The goal of this retrospective observational study, conducted at Kaiser Permanente South California, was to determine if inactivity was associated with COVID-19 outcomes such as hospitalization, ICU admission, and death. Eligibility requirements included 1) 18 or older, 2) positive COVID-19 test, and 3) minimum of three outpatient appointments with an exercise vital sign (EVS) measure from March 19, 2018 – March 19, 2020. The three physical activity groups included: consistently meeting guidelines (EVS>150 min/week), some activity (EVS 11-149 min/week), and consistently inactive (EVS 0-10 min/week). The analysis included 48,440 participants and revealed that the consistently inactive group had a 2.26 increase in odds of hospitalization, 1.73 increased odds of ICU admission, and a 2.49 increased odds of death compared to patients who were in the consistently meeting guidelines group. Patients who meet physical activity guidelines were less likely to suffer from severe COVID-19; therefore, authors suggest that public health authorities should emphasize the importance of physical activity to prevent severe COVID-19.