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Table of Contents
Year : 2021  |  Volume : 9  |  Issue : 4  |  Page : 206-208

Can COVID-19 patients exercise? An insight

1 Alva's Health Centre, Moodabidri, Karnataka, India
2 Senior Physician, Department of Musculoskeletal and Sport, Alvas's College of Physiotherapy, Moodabidri, Karnataka, India

Date of Submission24-Dec-2020
Date of Decision09-Mar-2021
Date of Acceptance15-Mar-2021
Date of Web Publication20-Oct-2021

Correspondence Address:
Dr. Sadananda B Naik
Alva's Health Centre, Moodabidri - 574 227, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajim.ajim_113_20

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Practice of mild-to-moderate physical exercise could be beneficial to patients recuperating from COVID-19, whereas vigorous physical exercise could result in opposite health effect. Evaluation of pulmonary and cardiac function could show silent functional impairment.

Keywords: COVID-19, myocardial injury, physical exercise, pneumonia

How to cite this article:
Naik SB, Shetty KS. Can COVID-19 patients exercise? An insight. APIK J Int Med 2021;9:206-8

How to cite this URL:
Naik SB, Shetty KS. Can COVID-19 patients exercise? An insight. APIK J Int Med [serial online] 2021 [cited 2022 Dec 2];9:206-8. Available from: https://www.ajim.in/text.asp?2021/9/4/206/328670

  Introduction Top

Social media is flooded with videos showing COVID-19 patients performing various types of exercises such as push-ups, dancing to the tunes of their favorite dance numbers, playing various types of indoor group games, and yoga while recuperating from the viral infection. Never before, we have witnessed patients exercising while suffering from an infectious ailment. We are used to listening to our doctors telling “take rest” and “don't strain.” This article is an insight into the pros and cons of carrying out exercise while suffering from COVID-19 with available evidence.

  Health Benefits of Exercise in Relation to an Infectious Disease Top

The idea of practicing physical exercise while suffering from this viral disease is due to the fact that it would reduce stress and anxiety and it is known to have mood-boosting ability while recovering from an illness, especially in an unfamiliar and isolation setup. Exercise is also known to enhance the psychological well-being, which in turn is supposed to improve the overall immunity in a bid to withstand the infections.[1] The other health benefits would be improvement in the overall health status, including the cardiovascular, musculoskeletal fitness, body composition, and metabolism. Better sleep and prevention of weight gain could be the other added advantages of regular physical exercise.[2] Carrying out moderate exercise regularly has shown to benefit the immune system to lower the risks of respiratory infections.[3] On the contrary, the lack of physical activity could accelerate the musculoskeletal aging process, leading to sarcopenia and worsening of overall health status.[4]

  Classification of Physical Activities/Exercise Top

The physical activities could be classified as light, moderate, and vigorous based on the energy expenditure measured in terms of metabolic equivalents (METs). Any physical activity with energy expenditure >3.0 METs is light, between 3.0 and 5.9 METs is moderate, and 6.0 METs or more is vigorous. Walking slowly, household works such as washing dishes, ironing, and cooking, indulging in arts and crafts, playing cards, fishing, and playing musical instruments would come under the category of light physical activity, while walking briskly, washing clothes, mowing lawn, carrying stacks of wood, sweeping floors, and playing badminton, basketball, dancing, table tennis, volley ball, etc., for recreation would come under moderate physical activity. The vigorous or strenuous physical activities include jogging, running, hiking, shoveling, swimming, bicycling, competitive games, and sports.[5] The mild and moderate physical activities could be categorized as low-intensity exercise and vigorous would come under high intensity. Yoga, resistance training, etc., come under the category of low-intensity exercises.[4]

  Immunophysiology of Exercise Top

It has been found that moderate physical activities reduce the incidence of viral respiratory infections by enhancing the immune response. This is evident by the increase in neutrophil and natural killer cells (NK cells) along with the rise in salivary IgA levels. Moderate physical activity also aides in release of stress hormones, which in turn helps in reduction of excessive inflammation. The end result of all these would be change in Th1/Th2 cell response, boosting the immunity against the viral infections.[6]

However, high-intensity or vigorous physical activity seems to have an opposite and detrimental effect due to immunosuppression.[6] This is because of the fact that, the high-intensity exercises both short and long term (more than 60 min) could stimulate NK cell cytotoxicity and weaken the immune system.[7] There could also be a short-term suppression of the immune system following a bout of exhaustive exercise, a hypothesis known as “open window” theory, making the performer more susceptible for upper respiratory illness.[8] This has been well supported by the incidence of more frequent infections in athletes who carry out strenuous exercise.[9] This observation has also been reiterated during this COVID-19 pandemic. Although anecdotal, we do have reports of young and fit international celebrity athletes with no comorbidities and healthy life style without any history of smoking, developing severe form of COVID-19 including pneumonias. Hence, it is very interesting that healthy life style with strong lungs does not make any difference to their morbidity and susceptibility to COVID-19.[4],[10],[11] This could be due to the fact that they were practicing high-intensity exercise.

  Imminent Risks of Exercise in COVID-19 Patients Top

There are reports of COVID-19 patients having asymptomatic pneumonias without any signs, diagnosed during routine computed tomography chest. Hence, in such situations, carrying out exercise could result in aggravation hypoxia if practiced without pulmonary evaluation.[12] There is also evidence of reduction of pulmonary function in COVID-19 patients by 20%–30%.[13] Similarly, COVID-19 patients have shown a prevalence of 23%–28% myocardial injury, and this is shown to occur at different phases of this viral infection and, sometimes, as late as 7 days following the onset of symptoms. Hence, exercising in such scenario could aggravate silent myocardial injuries.[14] Thus, there is always a risk of underlying silent diseases getting aggravated by exercise while ailing from COVID-19.

The lessons learned in the past in the patients with symptoms of upper respiratory tract infections such as influenza could become handy now. The “neck check rule” which categorizes patients of upper respiratory tract infections into those who have symptoms above the neck such as cough, sneezing, and sore throat, as well as symptoms below the neck such as myalgia, fever, and gastrointestinal symptoms, would be our guide to carry out exercise or not. As per this guide, anyone who has symptoms below the neck should avoid physical exercise until full recovery and those with pneumonia much more than 4 weeks. Those who are having symptoms above the neck like cough, sneezing and sore throat can try jogging for 10 minutes and if there is worsening of general health following that, the patient should abstain from continuing any more exercise during the course of the illness. The patients with no change after a jog are permitted to exercise but below 80% of VO2 max.[6] The fever per se results in higher insensible fluid loss, accelerates the metabolism, and could be detrimental in the functioning of musculoskeletal system by way of decrease in the endurance and strength, eventually leading to undue fatigue.[15]

  Conclusion Top

Mild or light and moderate exercise is beneficial to the COVID-19 patients, whereas vigorous or high-intensity exercise would be detrimental. Over enthusiasm to carry out physical exercise without proper medical evaluation of the pulmonary and cardiac function could be counterproductive.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Abdurachman, Herawati N. The role of psychological well-being in boosting immune response: An optimal effort for tackling infection. Afr J Infect Dis 2018;12:54-61.  Back to cited text no. 1
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. CMAJ 2006;174:801-9.  Back to cited text no. 2
Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, et al. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev 2020;26:8-22.  Back to cited text no. 3
Wackerhage H, Everett R, Krüger K, Murgia M, Simon P, Gehlert S, et al. Sport, exercise and COVID-19, the disease caused by the SARS-CoV-2 coronavirus. Dtsch Z Sportmed 2020;71:E1-12.  Back to cited text no. 4
Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32:S498-504.  Back to cited text no. 5
Halabchi F, Ahmadinejad Z, Selk-Ghaffari M. COVID-19 epidemic: Exercise or not to exercise; that is the question! Asian J Sports Med 2020;11:e102630.  Back to cited text no. 6
Zimmer P, Schenk A, Kieven M, Holthaus M, Lehmann J, Lövenich L, et al. Exercise induced alterations in NK-cell cytotoxicity - Methodological issues and future perspectives. Exerc Immunol Rev 2017;23:66-81.  Back to cited text no. 7
Kakanis MW, Peake J, Brenu EW, Simmonds M, Gray B, Hooper SL, et al. The open window of susceptibility to infection after acute exercise in healthy young male elite athletes. Exerc Immunol Rev 2010;16:119-37.  Back to cited text no. 8
Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, et al. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev 2020;26:8-22.  Back to cited text no. 9
Paterlini M. On the front lines of coronavirus: The Italian response to COVID-19. BMJ 2020;368:m1065.  Back to cited text no. 10
ITv. Coronavirus Survivor Describes His Experience | Good Morning Britain. In: 2020. Available from: https://www.youtube.com/watch?v=tbAYN9zKIJQ. [Last accessed on 2021 Mar 31].  Back to cited text no. 11
Samsami M, Zebarjadi Bagherpour J, Nematihonar B, Tahmasbi H. COVID-19 pneumonia in asymptomatic trauma patients; report of 8 cases. Arch Acad Emerg Med 2020;8:e46.  Back to cited text no. 12
Cheung E. Coronavirus: Some Recovered Patients may have Reduced Lung Function and are Left Gasping for air while Walking Briskly, Hong Kong Doctors find, in: South China Morning Post. South China Morning Post Publishers; 13 March 2020. Available from: https://www.scmp.com/news/hong-kong/health-environment/article/3074988/coronavirus-some-recovered-patients-may-have. [Last accessed on 2020 Aug 07].  Back to cited text no. 13
Cosyns B, Lochy S, Luchian ML, Gimelli A, Pontone G, Allard SD, et al. The role of cardiovascular imaging for myocardial injury in hospitalized COVID-19 patients. Eur Heart J Cardiovasc Imaging 2020;21:709-14.  Back to cited text no. 14
Dick NA, Diehl JJ. Febrile illness in the athlete. Sports Health 2014;6:225-31.  Back to cited text no. 15


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