Exercising During the COVID-19 Pandemic
This article was written by Elizabeth Moxley, PhD, RN, BS.
According to epidemiological evidence, exercise is the ‘real polypill.’1 Exercise improves fitness, strength, coordination,2-3 immunity and suppresses inflammation,4 and has mental health benefits as well, especially for depression.5 This is especially important for older adults, since immune defenses and exercise adherence decrease with age, and for those who are immunocompromised (cancer or HIV).4, 6 While certain diseases increase bodily inflammation, i.e., heart and lung disease and excess weight, the immune system is highly responsive to exercise,6 therefore, strategies to increase exercise engagement may protect against COVID-19.
During the COVID-19 pandemic,7 we have become increasingly aware of another global pandemic; physical inactivity, which has been prevalent for more than a decade8-10 and will likely persist long after the COVID-19 pandemic.11 Recent research conducted by Saint-Maurice and colleagues reveals that only 4000 steps per day at any pace may improve long-term health benefits.12 The US Physical Activity Guidelines13 recommend 150 minutes to 300 minutes per week of moderate-intensity for adults, which is equivalent to 30 minutes of daily brisk walking. Even fitting in 2, 5, 10, or 20 minutes for an exercise session whenever possible is beneficial according to the American College of Sports Medicine.14 Patients should focus on consistency instead of quantity and be advised to begin slowly and stop when tired, as consistency supersedes quantity. Various modalities should be used to prevent monotony: active games with family, bike rides, gardening, or walking and jogging in a park.14
Social Distancing During Exercise
Speed and type of exercise are important to consider for social distancing.15 Five meters is a safe distance when walking fast, ten meters when running with a side-by-side approach, and 1.5-meters between those ahead of you.15 If fever, cough or shortness of breath develop, stop exercising and contact a health care provider.14
Exercising with Preexisting Cardiovascular Conditions
Those individuals who with preexisting cardiovascular conditions should avoid indoor gyms altogether, although if exercising in an indoor facility, refrain from classes in a closed space, bring a home water bottle, wipes to clean equipment, and wear a cloth mask.16 Mask wearing has been associated with decreased COVID-19 transmission in countries where masks are national policy.17 Up to two layers of fabric for cloth masks or face coverings is recommended to avoid overheating, and avoid reserve filtering facepiece respirators (e.g. N95/FFP1/FFP2).18 Since moisture from exhalation and sweat may facilitate viral transmission, bring a replacement mask and hand sanitizer.18
Affordable exercise that requires no equipment whatsoever can be feasibly performed at home. An easy circuit training routine includes:
- Select 5 exercises that provide cardiovascular and strength benefits, perform them each for a minute and then repeat 3 to 5 times.15
- Walk briskly up and downstairs for 10—15 minutes, add music or exercise to a video, use a cardio machine, or invite a friend to walk outdoors.11
- Resistance exercises such as yoga with deep breathing, transporting light or moderate weight items or jumping rope offer variety and health benefits.15
- Strength training videos are also available on YouTube and free apps with real-time data can be combined with wearable tech such as pedometers or smartwatches.15Perhaps most important, however, is to select an exercise that is enjoyable for decreasing stress and distracting from the ongoing COVID-19 pandemic.
Perhaps most important, however, is to select an exercise that is enjoyable for decreasing stress and distracting from the ongoing COVID-19 pandemic.
- Jiménez-Pavón D, Carbonell-Baeza A,, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Prog Cardiovasc Dis. 2020 Mar 24. doi: 10.1016/j.pcad.2020.03.009 [Epub ahead of print]
- Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary behavior, exercise, and cardiovascular health. Circ Res. 2019;124(5):799–815.
- Ozemek C, Laddu DR, Lavie CJ. An update on the role of cardiorespiratory fitness, structured exercise and lifestyle physical activity in preventing cardiovascular disease and health risk. Prog Cardiovasc Dis. 2018;61(5–6):484–490.
- Duggal NA, Niemiro G, Harridge SDR, Simpson RJ, Lord JM. Can physical activity ameliorate immunosenescence and thereby reduce age-related multi-morbidity? Nat Rev Immunol 2019;19(9):563-572. doi:10.1038/s41577-019-0177-9
- Broman-Fulks JJ, Abraham CM, Thomas K, Canu WH, Nieman DC. Anxiety sensitivity mediates the relationship between exercise frequency and anxiety and depression symptomology. Stress Health. 2018;34(4):500-508. doi:10.1002/smi.2810
- Nieman DC, Wentz LM. The compelling link between physical activity and the body’s defense system. J Sport Health Sci 2019;8(3):201–17. doi: 10.1016/j.jshs.2018.09.009)
- World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. 2020.
- Kohl HW, Craig CL, Lambert EV. The pandemic of physical inactivity: global action for public health. The Lancet. 2012;380(9838):294–305. https://www.who.int/dietphysicalactivity/factsheet_inactivity/en/.
- Centers for Disease Control. Lack of physical activity. 2020. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/physical-activity.htm
- Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health 2018;6(10):e1077-e1086
- Hall G, Laddu DR, Phillips SA, Lavie CJ, Arena R. A tale of two pandemics: how will COVID-19 and global trends in PI and sedentary behavior affect one another? Progress Cardiovascular Disease doi: 10.1016/j.pcad.2020.04.005 [Epub ahead of print]
- Saint-Maurice PF, Troiano RP, Bassett DR, et al. Association of daily step count and step intensity with mortality among US adults. JAMA 2020;323(12):1151-1160.
- Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020-2028. doi:10.1001/jama.2018.14854
- American College of Sports Medicine. Staying active during the coronavirus pandemic. 2020. https://www.exerciseismedicine.org/assets/page_documents/EIM_Rx%20for%20Health_%20Staying%20Active%20During%20Coronavirus%20Pandemic.pdf.
- Nyenhuis SM, Greiwe J, Zeiger JS, Nanda A, Cooke A. Exercise and fitness in the age of social distancing during the COVID-19 pandemic. J Allergy Clin Immunol Pract. 2020;8(7):2152-2155. doi:10.1016/j.jaip.2020.04.039
- Reynolds G. Exercising while wearing a mask. New York Times, June 17, 2020.
- Greenhalgh T. Face coverings for the public: laying straw men to rest. J Eval Clin Pract. 2020;26:1070–1077. doi.org/10.1111/jep.13415
- Blanco JH, Janse van Rensburg, DC. Should people wear a face mask during exercise: What should clinicians advise? British Journal of Sports Medicine blog post, June 12, 2020 by Karim Khan.