Purpose 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. Methods Data regarding 212 768 Korean adults (age ≥20 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. Results 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; 500–1000 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. Conclusion 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. Data are available on reasonable request. Study protocol, statistical code: available from DKYon (email: yonkkang@gmail.com). Data set: available from the National Health Insurance Service of Korea (NHIS-COVID-19 data) through a data use agreement.

中文翻译：

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韩国的体力活动与 SARS-CoV-2 感染、严重 COVID-19 疾病和 COVID-19 相关死亡率的风险：一项全国性队列研究

目的 利用韩国全国队列研究确定体力活动与 SARS-CoV-2 感染、COVID-19 严重疾病以及与 COVID-19 相关的死亡风险之间的潜在关联。方法 从韩国国民健康保险局获取 2020 年 1 月 1 日至 2020 年 5 月 30 日期间进行 SARS-CoV-2 检测的 212 768 名韩国成年人（年龄≥20 岁）的数据，并进一步与国家总体健康保险相联系。 2018年1月1日至2019年12月31日期间进行健康检查，以评估身体活动水平。SARS-CoV-2 阳性、严重的 COVID-19 疾病和与 COVID-19 相关的死亡是主要结果。观察期为2020年1月1日至2020年7月31日。结果 在完成一般健康检查并接受SARS-CoV-2检测的76 395名参与者中，2295人（3.0%）的SARS-CoV-2呈阳性，446人(0.58%) 因 COVID-19 患重病，45 人 (0.059%) 因 COVID-19 死亡。根据 2018 年体力活动指南同时进行有氧运动和肌肉强化活动的成年人感染 SARS-CoV-2 的风险较低（2.6% vs 3.1%；调整后相对风险 (aRR)，0.85；95% CI 0.72 至 0.96） ）、严重 COVID-19 疾病（0.35% vs 0.66%；aRR 0.42；95% CI 0.19 至 0.91）和 COVID-19 相关死亡（0.02% vs 0.08%；aRR 0.24；95% CI 0.05 至 0.99）从事不足的有氧运动和肌肉强化活动。此外，推荐的代谢当量任务范围（MET；500-1000 MET 分钟/周）与降低 SARS-CoV-2 感染风险的最大有益效应大小相关（aRR 0.78；95% CI 0.66 至 0.92），严重的 COVID-19 疾病（aRR 0.62；95% CI 0.43 至 0.90）和 COVID-19 相关死亡（aRR 0.17；95% CI 0.07 至 0.98）。在不同的敏感性分析中观察到类似的关联模式。结论 进行建议水平的体力活动的成年人与 SARS-CoV-2 感染、严重 COVID-19 疾病和与 COVID-19 相关的死亡的可能性降低相关。我们的研究结果表明，参加体育活动具有重大的公共卫生价值，并显示出对抗 COVID-19 的潜在益处。可根据合理要求提供数据。研究方案、统计代码：可从 DKYon 获取（电子邮件：yonkkang@gmail.com）。数据集：通过数据使用协议从韩国国民健康保险公团获取（NHIS-COVID-19 数据）。