Abstract
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.
Highlights
Pneumonia is an inflammatory condition of the lung tissue commonly caused by bacteria or viruses [1]
Some studies have reported associations between physical activity and risk of pneumonia [10,11,12], others have reported no evidence of an association [13,14,15]
We explored for the effect of interactions on the association using study-level characteristics such as geographical location (Europe vs. North America vs. Asia), sex, the average age at baseline (≥ 55 vs. < 55 years), the average duration of follow-up (< 10 vs. ≥ 10 years) based on the distribution of the data, type of pneumonia outcome, number of events (≥ 350 vs. < 350), and degree of adjustment (+ vs. + +), which was conducted using stratified analysis and random effects meta-regression [29]
Summary
Pneumonia is an inflammatory condition of the lung tissue commonly caused by bacteria or viruses [1]. It can be acquired in the community (communityacquired pneumonia, CAP) or in the hospital environment (hospital acquired pneumonia, HAP) [2]. Pneumonia constitutes a substantial public health burden globally and is a preventable cause of death and disability. The beneficial effects of regular physical activity in promoting health and preventing vascular and non-vascular diseases are well documented [5,6,7]. Regular physical activity reduces the risk, duration or severity of infectious diseases [8] and has been shown to improve acute and long-term prognosis of pneumonia in older patients [9]. The reasons for the null associations in some of these studies are uncertain but could be related to inadequate power (low event rates), effects
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