When the coronavirus disease 2019 (COVID-19) spread worldwide, many governments were forced to enact costly and restrictive measures to prevent the disease from spreading. At the start of the pandemic, there was very little information about which activities could increase the change of increasing transmission, so many countries opted for very wide-ranging measures. These included mandatory face masks, the closing of public spaces, and even full lockdowns/stay-at-home orders.
Study: Covid-19 transmission in fitness centers in Norway - a randomized trial. Image Credit: Naeblys/Shutterstock
Lockdowns were crippling to many businesses. With many gyms, training facilities, and other public exercise locations closed, scientists saw a reduction in exercise levels and more individuals living a sedentary lifestyle. In a study published in BMC Public Health, researchers from the University of Oslo oversaw a trial in Norway in which several fitness centers were allowed to open.
The researchers examined five fitness centers in Oslo, opened specifically to examine the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission among randomized participants. All other fitness centers in the country remained closed. Any fitness center member between 18 and 65 was eligible for participation, so long as they were not at increased risk of severe disease. Eligible individuals were assigned to either the fitness center or the control group.
The researchers enforced several measures designed to reduce transmission in all fitness centers. A one-meter distance was required between all individuals, rising to two-meter for intensive exercise. No body contact was allowed, disinfectant was provided at all work stations, the user cleaned all equipment after exercise, and the facilities were regularly cleaned by staff. Lids on rubbish bins were removed, individuals with COVID-19 symptoms were prevented from attending, and staff ensured no overcrowding occurred. All participants were mailed a test kit with two swabs and a tube with media for transport.
Swabs were analyzed using a commercially available RT-PCR test. Participants were also asked to provide a blood spot card thirty days after the end of the study, which was then analyzed using a multiplex flow cytometric assay known as microsphere affinity proteomics (MAP), looking for anti-SARS-CoV-2 IgG antibodies.
Following randomization, removal of ineligible individuals, and several removals of consent, 3764 participants were enrolled, with roughly half assigned to train in the facilities or the control group. At the two-week RNA testing for SARS-CoV-2 infection, only one patient assigned to training in the fitness centers received a positive test - and this individual had not used the fitness center until they arrived for the test.
Contact tracing revealed a likely primary infection at the individual's workplace. No individuals in the control group were infected. 83.4% of those mailed antibody testing kits returned the kits to the researchers. Eleven individuals assigned to the fitness centers displayed positive results for SARS-CoV-2 antibodies, compared to 27 individuals in the control group. No employees who tested for SARS-CoV-2, either using the antibody or RNA kit, received a positive result
The researchers identified several potential issues with their data. Generally, more women were in the training facilities than in the control group, and the control group was on average older than the training group. Being male and older are both risk factors for COVID-19, which could have potentially disrupted the results. However, sensitivity analyses suggested that the results are strong enough, with enough statistical power, that this should not have affected the outcome.
The researcher's highlight that their trial shows no increased risk of SARS-CoV-2 infection in fitness centers with strict enforcements of disease control measures. However, they warn that these measures were strictly enforced in the trial and that less stringent measures may lead to different results. They also highlight that the trial does not test what would happen if the centers opened during the pandemic with no hygienic measures or social distancing.
The Norwegian government reopened all such facilities on the 15th of June 2020, as long as the facilities enforced similar restrictions to those seen in this study. While many countries have now ended quarantine and lockdown procedures, variants continue to emerge, and this information could prove useful in helping to determine if it is necessary to close fitness centers in the future.