High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there potential implications for COVID-19?

Setor K Kunutsor,Jari A Laukkanen

doi:10.1111/eci.13490

Abstract

BackgroundThere is an ongoing debate on a potential protective role of habitual physical activity and passive heat therapy on the risk of COVID‐19, a respiratory infectious disease that can manifest as severe pneumonia. To explore these putative roles, we evaluated the independent and joint associations of cardiorespiratory fitness (CRF) and frequency of sauna bathing (FSB) with pneumonia risk in a prospective cohort study of 2275 men aged 42‐61 years at recruitment.Material and MethodsObjectively measured CRF and self‐reported sauna bathing habits were assessed at baseline. CRF was categorized as low and high (median cut‐offs) and FSB as low and high (defined as ≤1 and 2‐7 sessions/wk, respectively). Multivariable‐adjusted hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident pneumonia.ResultsDuring a median follow‐up of 26.6 years, 529 cases of pneumonia occurred. Comparing high vs low CRF, the multivariable‐adjusted HR (95% CIs) for pneumonia was 0.75 (0.61‐0.91). Comparing high vs low FSB, the corresponding HR was 0.81 (0.68‐0.97). Compared to men with low CRF & low FSB, the multivariable‐adjusted HRs of pneumonia for the following groups: high CRF & low FSB; low CRF & high FSB; and high CRF & high FSB were 0.88 (0.65‐1.20), 0.89 (0.71‐1.13), and 0.62 (0.48‐0.80) respectively.ConclusionsIn a general male Caucasian population, a combination of high fitness levels and frequent sauna baths is associated with a substantially lowered future pneumonia risk compared with each modality alone. The implications of these findings in altering COVID‐19 disease or its severity deserve study.

Highlights

Pneumonia infection is the result of a complex inflammatory process where the lower respiratory tract suffers the invasion of an infective microorganism
In recent evaluations of the joint impact of cardiorespiratory fitness (CRF) and frequency of sauna bathing (FSB) on the risk of cardiovascular outcomes and all-cause mortality, we demonstrated that high CRF and frequent sauna bathing confer stronger long-term protection on these outcomes compared with each exposure alone.[16,17]
Compared to men with low CRF, high CRF was associated with a decreased risk of pneumonia following adjustment for potential confounders (age, body mass index (BMI), smoking status, systolic blood pressure (SBP), history of type 2 diabetes, history of coronary heart disease, history of asthma, history of chronic bronchitis, history of tuberculosis, alcohol consumption, socioeconomic status (SES), physical activity and high sensitivity C-reactive protein 0.74 and this remained unchanged on further adjustment for FSB (Table 2)

Summary

Introduction

Pneumonia infection is the result of a complex inflammatory process where the lower respiratory tract suffers the invasion of an infective microorganism (viruses or bacteria). There is an ongoing debate on a potential protective role of habitual physical activity and passive heat therapy on the risk of COVID-19, a respiratory infectious disease that can manifest as severe pneumonia To explore these putative roles, we evaluated the independent and joint associations of cardiorespiratory fitness (CRF) and frequency of sauna bathing (FSB) with pneumonia risk in a prospective cohort study of 2275 men aged 42-61 years at recruitment. Conclusions: In a general male Caucasian population, a combination of high fitness levels and frequent sauna baths is associated with a substantially lowered future pneumonia risk compared with each modality alone The implications of these findings in altering COVID-19 disease or its severity deserve study

Methods

Results

Conclusion