Wellness Check: Exercise | 2 Minute Medicine


Aerobic and restorative physical activity may have a dose-response association with mortality

1. In this study, a significant reduction in mortality risk was associated with 1 hour/week aerobic PA compared to no aerobic physical activity (PA) and levels off at 3 hours/week.
2. Muscular strengthening exercise (MSE) provided an additional reduction in mortality risk at 1 time/week but was no longer beneficial at 7 times/week.

Evidence Rating Level: 2 (good)

Despite its numerous benefits, more than 1 billion adults do not meet standard World Health Organization recommendations. Although recent analyzes have examined the association between physical activity and all-cause mortality risk, there is minimal evidence on the minimum effective dose. Consequently, the aim of the present prospective cohort study was to identify the dose-response association and the minimum effective doses of aerobic PA and MSE required to result in a clinically significantly lower risk of all-cause mortality.

The present study used data from the National Health Interview Survey (1997-2014) and included 416,420 adults from the United States (USA). Participants were excluded if they were not permanent residents of the United States, were in correctional facilities, were on active military duty, or were in long-term care facilities. Activity levels were reported using a standardized questionnaire. The study adhered to the guidelines for strengthening the reporting of observational studies in epidemiology (STROBE). Cox proportional hazard models were used to assess the association between physical activity and all-cause mortality.

The results showed that compared to no aerobic PA, a significant reduction in mortality risk was associated with 1 hour/week aerobic PA and leveled off at 3 hours/week. Muscle building exercise (MSE) resulted in an additional reduction in mortality risk at 1 time/week but was no longer beneficial at 7 times/week. Despite these results, the study was limited by the self-reported nature of physical activity. Nonetheless, this longitudinal analysis of data from a large sample of US adults provided a better understanding of the relationship between PA/MSD and mortality and may inform US healthcare providers.

Regular physical activity can offer protection against unwanted consequences of COVID-19

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1. In this study, regular physical activity had a lower risk of infection, hospitalization, severe COVID-19 illness, and COVID-19-related death compared to inactive peers.

2. The greatest benefit was seen with 150 minutes of moderate or 75 minutes of vigorous physical activity per week.

Evidence Rating Level: 1 (excellent)

It is known that physical activity has a variety of beneficial effects on health and boosts immunity. To date, the link between regular physical activity and COVID-19 outcomes is poorly understood. Therefore, the aim of the present systematic review and meta-analysis was to quantify the association between physical activity and the risk of COVID-19 infection, hospitalization, serious illness and death in adults.

From 4,063 identified records, 16 studies were included in the systematic review (n=1,853,610) from the beginning of the database to March 2022. Studies were eligible if they examined the effects of physical activity (questionnaires or objective measurements) on outcomes from COVID-19. Studies were excluded if participants self-reported COVID-19 infection or were hospitalized. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) used for the assessment. Statistical analysis was performed using a random effects inverse variance model.

Results showed that regular physical activity had a reduced risk of infection, hospitalization, severe COVID-19 illness, and COVID-19-related death compared to inactive peers. Additionally, the greatest benefit was seen with 150 minutes of moderate-intensity or 75 minutes of vigorous physical activity per week. Despite these results, the study was limited by the possibility that the pooled estimates could be biased. Nonetheless, these findings may help physicians encourage physical activity in patients to reduce the burden of COVID-19 health outcomes.

Physical activity at work and during leisure time can have different effects on inflammation

1. Lower levels of recreational physical activity and higher levels of physical activity at work were associated with elevated levels of the highly sensitive C-reactive protein (hs-CRP).
2. When analyzed as continuous variables, only recreational physical activity was strongly associated with hs-CRP levels.

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Evidence Rating Level: 2 (good)

Paradoxically, the literature has shown that occupation-related physical activity increases cardiovascular disease and mortality; a finding that does not apply to physical activity combined with leisure time. Although many mechanisms have been proposed, persistent systemic inflammation (as measured by hs-CRP levels) may be an important contributor. In order to further investigate this connection, the aim of the present cross-sectional study was to determine to what extent physical activity at work and during leisure time is associated with systemic inflammation.

The present study used data from the Copenhagen Aging and Midlife Biobank (CAMB) cohort. 5304 blood samples including the hs-CRP biomarker were collected from 12656 invited participants. Physical activity at work was measured using an occupational exposure matrix based on self-reported occupational history. Recreational physical activity was self-reported using the CAMB questionnaire. The association between the two types of physical activity and hs-CRP was established using multivariable linear regression models and post hoc analyses.

Results showed that lower levels of recreational physical activity and higher levels of physical activity at work were associated with elevated levels of the highly sensitive C-reactive protein (hs-CRP). Furthermore, when analyzed as continuous variables, only recreational physical activity was strongly associated with hs-CRP levels. Despite these results, the study was limited by the risk of misclassification since physical activity was based on job title. Nonetheless, the inclusion of a large number of participants reinforced the findings of the present study and the fact that systemic inflammation may indeed explain the physical activity paradox.

Osteoarthritis of the lower limbs may be more common in retired Olympians

1. In this study, one in four retired Olympians reported having medically diagnosed osteoarthritis (OA), with injury associated with an increased risk of osteoarthritis and pain in the knees, hips, and ankles.
2. After accounting for risk factors, Olympians were more likely to have osteoarthritis of the knee and hip after injury compared to the general population.

Evidence Rating Level: 3 (average)

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Joint injuries can be a risk factor for the future development of OA, especially for elite athletes. To date, few studies have compared the extent of OA at different body sites in elite athletes (e.g. Olympians) and the general population. Therefore, the aim of the present cross-sectional study was to compare the prevalence of physician-diagnosed lower extremity osteoarthritis and pain in retired Olympians and to determine the contributing factors.

The present study included self-reported data from an online survey conducted among Olympians (via Olympic federation platforms) and the general population (in three distinct phases). 3,357 retired Olympians (mean age = 44.7 years) and 1,735 (mean age = 40.5 years) members of the general population participated in the survey between April 2018 and June 2019. Retired Olympians had to be at least 16 years old and have competed at least one summer /and or Winter Olympics. General population controls included people over the age of 16 who had not competed in the Olympics. Independent t-tests, Mann-Whitney U-tests, chi-square tests and logistic regression were used for statistical analyses.

Results showed that one in four retired Olympians reported medically diagnosed osteoarthritis (OA), and injury was associated with an increased risk of osteoarthritis and pain in the knees, hips and ankles. In addition, after adjusting for risk factors, Olympians were more likely to have osteoarthritis of the knee and hip after injury compared to the general population. Despite these results, the study was limited as it represented only 4% of the total retired Olympian population. Nonetheless, the present results may help inform prevention strategies to reduce the risk of lower extremity osteoarthritis in Olympians after retirement from their sport.

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