{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T21:16:04Z","timestamp":1794431764318,"version":"4.9.1"},"reference-count":42,"publisher":"BMJ","issue":"16","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"crossref","award":["NRF2019R1G1A109977913"],"award-info":[{"award-number":["NRF2019R1G1A109977913"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2021,6,30]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To determine the potential associations between physical activity and risk of SARS-CoV-2 infection, severe illness from COVID-19 and COVID-19 related death using a nationwide cohort from South Korea.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data regarding 212 768 Korean adults (age \u226520 years), who tested for SARS-CoV-2, from 1 January 2020 to 30 May 2020, were obtained from the National Health Insurance Service of South Korea and further linked with the national general health examination from 1 January 2018 to 31 December 2019 to assess physical activity levels. SARS-CoV-2 positivity, severe COVID-19 illness and COVID-19 related death were the main outcomes. The observation period was between 1 January 2020 and 31 July 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of 76 395 participants who completed the general health examination and were tested for SARS-CoV-2, 2295 (3.0%) were positive for SARS-CoV-2, 446 (0.58%) had severe illness from COVID-19 and 45 (0.059%) died from COVID-19. Adults who engaged in both aerobic and muscle strengthening activities according to the 2018 physical activity guidelines had a lower risk of SARS-CoV-2 infection (2.6% vs 3.1%; adjusted relative risk (aRR), 0.85; 95% CI 0.72 to 0.96), severe COVID-19 illness (0.35% vs 0.66%; aRR 0.42; 95% CI 0.19 to 0.91) and COVID-19 related death (0.02% vs 0.08%; aRR 0.24; 95% CI 0.05 to 0.99) than those who engaged in insufficient aerobic and muscle strengthening activities. Furthermore, the recommended range of metabolic equivalent task (MET; 500\u20131000 MET min\/week) was associated with the maximum beneficial effect size for reduced risk of SARS-CoV-2 infection (aRR 0.78; 95% CI 0.66 to 0.92), severe COVID-19 illness (aRR 0.62; 95% CI 0.43 to 0.90) and COVID-19 related death (aRR 0.17; 95% CI 0.07 to 0.98). Similar patterns of association were observed in different sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adults who engaged in the recommended levels of physical activity were associated with a decreased likelihood of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related death. Our findings suggest that engaging in physical activity has substantial public health value and demonstrates potential benefits to combat COVID-19.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2021-104203","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T17:25:40Z","timestamp":1626974740000},"page":"901-912","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":145,"title":["Physical activity and the risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 related mortality in South Korea: a nationwide cohort study"],"prefix":"10.1136","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5632-5208","authenticated-orcid":false,"given":"Seung Won","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhee","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Yong","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Young","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jee Myung","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Ogino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyang","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Hwi","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramy","family":"Abou Ghayda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kronbichler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Koyanagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Jacob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Dragioti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Giovannucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1083-6907","authenticated-orcid":false,"given":"I-Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Hoon","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keum Hwa","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youn Ho","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2115-7835","authenticated-orcid":false,"given":"Min Seo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Hee","family":"Won","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Ekelund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Il","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1628-9948","authenticated-orcid":false,"given":"Dong Keon","family":"Yon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"key":"2024051414535276000_56.16.901.1","article-title":"Proton pump inhibitors and the risk of severe COVID-19: a post-hoc analysis from the Korean nationwide cohort","author":"Lee","year":"2020","journal-title":"Gut"},{"key":"2024051414535276000_56.16.901.2","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S2215-0366(20)30421-1","article-title":"Association between mental illness and COVID-19 susceptibility and clinical outcomes in South Korea: a nationwide cohort study","volume":"7","author":"Lee","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2024051414535276000_56.16.901.3","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322248"},{"key":"2024051414535276000_56.16.901.4","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)00947-8"},{"key":"2024051414535276000_56.16.901.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.08.008"},{"key":"2024051414535276000_56.16.901.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1198"},{"key":"2024051414535276000_56.16.901.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61031-9"},{"key":"2024051414535276000_56.16.901.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4570"},{"key":"2024051414535276000_56.16.901.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3857"},{"key":"2024051414535276000_56.16.901.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.14854"},{"key":"2024051414535276000_56.16.901.11","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.20.3082"},{"key":"2024051414535276000_56.16.901.12","doi-asserted-by":"crossref","unstructured":"Chastin S , Abaraogu U , Bourgois J , et al . Physical activity, immune function and risk of community acquired infectious disease in the general population: systematic review and meta-analysis. SSRN 2020.doi:10.2139\/ssrn.3673184","DOI":"10.2139\/ssrn.3673184"},{"key":"2024051414535276000_56.16.901.13","first-page":"126","article-title":"Cohort study on low physical activity level and recurrent acute respiratory infections in schoolchildren","volume":"9","author":"Jedrychowski","year":"2001","journal-title":"Cent Eur J Public Health"},{"key":"2024051414535276000_56.16.901.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2020-000960","article-title":"Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review","volume":"7","author":"Stockwell","year":"2021","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2024051414535276000_56.16.901.15","doi-asserted-by":"crossref","DOI":"10.2196\/20992","article-title":"Nationwide results of COVID-19 contact tracing in South Korea: individual participant data from an epidemiological survey","volume":"8","author":"Lee","year":"2020","journal-title":"JMIR Med Inform"},{"key":"2024051414535276000_56.16.901.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-102637"},{"key":"2024051414535276000_56.16.901.17","doi-asserted-by":"publisher","DOI":"10.7326\/m20-2665"},{"key":"2024051414535276000_56.16.901.18","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.mayocp.2020.10.032","article-title":"Association of timing and balance of physical activity and Rest\/Sleep with risk of COVID-19: a UK Biobank study","volume":"96","author":"Rowlands","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"2024051414535276000_56.16.901.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2020.10.003"},{"key":"2024051414535276000_56.16.901.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbi.2020.05.059"},{"key":"2024051414535276000_56.16.901.21","doi-asserted-by":"crossref","DOI":"10.1136\/bjsports-2021-104080","article-title":"Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients","author":"Sallis","year":"2021","journal-title":"Br J Sports Med"},{"key":"2024051414535276000_56.16.901.22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m2031"},{"key":"2024051414535276000_56.16.901.23","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jaci.2020.04.041","article-title":"Incidence of cancer after asthma development: 2 independent population-based cohort studies","volume":"147","author":"Woo","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"2024051414535276000_56.16.901.24","doi-asserted-by":"publisher","DOI":"10.1249\/01.MSS.0000078924.61453.FB"},{"key":"2024051414535276000_56.16.901.25","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-200009001-00009"},{"key":"2024051414535276000_56.16.901.26","doi-asserted-by":"crossref","DOI":"10.1016\/S2665-9913(21)00151-X","article-title":"Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study","author":"Shin","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2024051414535276000_56.16.901.27","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/j.jaci.2019.08.037","article-title":"Short-Term effects of multiple outdoor environmental factors on risk of asthma exacerbations: age-stratified time-series analysis","volume":"144","author":"Lee","year":"2019","journal-title":"J Allergy Clin Immunol"},{"key":"2024051414535276000_56.16.901.28","doi-asserted-by":"crossref","first-page":"2262","DOI":"10.1016\/j.jaip.2021.03.044","article-title":"Estimating COVID-19 infection and severity risks in patients with chronic rhinosinusitis: a Korean nationwide cohort study","volume":"9","author":"Lee","year":"2021","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2024051414535276000_56.16.901.29","doi-asserted-by":"crossref","first-page":"278","DOI":"10.3345\/cep.2019.01291","article-title":"Ten-Year trends and prevalence of asthma, allergic rhinitis, and atopic dermatitis among the Korean population, 2008\u20132017","volume":"63","author":"Ha","year":"2020","journal-title":"Clin Exp Pediatr"},{"key":"2024051414535276000_56.16.901.30","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1249\/MSS.0000000000000953","article-title":"Leisure-Time physical activity and the risk of suspected bacterial infections","volume":"48","author":"Pape","year":"2016","journal-title":"Med Sci Sports Exerc"},{"key":"2024051414535276000_56.16.901.31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0190270","article-title":"Physical activity, sleep and risk of respiratory infections: a Swedish cohort study","volume":"13","author":"Ghilotti","year":"2018","journal-title":"PLoS One"},{"key":"2024051414535276000_56.16.901.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2009.07.028"},{"key":"2024051414535276000_56.16.901.33","first-page":"Cd010596","article-title":"Exercise versus no exercise for the occurrence, severity, and duration of acute respiratory infections","volume":"4","author":"Grande","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"2024051414535276000_56.16.901.34","doi-asserted-by":"publisher","DOI":"10.1016\/bs.pmbts.2015.08.001"},{"key":"2024051414535276000_56.16.901.35","doi-asserted-by":"publisher","DOI":"10.1159\/000488953"},{"key":"2024051414535276000_56.16.901.36","doi-asserted-by":"crossref","first-page":"2266","DOI":"10.1002\/oby.23041","article-title":"Effects of exercise on ACE2","volume":"28","author":"Kl\u00f6ting","year":"2020","journal-title":"Obesity"},{"key":"2024051414535276000_56.16.901.37","doi-asserted-by":"crossref","DOI":"10.1016\/j.mehy.2021.110502","article-title":"Could diet and exercise reduce risk of COVID-19 syndemic?","volume":"148","author":"Chesnut","year":"2021","journal-title":"Med Hypotheses"},{"key":"2024051414535276000_56.16.901.38","doi-asserted-by":"crossref","DOI":"10.1136\/bjsports-2021-104218","article-title":"Competing against COVID-19: have we forgotten about student-athletes' mental health?","author":"Grubic","year":"2021","journal-title":"Br J Sports Med"},{"key":"2024051414535276000_56.16.901.39","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9517-6"},{"key":"2024051414535276000_56.16.901.40","article-title":"Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic","author":"Serling-Boyd","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"2024051414535276000_56.16.901.41","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4587"},{"key":"2024051414535276000_56.16.901.42","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.i1981","article-title":"Sparse data bias: a problem hiding in plain sight","volume":"352","author":"Greenland","year":"2016","journal-title":"BMJ"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2021-104203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T22:14:11Z","timestamp":1715724851000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2021-104203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,22]]},"references-count":42,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,7,29]]},"published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1136\/bjsports-2021-104203"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2021-104203","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,22]]}}}