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My COVID-19 Involvement:

Updated: Mar 23, 2023

Physical Activity as a Priority for COVID-19

James F. Sallis, Ph.D.

As of March 2023

[A list of my COVID-related publications and presentations follows the text]


2020

Origins of my COVID-19 involvement

As we all adjusted to the coronavirus pandemic in early 2020, many people were looking for ways to make positive contributions. As a longtime physical activity researcher and advocate, I wanted to contribute to educating people about the multiple important roles of physical activity in reducing the impact of the pandemic, in hopes that improved understanding will lead to actions to promote more physical activity. That initial impulse has led to several years of varied efforts to make some progress, and this work has given me a sense of purpose and mission during the pandemic. Though the activities have been fulfilling, the impact I was hoping to achieve has been elusive for reasons I don’t understand.


The origin of this mission for me was a presentation I made at a cancer conference in Varanasi, India in mid-February 2020 on physical activity, inflammation, immunity, and cancer. As a health psychologist, this was not my expertise, so I had to do extensive background reading. As concern about the international spread of the novel coronavirus was happening in February, it occurred to me that what I learned about physical activity’s beneficial effects on immune functioning and inflammation also applied to viral infections. So physical activity has the potential to reduce the impact of the pandemic.



[I want to express appreciation to my neighbor in San Diego, Dr. Bharat Aggarwal, for inviting me to speak at this meeting. He is one of most cited scientists in any field who spent most of his career at MD Anderson Cancer Center in Houston studying inflammation. He specialized in the impact of Indian spices, especially turmeric. He has written hundreds of scientific papers as well as popular press books on these topics. He is on the far right in the photo.]


This seemed like important and timely information that I had not seen or heard covered in the media. I decided to bring attention to the topic and recruited Dr Michael Pratt to co-author an op-ed with me. About March 20 we first submitted the op-ed. Then we spent the next two weeks accumulating five rejections. Though we were disappointed, we continued to believe the information is important and timely. That belief was supported by an article in the American College of Sports Medicine (ACSM) newsletter in which Dr. Richard J. Simpson of the University of Arizona explained in detail the ways physical activity stimulates the immune system to fight infection. (https://www.acsm.org/home/featured-blogs---homepage/acsm-blog/2020/03/30/exercise-immunity-covid-19-pandemic) We were also pleased that Exercise Is Medicine, an initiative of ACSM, posted a fact sheet about physical activity’s benefits for COVID-19. (https://www.exerciseismedicine.org/assets/page_documents/EIM_Rx%20for%20Health_%20Staying%20Active%20During%20Coronavirus%20Pandemic.pdf)


Having been unsuccessful with mass distribution of our op-ed, on April 3, 2020 we directly emailed our piece to about 100 physical activity and public health organizations and leaders, as well as infectious disease experts. We encouraged recipients to consider educating others about how promotion of physical activity could help millions of people during the pandemic. There was a small but positive response to the op-ed, but only by those in the physical activity field. The most important outcome was that numerous groups posted some version of the op-ed as a blog on their websites. The links we know of are listed at the end of this blog, and anyone is welcome to post it. We are gratified by this assistance in distributing the piece, but we continued to search for ways to communicate these messages to wider audiences, especially beyond the physical activity community.


In March I had the opportunity to deliver a lecture on this topic to UC San Diego medical students as part of an online course on COVID-19. Because this might be the only lecture they receive on physical activity, the first part was general physical activity background, and the second part was more specific to COVID-19. The 40-minute lecture is posted on youtube:


I was pleased to have the opportunity to participate in several well-attended webinars, and my presentations focused in part or in whole on COVID-19. The links are listed at the end. Dr. Pratt and I expanded the original op-ed/blog into a paper with more benefits of physical activity for the pandemic, consideration of equity issues, and ideas related to the re-opening of places to be active. This paper was published in a special COVID-19 issue of the Brazilian Journal of Physical Activity and Health. (https://rbafs.org.br/RBAFS/article/view/14268)


Public health research priorities

I’m pleased our paper on public health research priorities related to physical activity and COVID-19 was published in a special COVID-19 issue of the Journal of Sport and Health Science. The co-authors are Deepti Adlakha, Adewale Oyeyemi, and Deborah Salvo. https://doi.org/10.1016/j.jshs.2020.05.005 This paper announces a repository of physical activity and COVID-19 research studies that supports researchers with similar interests to connect (https://forms.gle/rZ9k4TNruSVnpKiv9). Please use it to register your study idea, study aims and methods, or results of completed studies. You can find research ideas and potential collaborators on the registry. Of course, since July 2020, very many studies on physical activity and COVID-19 have been published.


Does density promote COVID-19?

I happened to read an alarming op-ed in the Los Angeles Times that concluded because density promotes spread of the infection, we should aim to reduce density and build more low-density sprawl developments. I thought this was a wrong and dangerous conclusion, so I wrote a rebuttal. The op-ed and my letter to the editor response are linked at the end.


Relatedly, Dr. Deepti Adlakha and I published a commentary on built environments as they relate to both infectious diseases and non-communicable diseases in a special COVID-19 issue of Cities & Health. (https://www.tandfonline.com/doi/full/10.1080/23748834.2020.1783479). The paper is supplemented by an infographic (https://www.tandfonline.com/doi/suppl/10.1080/23748834.2020.1783479/suppl_file/rcah_a_1783479_sm0702.pdf) and an article in The Conversation (UK). (https://theconversation.com/mengapa-kota-yang-padat-baik-untuk-kesehatan-bahkan-selama-pandemi-143474)


Trying to bring attention to physical activity’s benefits for COVID-19

In August 2020, I was disappointed by the continued absence of information and promotion related to physical activity. Thus, Dr. Pratt and I wrote another op-ed, written in a more provocative style to bring attention to the potential for physical activity to improve immune responses to vaccines among older adults. Phase 3 vaccine trials were getting underway at the time, so it seemed like urgent action was needed to advocate for at least some of those trials to include evaluation of physical activity as a vaccine adjuvant among older adults.


Once again, multiple newspapers ignored our op-ed. So we published it as a blog on the Exercise Is Medicine website (https://www.exerciseismedicine.org/support_page.php/stories/?b=912) and elsewhere. We also emailed it to almost 100 physical activity, public health, and infectious disease leaders in the US and internationally. We received few responses of any kind. Thus, after a busy 5 or 6 months trying to raise the visibility of physical activity as a remedy for COVID-19, there was no noticeable impact outside of the physical activity field. This has been a big disappointment for me.


On the positive side, we published three papers in 2020, I had the opportunity to co-author several blogs, and I was invited to participate in many webinars. Almost all of these resources are freely available, and the listings and links are provided at the end of this blog.


If you are reading this on my website, you must have an interest in COVID-19 and physical activity. Thus, I urge you take the same actions we requested of the recipients of our April and August 2020 email blasts.


Actions You Can Take

1. Communicate with your networks about physical activity's potential role in reducing morbidity and mortality during the pandemic. You are welcome to use and share the op-ed/blog any way you see fit.

2. Advocate for increased action to promote physical activity from the Federal Coronavirus Task Force, state and local health departments, and international health organizations. We are pleased the World Health Organization promoted physical activity early in the pandemic. [https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/be-active-during-covid-19 ]

3. Advocate for rapid response funding in all countries to study the impact of physical activity on the severity of COVID-19 infections and on population stress responses to the pandemic. Encourage investigators to study these issues rapidly so results can inform better responses to the pandemic.


2021

Our study of almost 50,000 patients showed physical INactivity prior to infection was the strongest modifiable risk factor for hospitalization and death

In the latter part of 2020 I contacted colleagues at Kaiser-Permanente Southern California to discuss analyses of their unique database. With leadership from Robert Sallis, MD (no relation), a family and sports medicine physician, several Kaiser-Permanente units routinely ask adults to report their physical activity at every outpatient visit. This validated Exercise Vital Sign was recorded in the electronic health record (EHR), and it could be linked with everything else in the EHR. Along with Deborah Young, PhD, Deborah Cohen, MD, MPH, and others, we developed a plan to examine whether pre-COVID-19 physical activity reduced severe outcomes among infected patients. This would be expected based on prior evidence about physical activity’s effects on immune function and inflammation. The analyses were conducted with over 48,000 COVID-19 patients, results supported our hypotheses to a dramatic degree, and the paper was published in British Journal of Sports Medicine in April 2021. The bottom line was that physical INactivity was a stronger risk factor for hospitalization and death from COVID-19 than other demographic or health variables, except age and history of transplant. Fortunately, Gretchen Reynolds, the fitness reporter at the New York Times, published a summary of our study on the day of its release. The New York Times story led to extensive global media coverage in well over 300 media outlets. Finally, we had evidence of physical activity’s benefits specific to COVID-19 outcomes, and the study received extensive attention beyond the physical activity community. However, it received no apparent attention in the infectious disease community. We are planning additional analyses of the Kaiser-Permanente data.


Commentary in Journal of Physical Activity and Health spells out missed opportunities

We have published a commentary on COVID-19 in Journal of Physical Activity and Health that references the 3rd Lancet Series on Physical Activity. https://doi.org/10.1123/jpah.2021-0454

Despite the strong evidence that has since been corroborated by multiple studies, public health leaders in the US still were not educating people about the benefits of being active during the pandemic or encouraging people to be active. CDC did not list physical inactivity as a risk factor for severe COVID-19. Thus, we contacted leaders at both CDC and WHO to encourage them to take action on the physical activity evidence. WHO had identified physical inactivity as a risk factor for severe COVID-19 early in the pandemic, and they sponsored a global webinar on physical activity and COVID-19 that highlighted our Kaiser-Permanente study and included a

discussion of recommended actions. See below for links to the full webinar and 6 minutes of highlights.


Commentary in Obesity

The Roundtable on Obesity Solutions is a program of the National Academies of Science, Engineering, and Medicine, and I served as a member for the first six years. I still participate in the affiliated Physical Activity Innovation Collaborative (IC), which can take independent actions. Based on discussions in the IC, we decided to write a commentary that would explain the benefits of physical activity for the pandemic, with specific reference to people with obesity. We were pleased this paper was accepted and published in Obesity, because it will reach the large audience of obesity experts. https://onlinelibrary.wiley.com/doi/10.1002/oby.23269


Commentary in American Journal of Lifestyle Medicine

I am a member of the Health Equity workgroup of the ACSM Strategic Health Initiative. This group wrote an article on COVID-19, physical activity, and health equity for the American Journal of Lifestyle Medicine. The lead author was Dr. Rebecca Hasson. https://doi.org/10.1177/15598276211029222


2022

The COVID-19 “pandemic” is actually a “syndemic”

The pandemic continued in 2022 with a worldwide surge of the Omicron variant, followed by multiple sub-variants. The situation was evolving to the extent that three opinion pieces were published in JAMA in mid-January, written by several advisors to the administration’s COVID-19 response, several of whom also frequently were interviewed in the mass media. I was contacted by my colleague, Dr. Jun Ma, who is a preventive medicine physician at University of Illinois Chicago. Both of us were alarmed by their proposals for a “new” COVID-19 strategy. To us, the proposals sounded like minor variations on the current COVID-19 strategy, with reliance on vaccinations, medications, and masking and social distancing as needed, but with improved implementation. We wrote a commentary responding to these opinion pieces. Our key point was that the proposals for “new” strategies failed to recognize the reality that we are experiencing a “syndemic” or synergistically-interacting epidemics of COVID-19, chronic diseases, and multiple dimensions of health inequities. Our arguments were based on evidence from the beginning of the pandemic that about 95% of COVID-19 hospitalizations were in people with common chronic diseases (e.g., cardiovascular diseases and risk factors, cancers, diabetes), and people of color have been disproportionately affected by COVID-19. Though our commentary was rejected by JAMA, it was published in May 2022 by the Journal of General Internal Medicine (https://link.springer.com/article/10.1007/s11606-022-07552-y). We were pleased with this outcome because the journal is read by a broad medical audience. We proposed the Society of Behavioral Medicine (SBM) adopt the call for an appropriate syndemic response as a topic for policy advocacy. We worked with leaders of SBM to create a letter to the leaders of the US COVID-19 response at the Centers for Disease Control and Prevention, Department of Health and Human Services, and Biden Administration. The letter was co-signed by 11 other organizations and sent at the end of May. There has been no response to the letter.


On the basis of its own systematic review, CDC adds “physical inactivity” as an underlying condition for COVID-19

On the physical activity front there was some good news in early 2022. A systematic review of the physical activity and COVID-19 literature, conducted by CDC in Fall of 2021, was finally released in mid-February 2022. The review included 25 studies from several countries that examined some aspects of physical activity or fitness among adults prior to COVID-19 infection and analyzed their relation to COVID-19 outcomes. The review judged the studies to provide “consistent and conclusive” evidence that physical activity and fitness protected from hospitalization, being placed on a ventilator, and dying. A summary report of the review was placed on the CDC website (https://www.cdc.gov/coronavirus/2019-ncov/downloads/clinical-care/E-Physical-Inactivity-Review.pdf), though I will note it is difficult or impossible to find by searching the CDC COVID-19 website. The good news is the review led to physical inactivity being added to the list of “underlying conditions” on the CDC website. The bad news is there was no press release, no public education, no inclusion of physical activity in pandemic planning, and no apparent actions taken by CDC other public health agencies as a result of this new evidence review.


For the third time, Mike Pratt and I assumed responsibility for doing what we could to educate people about this good news of the “conclusive” evidence that physical activity protects people from severe COVID-19 outcomes. Once again, our op-ed was rejected by six major newspapers. We have seen no other efforts to make this good news public.


Why are COVID-19 deaths unexpectedly low in sub-Saharan Africa? A hypothesis

In March 2022 I read a surprising article in the New York Times about unexpectedly low death rates from COVID-19 across sub-Saharan Africa that scientists were unable to explain (https://www.nytimes.com/2022/03/23/health/covid-africa-deaths.html ). I contacted colleagues in Africa and the HL-PIVOT network to discuss this report and potential explanations. Based upon an existing literature showing generally high levels of physical activity among Africans (at least those not living in cities) and the literature on the protective effects of physical activity on infectious diseases, we hypothesized that substantial amounts of routine physical activity could be protecting African adults from severe COVID-19 effects, despite low vaccination rates, poverty, and crowded living conditions that would otherwise predict high death rates. We explained our hypothesis in a commentary coordinated by the HL-PIVOT network and included in a special issue of Progress in Cardiovascular Diseases on social equity in April 2022 (https://www.sciencedirect.com/science/article/pii/S003306202200041X ). We have not yet found data that could be used to test this hypothesis in Africa.


I was invited to co-author another paper coming from HL-PIVOT, which is a network of investigators promoting the importance of healthy living behaviors, generally thought to be important for chronic diseases, that also can be helpful in the COVID-19 pandemic. This article, led by Dr. Ross Arena of the University of Illinois Chicago, begins with a map of per capita COVID-19 deaths for all US states. This is followed by maps of state- or county-level prevalence of major chronic diseases and related health behaviors. Physical inactivity is one of the behaviors mapped. The maps demonstrate a great deal of similarity, with the most apparent pattern being that prevalences of COVID-19 deaths, chronic disease deaths, and unhealthy behaviors, including physical inactivity, tend to be worst in the Southeastern states. This is additional evidence of the syndemic of COVID-19 and chronic diseases. https://www.sciencedirect.com/science/article/pii/S0002934322004958?via%3Dihub


A meta-analysis finds physical activity reduces COVID-19 mortality by 43%

On September 7, 2022 an article in the New York Times summarized a new study. (https://www.nytimes.com/2022/09/07/well/move/exercise-immunity-covid.html) The meta-analysis study of over 1.8 million COVID patients in the British Journal of Sports Medicine showed people who were more active had less severe cases of COVID-19. (https://bjsm.bmj.com/content/early/2022/07/07/bjsports-2022-105733)


I was pleased to see this important new study summarized in the Times. I particularly commend Ms. Sheik for obtaining comments from two infectious disease experts. Since other articles on physical activity and COVID-19 have been ignored by the infectious disease community, it is instructive to gain a little insight into their thinking. I was disappointed that the study results were dismissed for the simplistic reason that physical activity measures have error. In fact, all measures have error, including biomedical tests such as all COVID-19 tests. That does not make them worthless. This critique also is nonsensical because measurement error leads to underestimates of true effects. This means physical activity likely reduces the risk of death from COVID-19 by MORE THAN 43%. It’s also hard to believe his other assertion that a placebo effect could protect people from dying from COVID-19. I doubt Dr. Chin-Hong is aware that CDC reviewed 25 similar studies and judged they provided “consistent and conclusive” evidence that physical activity protects from multiple severe COVID-19 outcomes, including death. (https://www.cdc.gov/coronavirus/2019-ncov/downloads/clinical-care/E-Physical-Inactivity-Review.pdf) Unfortunately, CDC has not communicated these findings to the public. I urge infectious disease specialists and public health leaders to take seriously an action people can do for free that may reduce their risk of dying from COVID-19 by almost half.


Here is the letter to the editor I submitted to the NY Times. It was not published.

Re: Can exercise strengthen your immunity? By Knvul Sheikh. September 7, 2022

Dear Editor:

This study of 1.8 million adults showed physical activity prior to COVID-19 infection reduced risk of death. Comments from two infectious disease experts give insight into why physical activity evidence seems to be dismissed by the infectious disease community. I respond to some of their concerns.

1. It’s hard to know whether benefits come from changes to the immune system or overall better health: The unique value of physical activity is likely to be that it reduces risk for severe outcomes by multiple well-documented mechanisms.

2. Participants self-report exercise, which can be inaccurate: All measures have error, including biomedical tests. Because measurement error under-estimates true effect sizes, it is likely physical activity reduces COVID-19 deaths more than the reported 43%.

3. It is hard to tell how much exercise is ideal for immune function: The study provides dose-response information. The best results were among people who met current physical activity guidelines.

I encourage infectious disease experts to incorporate physical activity into pandemic control plans and spend less effort finding excuses to dismiss compelling evidence.


James F Sallis, PhD

Distinguished Professor Emeritus, Herbert Wertheim School of Public Health, University of California San Diego


2023

Second paper from Kaiser-Permanente data shows physical activity’s protective effects apply across demographic and health subgroups

The Robert Sallis et al paper in 2021 provided strong evidence that consistently meeting physical activity guidelines substantially reduced risk of severe COVID-19 outcomes among adults. A second analysis was conducted with a much larger sample of almost 200,000 patients of Kaiser-Permanente Southern California to answer two additional questions. First, what is the dose-response relation of physical activity to COVID-19 outcomes? Second, do the protective effects apply to important and high-risk subgroups defined by demographics and health status? Dr. Deborah Young led this paper that was accepted by American Journal of Preventive Medicine, published online December 2022, and printed in the April 2023 issue. (DOI: https://doi.org/10.1016/j.amepre.2022.10.007) A dose-response relation was shown in the entire sample, with each higher level of activity providing more protection from hospitalization, adverse events, and death. The subgroup analyses were especially revealing. Dose-response associations were seen in females and males, 4 race/ethnic groups, all age groups except <40 years (in which there were very few deaths), 4 body mass index categories, history of cardiovascular diseases or not, and history of hypertension or not. Given the many inequities of COVID-19’s impact, physical activity could be tool for improving outcomes for many high-risk subgroups. I encourage you to share this paper with colleagues and organizations with an interest in health equity.


My mission continues

As the pandemic surges and subsides, barriers to worldwide vaccinations continue, variants emerge, and political opposition to US public health efforts further complicate effective responses to the pandemic, I continue to advocate for more attention to the benefits of physical activity for COVID-19. Now with COVID-19 at a low ebb in 2023, and attention fading, it is still important to plan to use what we have learned about physical activity to prepare for future infectious disease epidemics and pandemics. Implementing evidence-based strategies to increase physical activity could help reduce stress and mental health problems, which have increased worldwide. More physical activity could reduce the risk of severe COVID-19 by several mechanisms, including reduction of chronic diseases. More physical activity has the potential to sustain the efficacy of vaccines, especially among older adults. Physical activity could possibly reduce risk of long-COVID, and this should be studied. The need for research on, and applications of, physical activity to reducing harm from the COVID-19 continues. I would even like to see research on why infectious disease and public health leaders in many countries are not taking physical activity seriously and acting on the compelling evidence that has been produced very rapidly during the pandemic.


I welcome your thoughts about how to bring more attention to physical activity during this pandemic, both in the US and globally. Please let me know about actions you or your organization take related to the application of physical activity to reduce the impact of the current pandemic/syndemic or a future one.


Stay well and thank you for your work to improve public health,


James F. Sallis, Ph.D.



Peer-reviewed publications related to physical activity and COVID-19

Adlakha, D., and Sallis, J.F. (2020). Activity-friendly neighbourhoods can benefit non-communicable and infectious diseases. Cities & Health: 1783479. DOI: 10.1080/23748834.2020.1783479

See an article in The Conversation (UK) based on this paper. Released July 24, 2020. https://theconversation.com/why-urban-density-is-good-for-health-even-during-a-pandemic-142108

Republished in The Conversation (Indonesia): “Mengapa kota yang padat baik untuk kesehatan, bahkan selama pandemic.” July 28, 2020.


Sallis, J.F., Adlakha, D., Oyeyemi, A., and Salvo, D. (2020). An international physical activity and public health research agenda. Journal of Sport and Health Science, 9(4), 328-334. In Special Issue on COVID-19.

Links to International Coronavirus and Physical Activity Research Network (INCOPAR) registry of studies:

Google Form to enter study information: https://forms.gle/rZ9k4TNruSVnpKiv9

Repository (Google Sheets) to view all information:

Brief posted on GP RED website (Brief #11): https://www.gpred.org/research-briefs/

Authors quoted in this article in Scientific American. Released September 16, 2020. https://www.scientificamerican.com/article/population-density-does-not-doom-cities-to-pandemic-dangers/


Sallis, J.F., and Pratt, M. (2020). Multiple benefits of physical activity during the coronavirus pandemic. Brasilian Journal of Physical Activity/Revista Brasileira de Atividade Fisica & Saude, 25, 14268. In Special Issue on COVID-19.

Related blog posts (partial list):

https://www.isbnpa.org/index.php?r=article/view&id=146 (with references and link to medical school lecture)


Sallis, R., Rohm Young, D., Tartof, S.Y., Sallis, J.F., Sall, J., Li, Q., Smith, G.N., and Cohen, D.A. (2021). Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: A study in 48 440 adult patients. British Journal of Sports Medicine. Released online April 13, 2021.

New York Times summary by Gretchen Reynolds. April 14, 2021. https://www.nytimes.com/2021/04/14/well/move/exercise-covid-19-working-out.html

The Reynolds article was translated to Spanish and published in Argentina’s El Clarin. April 20, 2021. https://www.clarin.com/sociedad/coronavirus-descubren-falta-vacunas-20-minutos-ejercicio-diario-pueden-proteger-covid-grave_0_mewdwjw_0.html

Dana Santos article on CNN website. April 13, 2021.

Paul Sisson article in San Diego Union-Tribune. April 18, 2021.


New Zealand coverage:

Australian coverage:

Canadian coverage:

Quoted in local TV news story by Jared Aarons, ABC Channel 10 San Diego. April 21, 2021: Exercise has dramatic impact on severity of COVID-19 cases.

Article in The Nation newspaper, Kenya. April 28, 2021.


Hasson, R., Sallis, J.F., Coleman, N., Kaushal, N., Nocera, V., and Keith, N. (2021). COVID-19: Implications for physical activity, health disparities, and health equity. American Journal of Lifestyle Medicine.

DOI: DOI: 10.1177/15598276211029222


Economos, C.D., Dietz, W.H., Tullie, K., and Sallis, J.F. (2021). Physical activity may mitigate COVID-19 infections in people with obesity: A call to action. Obesity, 29(12), 1987-1989.


Ma, J., and Sallis, J.F. (2022). A national response to COVID response and pandemic preparedness must address noncommunicable chronic diseases. Journal of General Internal Medicine. Viewpoint (peer-reviewed). Released online May 9, 2022.

DOI: 10.1007/s11606-022-07552-y


Wachira, L.J., Arena, R., Sallis, J.F., Lambert, E.V., Ong'wen, O.M., Laddu, D.R., Onywera, V., and Oyeyemi, A.L. for the HL-PIVOT Network. (2022). Why are COVID-19 effects less severe in Sub-Saharan Africa? Moving more and sitting less may be a primary reason. Progress in Cardiovascular Diseases, 71, 103-105.

DOI:10.1016/j.pcad.2022.04.012


Arena, R., Pronk, N.P., Laddu, D., Whitsel, L.P., Sallis, J.F., and Lavie, C.J., On behalf of the HL-PIVOT Network. (2022). Mapping one million COVID-19 deaths and unhealthy lifestyle behaviors in the United States: Recognizing the syndemic pattern and taking action. The American Journal of Medicine,


Young, D.R., Sallis, J.F., Baecker, A., Cohen, D.A., Nau, C.L., Smith, G.N., and Sallis, R. (2023). Associations of physical inactivity and COVID-19 outcomes among subgroups. American Journal of Preventive Medicine, 64(4), 492-502.

Kaiser-Permanente summary:

Story by Gretchen Reynolds in Washington Post. December 21, 2022:

WebMD story by Lisa Jhung. January 9, 2023:

Story by Alex Janin in Wall Street Journal. January 16, 2023­

Interview with Holly Quan. KCBS radio in San Francisco. January 19, 2023.



Other publications

Sallis, J.F. & Pratt, M. Physical activity can be helpful in the pandemic. Columbia (Missouri) Daily Tribune. April 7, 2020. Commentary.

This is a recording of my lecture to UC San Diego medical students on this topic.

Blog posted on the Exercise Is Medicine website:

Featured on the EIM COVID-19 landing page

Spanish translation on the RAFA/PANA website that reaches physical activity professionals throughout Latin America:

Post on Agita Mundo website, based in Sao Paulo, Brazil.

Blog (with references) and lecture featured on ISBNPA website. https://www.isbnpa.org/index.php?r=article/view&id=146

PlayCore’s news and social media (lecture and blog):

Blog on America Walks website

Material incorporated into a blog from UCSD Health. Posted May 14, 2020.

Blog adapted for India.

Adlahka, D., Sallis, J.F., & Pratt, M. COVID-19 and India’s chronic disease burden: How exercise can be beneficial. The News Minute (India), April 16, 2020.


Sallis, J. Deadly sprawl. Letter to the editor, Los Angeles Times. May 2, 2020.

Commenting on this April 26, 2020 op-ed: Sprawl may have saved lives.


Hasson, R., Sallis, J., Coleman, N., Kaushal, N., Nocera, V., & Keith, N. (2020). The missing mandate: Promoting physical activity to reduce disparities during COVID-19 and beyond. American College of Sports Medicine blog. Posted June 3, 2020. https://www.acsm.org/home/featured-blogs---homepage/acsm-blog/2020/06/03/promoting-physical-activity-reduce-disparities-during-covid-19


Adlakha, D., & Sallis, J.F. Why urban density is good for health, even during a pandemic. The Conversation (UK). Released July 24, 2020.


Sallis, J.F., & Pratt, M. Why keep this COVID-19 remedy a secret?

Blog posted on the Exercise Is Medicine website. August 14, 2020. Promoted in ACSM Sports Medicine Bulletin, September 8, 2020.

Blog (with references) posted by International Society of Behavioral Nutrition and Physical Activity.


Sallis, J., Adlakha, D., Oyeyemi, A., & Salvo, D. GP RED Research Brief #11. An international physical activity and public health research agenda to inform Coronavirus Disease (COVID)-19 policies and practices. Posted on GP RED website August 14, 2020. https://www.gpred.org/research-briefs/


Ross, S.E.T., Hasson, R., Johnson, M., Nocera, V., Sallis, J., Simon, L., Wheeler, L., and the ACSM Strategic Health Initiative on Health Equity. The urgency of now: Achieving equity in school physical activity policies and practices during the COVID-19 pandemic. Blog on American College of Sports Medicine website. September 24, 2020.


Rosenberg, D., Sallis, J., Trinh, L., Pekmezi, D., Buscemi, J., Fitzgibbon, M., & Whitsel, L. (2021). Position Statement: Joint Recommendation to Increase Federal Efforts to Promote Physical Activity During and After the COVID-19 Pandemic. Released by Society of Behavioral Medicine and Physical Activity Alliance. June 8, 2021. http://bit.ly/COVIDPA


Ramirez Varela, A., Sallis, R., Rowlands, A.V., and Sallis, J.F. (2021). Physical inactivity and COVID-19: When pandemics collide. Journal of Physical Activity and Health. (commentary). Advance online publication. https://doi.org/10.1123/jpah.2021-0454.


Sallis, J.F., and McLoughlin, G.M. (2022). COVID-19’s impact on youth physical activity. Blog on SPARK website. Posted January 2022.



Webinars and lectures

Sallis, J.F. Lecture delivered to UC San Diego medical students as part of online course on COVID-19. March 2020. Posted to youtube April 1, 2020. https://youtu.be/F4mcbi9tD-M


Sallis, J.F. Presenter on webinar, “Celebrate trails @ home.” Rails to Trails Conservancy. April 16, 2020.

Archived on Facebook live:


Carson, R., Sallis, J., Hipp, A., & Johnson, C. Presenters on webinar, “Parks as equitable resources for youth physical activity, especially now.” PlayCORE scholar series. April 28, 2020.

Archived webinar:


Sallis, J.F. Physical activity and COVID-19. Presented in webinar, “Walking and walkability in the time of COVID-19: New policies and practices.” America Walks. May 13, 2020.

Archived webinar:

A clean re-recording: https://youtu.be/YwJi6XnmKjY


Sallis, J.F., & Salvo, D. The pandemic needs us: Research priorities for physical activity and COVID-19. Grand Rounds webinar, sponsored by Physical Activity Policy and Evaluation Network. July 22, 2020.


Interview (45 min) with Catherine Carrigan for her “Natural Healing Show” on UK Health Radio. Topic is physical activity and COVID-19. Recorded October 26, 2020. https://www.youtube.com/watch?v=hKrGJTGu_8Y&feature=youtu.be


Speaker on Facebook Live webinar: Safely getting outdoors on the trail in the winter during the COVID-19 surge. Sponsored by Rails to Trails Conservancy. November 23, 2020. Access recording on Youtube: https://www.youtube.com/watch?v=rBsCbg_beA8


Sallis, J.F. Physical activity, mental health, and COVID-19. 43rd International Symposium on Sport Science. Virtual conference based in Sao Paulo, Brazil. October 2, 2020. (Invited keynote.)


Sallis, J.F. How we used exercise science and what we are learning about physical activity and COVID-19 pandemic. In Fulton, J. (Chair), symposium. Physical Activity during the COVID-19 Pandemic: Perspectives from Public Health, Healthcare, and Exercise Science. American College of Sports Medicine (virtual). June 3, 2021.


Sallis, J.F. Physical activity benefits for COVID-19: Transitioning from promise to evidence. In Sallis, J.F. (Chair), symposium. COVID-19: Implications for Physical Activity, Health Disparities and Health Equity. American College of Sports Medicine (virtual). June 5, 2021.


Sallis, J.F. Learning about physical activity in the COVID-19 pandemic: Acting on what we learn. Congreso Latinoamericano de Investigacion en Actividad Fisica y Salus (Latin American Congress of Physical Activity and Health Research)(virtual). June 23, 2021.


Sallis, J. Panelist on webinar hosted by Fiona Bull and Amanda Harding. From Evidence to Policy: Physical Activity and COVID-19. Sponsored by World Health Organization as part of the “ReINVENT” series. June 10, 2021.

Full recording (90 mins) https://youtu.be/L3xB7eyAKhU

Highlights from 3rd webinar (6 mins) - https://youtu.be/bwi0rdgkO4c


Sallis, J.F. Why keep the benefits of physical activity for COVID-19 a secret? Webinar with panel discussion. Sponsored by the Australasian Society of Physical Activity. October 1, 2021.


Sallis, J.F., & McLoughlin, G.M. Mental health benefits of physical activity for students: Interventions for increasing physical activity. For SPARK program of Gopher Sport Inc. November 17, 2021.

Blog based on the webinar: COVID-19’s impact on youth physical activity. Posted January 2020.


Sallis, J.F. Designing cities so children can play, be active, and be healthy: Lessons from research and COVID-19. Growing IN Place 12th Annual Symposium. Urban outdoor play and learning: Post-pandemic lessons for policy and practice (virtual). Natural Learning Initiative, North Carolina State University. September 7, 2022.


Sallis, J.F. Physical activity as a priority for COVID-19????? National Academy of Kinesiology. Providence, RI. October 1, 2022. Invited, virtual.

Sallis, J.F. Physical activity is an underused resource in the COVID-19 pandemic. Pease Family Scholar Public Lecture. Iowa State University. Ames, IA. December 1, 2022.

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