Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this prospective cohort study, those who met aerobic and strength training recommendations had a significantly lower risk of influenza and pneumonia mortality than those who met neither guideline.

2. As for muscle strengthening, compared to those who engaged in <2 episodes per week, those who engaged in 2 episodes of strength training had a lower risk of influenza and pneumonia mortality, while those with ≥7 episodes/week had a higher risk.

Evidence Rating Level: 2 (Good)

The importance of physical activity may extend beyond cardiovascular, neurological, and cancer risk modification. In fact, studies have shown that regular physical activity may be protective against infectious diseases. Given that influenza and pneumonia represent a significant cause of death, the impact of physical activity on this mortality risk has a significant clinical interest. As a result, the objective of the present study was to describe the association between both aerobic and muscle-strengthening activity and the risk of mortality from influenza and pneumonia.

The present cohort study included 577,909 American participants (female = 52.2%) from the National Health Interview Survey from 1998-2018. Participants were excluded if they had an underlying condition, had ever smoked, had an abnormal body mass index (BMI), died within two years of their interview, or had missing physical activity or covariate data. Participants were classified based on whether they met the physical activity recommendation guidelines and were classified into one of five volume-based categories. Influenza and pneumonia mortality were identified through the 2019 National Death Index. Statistical analysis was performed using Cox proportional hazards models. The primary outcome was death from either influenza or pneumonia.

The results demonstrated that, over a median follow-up of 9.23 years, 1,516 deaths were attributed to pneumonia and influenza. Participants who met aerobic and muscle-strengthening physical activity guidelines had almost a 50% risk reduction in influenza and pneumonia mortality compared to those meeting neither guideline. As for muscle strengthening, those who engaged in 2 episodes per week had a lower mortality risk than those who engaged in <2 episodes/week. However, those who engaged in ≥7 episodes of muscle strengthening/week had an increased mortality risk. The present study was limited by the self-reported nature of the exposure data, which may have affected the results of the study. Despite this, the present study added additional evidence to suggest the importance of meeting the physical activity guidelines in reducing the risk of mortality for influenza and pneumonia.

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