1. In this South African case-control study, there was an inverse dose-response association with activity levels and the risk of COVID-19 admission.

2. Furthermore, high levels of activity in fully vaccinated individuals conferred elevated levels of vaccine effectiveness.

Evidence Rating Level: 3 (Average)

Exercise immunology is a growing field that has demonstrated how regular moderate intensity physical activity improves immunosurveillance. Currently, the most studied vaccine in the context of chronic physical activity and vaccine effectiveness is the influenza vaccine. In contrast, evidence for the COVID vaccine is lacking. As a result, the objective of the present case-control study was to assess the effectiveness of low, moderate, and high physical activity levels on vaccine effectiveness of a single dose of Ad26.COV2.S (Janssen/Johnson & Johnson).

The present test negative case-control study design was a retrospective analysis that used anonymized Discovery Health and Vitality client data from February 2021 to October 2021 in South Africa. Of 269,101 patients with COVID-19 PCR tests, 196,444 were included in the analysis. Patients were excluded if they received vaccines other than Ad26.COV2.S, had indeterminate test results, a negative result within 21 days of a positive test result, and a negative test within 7 days of each other. Individuals were mapped to physical activity subgroups using their average monthly physical point allocation in the 2 years prior to the study start date. Statistical analysis was performed using a modified Poisson regression model.

Results demonstrated that compared to individuals with low activity levels, vaccinated individuals with moderate and high activity levels had a lower risk of COVID-19 admission in a dose-response fashion. Furthermore, fully vaccinated individuals with high levels of activity had a vaccine effectiveness of 86% against COVID-19 hospitalization. Despite these findings, the study was limited by the lack of assessment of confounding variables such as diet, alcohol consumption, and sleeping patterns. Nonetheless, the study’s large sample of vaccinated individuals in whom the majority had directly measured physical activity data strengthens the study’s findings. This suggests physical activity may play a role in COVID-19 vaccine effectiveness against hospitalization.

Click to read the study in British Journal of Sports Medicine 

Image: PD

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