Association of timing and balance of physical activity and rest/sleep with risk of COVID-19: A UK Biobank study

Behavioural lifestyle factors are associated with cardiometabolic disease and obesity, which are risk factors for COVID-19. We aimed to investigate whether physical activity, and the timing and balance of physical activity and sleep/rest, were associated with SARS-CoV-2 positivity and COVID-19 severity. Data from 91,248 UK Biobank participants with accelerometer data, complete covariate and linked COVID-19 data to 19th July 2020 were included. The risk of SARS-CoV-2 positivity and COVID-19 severity, in relation to overall physical activity, moderate-to-vigorous physical activity (MVPA), balance between activity and sleep/rest, and variability in timing of sleep/rest, was assessed with adjusted logistic regression. Of 207 individuals with a positive test, 124 were classified as having a severe infection. Overall physical activity and MVPA were not associated with severe COVID-19, while a poor balance between activity and sleep/rest was (OR per standard deviation: 0.71 [95% CI: 0.62, 0.81]). This was related to higher daytime activity being associated with lower risk (OR 0.75 [0.61, 0.93]) but higher movement during sleep/rest with higher risk (OR 1.26 [1.12, 1.42]) of severe infection. Greater variability in timing of sleep/rest was also associated with increased risk (OR 1.21 [1.08, 1.35]). Results for testing positive were broadly consistent. In conclusion, these results highlight the importance of not just physical activity, but also quality sleep/rest and regular sleep/rest patterns, on risk of COVID-19. Our findings indicate the risk of COVID-19 was consistently ∼1.2 times higher per ∼40-minute increase in variability in timing of proxy measures of sleep, indicative of irregular sleeping patterns.