Lower COVID-19 mortality among physically active individuals in Sub-Saharan Africa

By Pooja Toshniwal PahariaReviewed by Aimee MolineuxApr 29 2022

A recent review in Progress in Cardiovascular Diseases enlisted the benefits of physical activity (PA) and being outdoors in reducing the incidence, prevalence, and severity of coronavirus disease 2019 (COVID-19) among low-income and underserved populations such as sub-Saharan Africans.

The COVID-19 scenario

COVID-19 has taken a devastating toll on human lives with significant morbidity and mortality across the globe. It is well established that the risk of COVID-19 severity outcomes such as increased hospitalizations and deaths are higher among the elderly, immunocompromised individuals with chronic comorbidities such as diabetes and hypertension.

The COVID-19 severity risk is also higher among obese and physically inactive individuals with unhealthy lifestyle habits such as lack of exercise, unhealthy diets, and smoking.

Another aspect to be taken into consideration is the health inequalities among the developed and developing nations. COVID-19 burden has been higher among low-income nations such as the sub-Saharan regions of Africa. Poverty, crowding, fewer medical resources, inadequate healthcare facilities, and vaccination uptake could be reasons for the catastrophic impact of COVID-19 among the underserved populations. In contrast, Africa has witnessed a less profound impact of COVID-19, based on articles in the New York Times and The Economist.

An understanding of the reasons for the lower COVID-19 severity in Africa could bring to light mechanisms to improve the COVID-19 impact in other low-income nations and decrease the global burden of COVID-19.

Benefits of physical activity

PA leads to lower levels of systemic inflammation, improved immune functioning, reduced rate of infections, less inflammation, decreased severity of infection outcomes, and improved vaccine efficacy, particularly in immunocompromised individuals. Such benefits of PA should result in improved cardiopulmonary fitness and enhanced immune resiliency during the pandemic.

A recently published multinational systematic review conducted by the United States (US) Centers for Disease Control and Prevention (CDC) that included 25 COVID-19 outcome-specific studies concluded that physically fit or active individuals prior had a reduced likelihood of being hospitalized or dying due to COVID-19. However, the evidence of a lower likelihood of intensive care unit (ICU) admissions or ventilation requirements in physically active individuals was lower. The CDC review underscored the importance of PA in improved COVID-19 severity outcomes and established lack of exercise as an important risk factor for severe COVID-19.

Another large-scale study that assessed the impact of PA on COVID-19 outcomes using several device-based PA measures on 65,361 South African individuals confirmed the findings of the CDC review, underpinning the protective effects of PA against COVID-19.

Higher physical activity among sub-Saharan Africans

Several studies have reported that Africans are significantly more physically fit or active compared to those in Europe or the US.  However, obesity is scaling up in Africa, and measures must be taken to reduce the body mass of Africans to prevent severe COVID-19 outcomes in these populations in the future.

Generally, African individuals spend more hours outdoors daily, particularly those residing in rural areas or outskirts of cities.  Several commonly performed leisure activities such as running, walking, digging, cycling, playing soccer, dancing, and swimming are performed in the outdoor environment.

Another aspect to consider is that most Africans did not substantially decrease their PA during the COVID-19 pandemic since PA is a part of their activities for earning a livelihood. For example, most Africans have to travel daily as part of their daily jobs, for which they rely on public transportation since a majority of them do not have the economic capacity to own private vehicles. These economically deprived individuals, most belonging to underprivileged households, rarely rely on digitized and motorized equipment and gadgets. Their means of economic sustenance are based on small-scale, informal, and labor-intensive businesses such as farming, which requires considerable movement of light or moderate intensities. Thus, moving more and sitting less is a feature of their standard of living.

Conclusions

This review highlights that sub-Saharan Africa is in a much better state compared to other low-income nations in terms of protection against the ongoing COVID-19 pandemic. The preparedness of sub-Saharan Africans residing in rural areas and practicing labor-intense, agricultural, and related small businesses toward the COVID-19 pandemic is much better compared to individuals residing in urban areas and higher-income nations such as Europe and the US. The authors believe that the improved pandemic fitness could be due to an overall younger age and regular PA, as part of the daily activities performed for their economic survival.

The review findings underpin the importance of PA in decreasing the incidence, prevalence of severity of the COVID-19 pandemic. This indicates that despite limited access to healthcare facilities and low availability of medical resources, low-income nations could improve their immune protection against COVID-19 by improving the physical fitness of their residents. Measures and strategies must be undertaken by all individuals to decrease obesity and inculcate good lifestyle habits into their daily routine to prevent the devastating effects of COVID-19 on their health.