COVID19, Exercise, Health and Athletes?

[PLEASE NOTE: THIS ARTICLE WAS WRITTEN DURING THE PANDEMIC- 2020]

Many persons across the country and around the world are required to stay at home in an attempt to curb the spread of the highly infectious disease, COVID-19. The order of life has definitely change, even our various lifestyle adaptations to include exercise and physical activity engagement. Many of us participate in exercise for different reasons to include improving or optimizing health, improving sports performance, maintaining fitness or improving our physiques. Unfortunately, the gyms, fitness centres, sports clubs and some parks are closed, and maybe your exercise partners are staying home in an attempt to maintain social distancing.?

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Home-Isolation and Sedentary Behaviour - A Health Crisis??

However, staying home may encourage sedentary behaviour, anxiety, depression, and physical inactivity (BJSM, 2020). This becomes a big concern especially for persons with compromised health or chronic non-communicable diseases (for example, diabetes, hypertension, heart disease, depression, etc.) because being "stuck" home, sedentary behaviours, and poor eating habits/patterns can worsen their conditions. Time spent being physically active is expected to decrease for millions of person across the world, this also becomes a huge global public health crisis, because before COVID-19, ~23% of adults and ~81% of adolescents were physically inactive (WHO, 2020).??

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Physical inactivity has been said to play a major role in 6-10% of major non-communicable diseases (NCDs), and responsible for about 9% of premature deaths, but while this figure sounds small, it is representative of 5.3 million of 57 million premature deaths in 2008 (Lee, et al., 2012). According to the NCD Alliance (Huber & Shilton, 2016) physical Inactivity is known to be the fourth (4th) leading risk factor for death in the world. While Covid19, is the immediate emphasis of global public health, encouraging persons and families to stay physically active while at home is also of high importance.?

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Exercise and Immunity?

While exercise is important for treatment and prevention of chronic diseases, it is known that exercise can also affect our immune system, our bodies defense against coronaviruses and other pathogens. According to the American College of Sports Medicine, Exercise is Medicine (EIM) section, when compared to sedentary behaviours, moderate-intensity physical activity is associated with better immune function and also lower levels of anxiety and perceived stress (Joy, 2020).?The COVID-19 pandemic brings a lot of stress and anxiety, Seiler, Fagundes and Christian (2020, pp. 71-92) stated that chronic stress in many researches have been correlated with various immune parameters, such as vaccine antibody response, infectious illness susceptibility, immune system's ability to suppress viruses and different inflammatory processes.???

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Persons at home now must be encouraged to exercise to not only improve their general health, but to assist in reducing?stress and anxiety, and improving their immune health. Acute exercise is a stimulus for the interaction of components of the innate immune system (e.g. leukocytes), lymph material and the blood, hence repeated bouts of acute exercise over time leads to what is called improved "immunosurveillance" against foreign bodies, pathogens and cancer cells, and decreased systematic inflammation (Nieman and Wintz, 2019). However, moderate-intensity physical activity is associated with a healthier immune system but high-intensity high-volume training may suppress immune function especially if a person or athlete is not accustomed to performing/training at this level (Nieman and Wintz, 2019 and Joy, 2020).?

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"Quaran-Training" (Exercising at Home)?

Firstly, QuaranTrain is a movement, that connects?healthcare professionals around the world to promote good health in difficult situations such as this COVID-19 pandemic, they have online resources which follow and advocate for WHO guidelines surrounding COVID-19, more information could be found at?https://quarantrain.org/ ?(BJSM, 2020).??

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From QuaranTrain comes the concept "Quaran-Training", which basically means exercising while we isolate at home during this COVID-19 pandemic.?Adults should still be encouraged to gain at least 30 minutes of moderate intensity physical activity or exercise daily (1 hour for children). Exercises can be aerobic in nature, and involve muscle strengthening and stretching activities. Persons who are unsure about how much physical activity is needed for persons in their home, whether children or the elderly or persons with chronic conditions, should be encouraged to contact a healthcare professional (Chen, et al., 2020).??

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Professionals who can be contacted for information are those who are aware of WHO physical activity guidelines, or those who are trained in exercise medicine prescription such as a physiotherapist or SEM physician or other SEM professionals. The American College of Sports Medicine (Joy, 2020) and Chen, et al., (2020) makes the following basic recommendations of exercises that can be dance at home :??

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Examples of Aerobic Activities:??

Inside: Put on your favourite music walk around the house or climb the stairs 10-15 minutes, 2-3 times for the day, dancing, jump rope, follow an exercise video, use home cardio machines, be creative do a Zoom meeting with friends and have a 30 minute exercise session probably could ask your fitness trainer to instruct.??

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Outside: Walk or jog around the community/neighbourhood (maintain 2 metres or 6 feet from others), spend time in nature (immune enhancing), bicycle riding, home gardening, walking to nearby stores and fun active games with the family.?

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Strength Training Activities:?

Download workout apps, watch videos done by certified fitness coaches, yoga . Other exercises that can be done home: squats, sit to stands, wall/counter-top/floor push-ups, lunges, step ups and carrying grocery bags.?

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Exercise Precautions & COVID-19?

The American College of Sports Medicine, recommends that persons who are under quarantine and infected but not symptomatic, can continue moderate intensity exercise and continue to adhere to hygienic practices and social distancing guidelines. If they should develop symptoms i.e. fever, cough and/or shortness of breath then STOP EXERCISING, contact a health care provider and follow the Ministry of Health protocols/guidelines (Joy, 2020).??

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Fever & Exercise?- while exercise has immune enhancing effects, some persons may attempt to?"sweat out" a fever by exercising, but this is not advised. According to a review done by Dick and Diehl (2014) in the Sports Health journal, they concluded that fever is associated with dehydration, body temperature dysregulation, decreased muscular strength and endurance (as a result of muscle catabolism), increased fatigue and worsening illness.?

They recommended that persons should rest from strenuous exercise if they have a fever, defined by 38°C or greater; and persons who are afebrile with symptoms confined above the neck may be allowed to engage in exercise of mild to moderate intensity for 10-15 minutes and continue if symptoms do not worsen. There was no consensus on recommendations to encourage return to activity before the fever is resolved, however training and activities should be resumed gradually after the resolution of fever and dehydration.??

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Additionally, myocarditis which can be fatal when a person is exercising (Shah & Phelan, 2018), can be caused by viral infections and symptoms of which can also include fever and shortness of breath (Harvard Health Publishing, 2018). There has been reports of cases of myocarditis related to COVID-19 infection (Ma, et al., 2020), even without reports of COVID-19 symptoms or signs of pneumonia at the time of hospital admission (Inciardi, et al., 2020).??

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COVID19 and Athletes?

Athletes should be encouraged to take precautions similar to those recommended for general population. In addition, to proper hygiene, social distancing and PPE use, athletes should try as best as possible to remain active while at home to maintain fitness . Also, this an opportune time for athletes to re-evaluate themselves and work on injuries. There are has been a variety of services made available to include tele-health, which can be used to provide diagnosis and rehabilitative services to athletes (FIFA Medical Network, 2020). Other services which athletes can access or healthcare professionals should aim to make available to them via technology or tele-health are fitness training, nutritional and mental health counseling.??

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The International Olympic Committee (2020) has an online resource called Athlete 365, which provides a variety of advice to support athletes' wellbeing and give them accurate information during this COVID19 pandemic, the website can be found at??https://www.olympic.org/athlete365/coronavirus/.??

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Lastly, we must encourage athletes were possible to use their influence to encourage their colleagues, fans and supporters to stay active while at home during this pandemic. Organizations such as FIFA has already partnered with WHO to support this initiative, which was launched on UN International Day of Sport for Development and Peace 2020 (WHO, 2020).??

#BeActive #HealthyAtHome?

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REFERENCES?

British Journal of Sports Medicine (2020) 'QuaranTrain- Online Support For Good Health and Well-being During The Covid-19 Pandemic',?Blog?British Journal of Sports Medicine, 23 March. Available at:?https://blogs.bmj.com/bjsm/2020/03/23/quarantrain-online-support-for-good-health-and-well-being-during-the-covid-19-pandemic/?utm_campaign=shareaholic&utm_medium=linkedin&utm_source=socialnetwork?(Accessed: 17 April 2020).??

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World Health Organization (2020)?Physical Inactivity: A Global Public Health Problem. Available at:??

https://www.who.int/ncds/prevention/physical-activity/inactivity-global-health-problem/en/?(Accessed: 17 April 2020).??

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Lee, I., Shiroma, E., Lobelo, F., Puska, P., Blair, S. and Katzmarzyk, P. (2012) 'Effect of Physical Inactivity on Major Non-Communicable Diseases Worldwide: An Analysis of Burden of Disease and Life Expectancy',?Lancet Physical Activity Series Working Group,?380(9838), pp. 219–229. Europe PMC [Online]. Available at:?https://europepmc.org/article/MED/22818936?(Accessed: 17 April 2020).??

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Huber, L. and Shilton, T. (2016) 'The 4th Leading Risk Factor for Death Worldwide: Physical Inactivity is An Urgent Public Health Priority',?NCD Alliance, 09 May. Available at:?https://ncdalliance.org/news-events/blog/the-4th-leading-cause-of-death-worldwide-physical-inactivity-is-an-urgent-public-health-priority?(Accessed: 17 April 2020).??

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Joy, L. (2020) 'Updates from EIM: Staying Active During COVID-19',?Exercise is Medicine American College of Sports Medicine, 08 April. Available at:?https://www.exerciseismedicine.org/support_page.php/stories/?b=892?(Accessed: 20 April 2020).??

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Seiler, A., Fagundes, C. and Christian, L. (2020)?Stress Challenges and Immunity in Space, 2nd edn., pp. 71-92.?Link Springer?[Online]. Available at:?https://link.springer.com/chapter/10.1007/978-3-030-16996-1_6?(Accessed: 20 April 2020).??

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Nieman, D. and Wentz, L. (2019) 'The Compelling Link Between Physical Activity and The Body's Defense System',?Journal of Sport and Health Science, 8(3), pp. 201-217.?Science Direct?[Online]. Available at:??

https://www.sciencedirect.com/science/article/pii/S2095254618301005#?(Accessed: 20 April 2020).?

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Chen, P., Moa, L., Nassis, G., Harmer, P., Ainsworth, B and Li, F. (2020) 'Coronavirus Disease (COVID-19): The Need to Maintain Regular Physical Activity While Taking Precautions',?Journal of Sport and Health Sciences, 9(2), pp. 103-104.?Science Direct?[Online]. Available at:?https://www.sciencedirect.com/science/article/pii/S2095254620300144?(Accessed: 20 April 2020).??

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Dick, N. and Diehl, J. (2014) 'Febrile Illness in the Athlete',?Sports Health, 6(3), pp. 225-231.?NCBI?[Online]. Available at:??

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000470/?(Accessed: 20 April 2020).??

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Harvard Health Publishing (2018)?Myocarditis. Available at:?https://www.health.harvard.edu/a_to_z/myocarditis-a-to-z?(Accessed: 20 April 2020).??

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Shah, N. and Phelan, D. (2018)?Myocarditis in the Athlete. Available at:?https://www.acc.org/latest-in-cardiology/articles/2018/01/18/15/00/myocarditis-in-the-athlete?(Accessed: 20 April 2020).??

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Ma, K., Liu, Z., Cao, C., Liu, M., Liao, J., Zou, J., Kong, L., Wan, K., Zhang, J., Wang, Q., Tian, W., Qin, G., Zhang, L., Luan, F., Li, S., Hu, L. and Li, Q. (2020) 'COVID-19 Myocarditis and Severity Factors：?An Adult Cohort Study',?MedRxiv?[Online]. Available at:?https://www.medrxiv.org/content/10.1101/2020.03.19.20034124v1?(Accessed: 20 April 2020).??

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Inciardi, R., Lupi, L., Zaccone, G., Italia, L., Raffo, M., Tomasoni, D., Cani, D., Cerini, M., Farina, D., Gavazzi, E., Maroldi, R.,?Adamo, M., Ammirati, E., Sinagra, G., Lombardi, C., and Marco, M. (2020) 'Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)',?JAMA Cardiology, JAMA Network?[Online]. Available at:?https://jamanetwork.com/journals/jamacardiology/fullarticle/2763843?(Accessed: 20 April 2020).??

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FIFA Medical Network (2020)?Can We Examine a Player’s Hip Via Telehealth ??Available at:??https://www.fifamedicalnetwork.com/can-we-examine-a-players-hip-via-telehealth/?(Accessed: 20 April 2020).??

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International Olympic Committee (2020)?Athlete 365: Coronavirus (COVID19) Updates. Available at:??https://www.olympic.org/athlete365/coronavirus/?(Accessed: 20 April 2020).??

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World Health Organization (2020)?#BeActive for the UN International Day of Sport for Development and Peace. Available at:?https://www.who.int/news-room/detail/06-04-2020-beactive-for-the-un-international-day-of-sport-for-development-and-peace?(Accessed: 20 April 2020).??

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ADRIAN PALMER,?PT,?PgDip?SEM,?BScPT, PAPHS?

Registered Physical Therapist (RPT)?

Postgraduate Diploma Sports & Exercise Medicine (PgDip?SEM)?

Physical Activity in Public Health Specialist?(ACSM/NPAS PAPHS)?

Phone/WhatsApp: 868-314-3639?