The world and how humanity interacts has dramatically changed in the last 18 months. We have had to rapidly adapt to a micro-organism seemingly hell-bent on disrupting our sense of ‘normal’. Over time we have gained a wealth of knowledge about who stands to have a bad day if they contract COVID or one of its many variants. Comorbidities are defined as simultaneous presence of two or more health conditions that influence the primary illness. Obesity, diabetes, hypertension, cardiovascular disease, and more account for a significant number of deaths in any given year. We have learnt that in addition to the elderly having poorer outcomes on contracting COVID; up to 95% of deaths due to COVID are in those with at least one comorbidity.
Public health response across the world has been swift and reactive – enforcing strict lockdowns, mask mandates and testing. Regular advice has focused on coughing into your elbow, washing hands diligently and staying home when sick. However, most of these strategies remain focused on how to avoid catching COVID. There have been very few strategies promoted that proactively seek to improve outcomes if one does in fact contract COVID or any viral illness for that matter.
A recent study published in the prestigious British Journal of Sports Medicine investigated the influence of physical activity levels on hospitalisation, ICU admission and death due to COVID. Importantly, physical activity was investigated as an independent factor meaning that all other comorbid variables mentioned above were excluded. Close to 50,000 patients were included in this American study at the height of the pandemic through early to late 2020.
Physical activity levels were broadly classified in line with global guidelines as the following:
- Consistently inactive = 0–10 min/week,
- Some activity = 11–149 min/week,
- Consistently meeting guidelines = 150+ min/week
With these categories in mind, the following astounding results were found:
- There is a 2.26 x greater risk of hospitalisation due to COVID for those who are consistently inactive compared to those who meet physical activity guidelines
- There is a 1.73 x greater risk of being admitted to ICU (typically requiring ventilation) due to COVID in those who are inactive compared to those meeting guidelines
- There is a 2.49 x greater risk of death due to COVID in those who are inactive compared to those who meet guidelines.
Despite countless messages about masks, coughing into one’s elbow and hand washing; it boggles the mind why ‘health’ authorities and politicians with a daily soapbox have failed to pick up on this study. In New Zealand, even the now thinly veiled and weary ‘Be Kind’ narrative surely could have been beefed up to tell the ‘Team of 5 million’ the benefits of getting out for a walk? The study concludes with strong recommendations that public health strategy on COVID needs to include messaging about physical activity.
It has been repeatedly stated that the primary goal of lockdown is to ensure that hospitals are not overwhelmed. The images of crowded hospital hallways in Italy come to mind. Why the radio silence on this and other ways to maintain a healthy lifestyle and immune system? Empowering people with this positive message must be used instead of simply resorting to fear to motivate compliance. Ironically an increase in physical activity would have a profound impact on the comorbidities that are also known to result in bad outcomes from COVID. The study pointed to even a very small change in exercise levels having a positive impact on risk. Just shifting someone to ‘some activity’; literally, anything from 11 minutes per week is all that could be needed.
Through the pandemic and indeed with a huge portion of modern medicine, it seems that we have become very good at stopping people from dying…but not very good at helping people truly live. The fact that over 66% of kiwis are overweight or obese speaks to this. That 33% of our kids are overweight or obese speaks to this. We have the highest rates of hospitalisation for chronic obstructive lung disease or asthma in the OECD. The fact that we are ranked 2nd in the OECD for youth suicide, 2nd for youth obesity and 4th for teen pregnancy speaks to this. The fact that we are the worst in the OECD for domestic violence speaks to this. That we have the 7th highest rate of child homicide in the OECD speaks to this.
If there is anything positive that can come from this pandemic it needs to be a greater appreciation for the holistic nature of health and wellbeing. Mental, emotional, physical, spiritual wellbeing need to be understood and advocated for so our nation can improve resilience in the future. To achieve this our healthcare system needs to shift from being disease-centric to truly being health-centric.
Sallis, R., Young, D.R., Tartof, S.Y. et al, “Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48,440 adult patients”. British Journal of Sports Medicine Epub, 2021.
Cho, S.I., Yoon, S., Lee, H-J, “Impact of comorbidity burden on mortality in patients with COVID-19 using the Korean health insurance database”. Scientific Reports, (Nature), 2021.