The beneficial effects of regular physical activity in promoting health and preventing chronic diseases are well documented. The relationship between regular physical activity and the risk of pneumonia is uncertain. We aimed to evaluate the magnitude and specificity of the prospective association between regular physical activity and the risk of pneumonia using a systematic review and meta-analysis of published observational cohort studies in general populations. Relevant studies with at least 1 year of follow-up were sought from inception until 15 September 2021 in MEDLINE, Embase, Web of Science, and manual search of relevant articles. Relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus the minimal amount of physical activity groups were pooled using fixed effects meta-analysis. The quality of the evidence was evaluated using the GRADE tool. A total of 10 prospective cohort studies comprising 1,044,492 participants and 7681 events were eligible. The pooled multivariable-adjusted RR (95% CI) of pneumonia comparing the most versus the least physically active groups was 0.69 (0.64–0.74). This association was significantly modified by type of outcome (p-value for meta-regression = .002): 0.82 (0.72–0.93) for incident pneumonia and 0.64 (0.59–0.70) for pneumonia-related mortality. There was no evidence of heterogeneity and publication bias. The GRADE quality of the evidence ranged from moderate to low. Aggregate analysis of 10 cohort studies shows that regular physical activity is associated with lowered risk of incident pneumonia and pneumonia-related mortality in the general population. Physical activity types that are attractive to and feasible for high-risk populations need to be identified and encouraged. Systematic review registration: PROSPERO 2021: CRD42021277514.

定期体育锻炼对促进健康和预防慢性疾病的有益作用已得到充分证明。定期体育活动与肺炎风险之间的关系尚不确定。我们旨在通过对已发表的一般人群观察性队列研究的系统评价和荟萃分析，评估定期体育活动与肺炎风险之间前瞻性关联的程度和特异性。在 MEDLINE、Embase、Web of Science 和相关文章的手动搜索中寻找从开始到 2021 年 9 月 15 日的至少 1 年随访的相关研究。使用固定效应荟萃分析汇总了最大与最小体力活动组的 95% 置信区间 (CI) 的相对风险 (RR)。使用 GRADE 工具评估证据的质量。共有 10 项前瞻性队列研究符合条件，包括 1,044,492 名参与者和 7681 起事件。比较体力活动最多组与体力活动最少组的合并多变量调整 RR (95% CI) 为 0.69 (0.64–0.74)。这种关联因结果类型而显着改变（元回归的p值 = 0.002）：肺炎相关死亡率为 0.82（0.72-0.93），肺炎相关死亡率为 0.64（0.59-0.70）。没有证据表明存在异质性和发表偏倚。证据的 GRADE 质量范围从中等到低。对 10 项队列研究的综合分析表明，规律的体育锻炼与降低普通人群中肺炎和肺炎相关死亡率的风险有关。需要确定和鼓励对高危人群有吸引力和可行的身体活动类型。系统评价注册：PROSPERO 2021：CRD42021277514。