 hour of moderate or high-intensity PA weekly). Sensitivity analyzes were performed and modified Poisson regression modeling was used for the analysis.

results and discussion

A total of 269,101 patients with SARS-CoV-2 positive PCR reports were initially enrolled, of whom 10,198 were excluded because they were less than 18 years old. In addition, 4,957 people were excluded due to negative test reports within three weeks of positive results, and 6,239 people were excluded due to negative results in the previous week with negative results.

In addition, 1,965 patients were excluded based on previous positive reports within six weeks, 69 were excluded because they had received multiple COVID-19 vaccines, 402 had missing data, 20,003 were excluded due to a second vaccination and 28,834 were excluded due to missing three random excluded reviews. As a result, 196,444 patients were analyzed, of which 79,952, 62,721 and 53,771 patients belonged to the high, moderate and low PA groups, respectively.

Within the low, moderate, and high PA groups, 64%, 56%, and 51% of the participants were women, respectively, most participants in all groups were between 18 and 44 years of age, and most of them had no history of COVID-19 . Among those with low PA, 94% and 5% were unvaccinated and fully vaccinated, respectively.

The corresponding percentages were 94% and 5 percent, respectively, for those with moderate PA, and 92% and 7 percent, respectively, for those with high PA. In vaccinated individuals, vaccine efficacy (VE) values ​​against SARS-CoV-2-associated hospitalizations for low, moderate, and high PA were 60%, 72%, and 86%, respectively.

Compared to COVID-19 vaccinees with low PA, those with high and moderate PA had a 2.8-fold and 1.4-fold reduced risk of SARS-CoV-2-associated hospitalization, respectively. Analyzing PCR reports from a cohort of admitted patients, the COVID-19 uptake VE in the fully vaccinated subjects in the low, moderate, and high PA groups was 39%, 47%, and 70%, respectively.

Using a single multinomial modified Poisson regression model, a 92% VE was observed for high PA vaccinated individuals relative to low PA unvaccinated individuals. Bayesian modeling analysis showed a 25% VE difference between high-PA and low-PA vaccinated individuals relative to the low-PA unvaccinated individuals.

The results of the main analysis and the sensitivity analysis were comparable. Higher VE in active individuals could be due to several factors, including psychosocial factors, elevated antibody titers (particularly salivary immunoglobulin A), and enhanced T-lymphocyte (particularly CD4 helper T-lymphocyte) responses. PA has also been reported to regulate mitochondrial biogenesis.


Overall, the study results showed that higher PA levels were associated with improved VE against SARS-CoV-2-associated hospital admissions. Therefore, the Public Health Bulletin should promote PA as a cheap and easy way to improve VE to mitigate the risks of COVID-19 severity levels.

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