Physical Activity and COVID-19

By: Abhishek Shastry

The COVID-19 pandemic has greatly impacted lives around the world, both by the nature of the disease and the preventative policies developed to combat its spread.  Nationwide restrictions on domestic and international travel, social distancing, mask-wearing in public, the prohibition of large gatherings, working from home, and innovations in virtual medical care have just been a fraction of the large and sweeping changes Canada has seen [1].  

Notably, these policies have also changed the way we exercise. In Ontario, the 3-stage system dictated that various fitness facilities were to be forcibly closed, and even as these limitations loosen, the number of people in these spaces remains greatly limited [2].  The Modern Period has seen the lowest engagement in physical activity possibly in history.  The reduced accessibility to fitness facilities, as well as work-from-home and government measures that limit outdoor travel, further exacerbate these decreased levels of physical activity.  Gauging the immediate changes in the behaviours of Canadian youth, a nationwide survey found that youth were less active, spent less time outdoors, and had more screen-based (sedentary) activities from the onset of the pandemic.  When examining the 24-Hour Movement Behaviour Guidelines (150 minutes of moderate- to vigorous-intensity aerobic physical activity per week; and muscle and bone strengthening activities using major muscle groups, at least 2 days per week), only 2.6% of the survey’s cohort met the criteria [3], compared to national samples collected before the outbreak (12.7% [4] & 17.1%[5]).  These measures of inactivity are even more pronounced in adults, who tend to engage in less physical activity due to employment, family, and other obligations. With the limited amount and capacity for fitness facilities in many regions, the introduction of physical activity may be necessary but burdensome. 

Interestingly, physical recreation can have both positive and negative consequences for healthy and individuals infected with the COVID-19 virus, respectively. Physical activity, particularly endurance and aerobic training (e.g. running, jogging, swimming) is shown to improve diaphragm muscle strength (by means of ‘preconditioning’) [6], heart health, stress testing scores [7], and reduce the risk of coronary artery disease and sudden cardiac death [8].  Maintaining a consistent exercise plan helps reduce muscle immobilization caused by sedentary behaviour; this is shown to decrease mitochondrion (yes, the powerhouse of the cell) homeostasis, causing organ— and system—level inflammation.  It’s important to note that inflammation and vascular leakage is a primary way that SARS-CoV-2 infects the body [9].  Referring back to Diaphragm ‘preconditioning’, once a person contracts COVID-19 and in the case that they require a ventilator, having a ‘preconditioned’ diaphragm (one that has been put through consistent, moderate-to-vigorous endurance training) reduces the risk of Ventilator-Induced Diaphragm Dysfunction, which happens frequently through long-term ventilator use [6]. On the other hand, if a person has already been infected with COVID-19, engaging in this level of physical activity is not recommended as it can increase the risk of cardiac damage, cardiac death, and muscle inflammation [10]. 

So, how can you stay healthy and active during the pandemic?  First, it is important to note that it is not recommended to immediately attempt the 24-Hour Movement Behaviour Guidelines if you have never previously engaged in consistent high intensity training (ex. HIIT). The risk of physical injury and immune vulnerability is high, as well introducing a consistent plan can’t happen if you start at high intensity.  So, you should start small, and gradually working your way up to meet the 150-min/week guidelines for physical activity.  Fortunately, there are many different ways to get started!

Füzéki et al. have published practical recommendations for practicing physical activity, regardless of any social distancing limitations.  They suggest practicing physical activity outdoors, such as walking, jogging, or running.  The outdoors have been shown to improve physical and mental wellbeing, with sun exposure specifically linked to improvements in the immune system.  However, if you are unable to leave your house, using the staircase as a tool for cardio exercise is a viable option.  Muscle strengthening exercises can be performed at home using bodyweight, resistance bands, and small weights.  These include squats, push-ups, sit-ups, and others exercises.  In all cases, increasing the intensity of exercise gradually is highly recommended [11].

There are many challenges that this new COVID-19 era has brought us.  It’s altered our daily lives and long-term goals, but also changed how we view self-care, physical activity, and health.  Hopefully as more solutions are found to bring us back to ‘normal’ again, we are still able to keep ourselves active and healthy during the pandemic.

References

[1] Canadian Institute for Health Information, "COVID-19 Intervention Timeline in Canada," 21 October 2020. [Online]. Available: https://www.cihi.ca/en/covid-19-intervention-timeline-in-canada.

[2] Government of Ontario, "Reopening Ontario in stages," 3 November 2020. [Online]. Available: https://www.ontario.ca/page/reopening-ontario-stages#section-6.

[3] S. A. Moore, G. Faulkner, R. E. Rhodes, M. Brussoni, T. Chulak-Bozzer, L. J. Ferguson, R. Mitra, N. O'Reilly, J. C. Spence, L. M. Vanderloo and M. S. Tremblay, "Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey," International Journal of Behavioral Nutrition and Physical Activity, vol. 17, no. 85, 2020. 

[4] R. E. Rhodes, J. C. Spence, T. Berry, G. Faulkner, A. E. Latimer-Cheung, N. O'Reilly, M. S. Tremblay and L. Vanderloo, "Parental support of the Canadian 24-hour movement guidelines for children and youth: prevalence and correlates," BMC Public Health, vol. 19, p. 1385, 2019. 

[5] V. Carson, J.-P. Chaput, I. Janssen and M. S. Tremblay, "Health associations with meeting new 24-hour movement guidelines for Canadian children and youth," Preventive Medicine, vol. 95, pp. 7-13, 2017. 

[6] S. K. Powers, M. Bomkamp, M. Ozdemir and H. Hyatt, "Mechanisms of exercise-induced preconditioning in skeletal muscles," Redox Biology, vol. 35, 2020. 

[7] K. Mandsager, S. Harb, P. Cremer, D. Phelan, S. E. Nissen and W. Jaber, "Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing," JAMA Network Open, vol. 1, no. 6, 2018. 

[8] J. N. Morris and M. D. Crawford, "Coronary Heart Disease and Physical Activity of Work," British Medical Journal, vol. 2, no. 5111, pp. 1485-1496, 1958. 

[9] R. W. Jackman and S. C. Kandarian, "The molecular basis of skeletal muscle atrophy," Am J Physiol Cell, vol. 287, no. 4, 2004. 

[10] L. L. G. Z. L. I. M. R. D. T. D. S. C. M. C. D. F. E. G. R. M. M. A. E. A. G. S. C. M. L. M. Riccardo M. Inciardi, "Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)," JAMA Cardiol., vol. 5, no. 7, pp. 1-6, 2020. 

[11] E. Füzéki, D. A. Groneberg and W. Banzer, "Physical activity during COVID-19 induced lockdown: recommendations," Journal of Occupational Medicine and Toxicology, vol. 15, p. 25, 2020.