Regular Physical activity

Written By Lifestyle Is Medicine

A recent Kaiser Permanente study comparing those who do very little physical activity and the very active, showed that the least physically active people had a greatly increased risk of having severe COVID-19 (1). This conclusion was found after assessing COVID-19 outcomes of over 40000 patients. What accounts for the protective effect of being physically active?

First, chronic diseases like type 2 diabetes, heart disease, obesity and hypertension greatly increase the risk for severe COVID-19 (2-9). It is well-documented that these diseases are lower among physically active people (10).

Second, physical activity has potent effects on the immune system, including:

  • Recruitment: increasing the numbers of most immune cells (11-13). For example, CD8 T-cell numbers can go up by 3-fold. Natural killer cell numbers can increase by up to 10-fold (14).

  • Immunosurveillance and deployment: transport of immune cells to peripheral tissues like the gut and lungs (15-16). SARS-CoV-2 (the virus that causes COVID-19 effects the lungs and the gut).

  • Immunocompetence: keeping the immune system younger, and thus more effective (14).


Third, severe COVID-19 is characterized by a state of hyper-inflammation (ie cytokine storm) (17). Physical activity tends to have an overall anti-inflammatory effect on the body (18-19). This may lower the risk of progressing to an overly inflammatory state if infected by SARS-CoV-2 (20-21).

The American College of Sports Medicine is recognized as one of the most reputable organizations in the exercise sciences. In 2020, they released a Call to Action Statement which emphasized the need for people to be physically active during the pandemic (22). Part of the statement read:

“During this pandemic, it is essential for those with normal health and chronic disease to activate, maintain, and advance physical activity to 30 min to 60 min most days of the week within the confines of social distancing.” (22)


Notice, even those who have chronic diseases should become physically active since being active is considered therapy for the same diseases that increase risk for severe COVID-19 (23).

The Canadian Society for Exercise Physiology recommends adults obtain 150 minutes per week of aerobic physical activity, and about two days of muscle strengthening activities (24). The aerobic activities should be intense enough to at least increase the breathing rate and induce some sweating (24). The muscle strengthening activities should include all the major muscle groups: chest, upper back, lower back, shoulders, arms, abdomen, thighs, buttocks and lower legs. It will be encouraging to many that significant health benefits still occur when moving from “doing nothing” to “doing something” even if it does not amount to 150 minutes per week (25).

If there was ever a time when people should be getting physically active, it is now.

References

  1. Sallis R, Young DR, Tartof SY, et al. 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 Published Online First: 13 April 2021. doi: 10.1136/bjsports-2021-104080

  2. Caussey, C et al. Obesity is associated with severe forms of COVID-19. Obesity. 2020 Apr 21. doi: 1002/oby.22842

  3. Simonnet, A et al. High prevalence of obesity in severe acute respiratory syndreom coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity. (2020). Doi: 10.1002/oby.22831

  4. Zheng, Z et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J infect. 2020 Apr 23; S0163 – 4453 (20) 30234-6

  5. Petrilli, C et al. Factors associated with hospitalization and critical illness among 4103 patients with Covid-19 disease in New York city. medRxic. (2020)

  6. Richardson, S et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020. Doi: 10.1001/jama.2020.6775

  7. Wang, B et al. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging. 2020 Apr 8; 12 (7): 6049 - 6057

  8. Li, B et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology

  9. DC Klonoff & GE Umpierrez, Covid-19 in patients with diabetes: risk factors that increase morbidity. Metabolism 92020), https://doi.org/10.1016/j.metabol.2020.154224.

  10. Warburton, D.E.R., & Bredin, S.S.D. (2017). Health benefits of physical activity. Current Opinion in Cardiology, 32 (5), 541 - 556

  11. Sitlinger, A, Brander, D & Bartlett, D. Impact of exercise on the immune system and outcomes in hematologic malignancies. Blood Adv (2020 4 (8): 1801 – 1811

  12. Goncalves, CAM, et al.(2020). Effect of acute and chronic aerobic exercise on immunological markers: a systematic review. Front Physiol. 10:1602

  13. Schlagheck, M et al. Cellular immune response to acute exercise: comparison of endurance and resistance exercise. (2020). Eur J Haematology. Doi: 10.1111/ejh.13412

  14. Campbell, J & Turner, J. Debunking the myth of exercise-induced immune suppression: redefining the impact of exercise on immunological health across the lifespan. Front. Immunol. (2018), 9: 648

  15. Simpson, RJ et al. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev. 2020; 26: 8-22

  16. Peake, J et al. Recovery of the immune system after exercise. J Apply Physiol 122: 1077 – 1087, 2017

  17. Tay, M et al. The trinity of COVID-19: immunity, inflammation and intervention. Nature Reviews Immunology. 2020

  18. Codella, R. The immune-modulatory effects of exercise should be favorably harnessed against COVID-19. J Endocrinol Invest. 2020 Sep 3: 1-4

  19. Pelinski da Silveira, M et al. Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature. Clin Exp Med. 2020 July 29: 1 – 14 

  20. Codella, R. The immune-modulatory effects of exercise should be favorably harnessed against COVID-19. J Endocrinol Invest. 2020 Sep 3: 1-4

  21. Pelinski da Silveira, M et al. Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature. Clin Exp Med. 2020 July 29: 1 – 14 

  22. Denay, K et al. ACSM Call to Action statement: COOVID-19 considerations for sports and physical activity. Curr Sports Med Rep.2020 Aug;19(8):326-328.  doi: 10.1249/JSR.0000000000000739. 

  23. Pedersen, B & Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015 Dec; 25 Suppl 3: 1- 72

  24. CSEP Movement Guidelines: https://csepguidelines.ca/

  25. P: Warburton, D.E.R., & Bredin, S.S.D. (2017). Health benefits of physical activity. Current Opinion in Cardiology, 32 (5), 541 - 556

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