Covid-19 – impact on exercise, how to exercise and are face masks the ultimate solution?
A lot of you are very keen on getting back to the gym and resuming indoor training. Under normal circumstances such interest in exercise would be very welcomed. It also worth noting that I am writing this as a fitness professional whom business suffered due to this pandemic.
This crazy drive to get back to the gym ASAP reminds me of all the online fitness classes from when the pandemic broke out. Not a lot of planning was put into it, it was the case of trying to carry on with your usual routine. The real kick in the teeth is that most of it is disguised under “exercise is good for you”. Whilst this statement remains true for the most part, we need to remember there’s more to it. For example, Nieman D. C., & Wentz L. M. (2019) found that exercise of moderate to vigorous activity of duration less than 60 min is an important part of stimulating your immune system. In contrast, high exercise training workloads and competition events are linked with a negative impact on your immune system. As it often is the case, the truth lies somewhere in between.
The most important question in the current climate is – how does pulmonary (lung) disease impact your training?
A very interesting research conducted by Madjid M., Safavi-Naeini P., Solomon SD., et al. (2020) explored the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). This virus causes a viral pneumonia with additional complications, including damage to the lungs (fibrosis – scarring of the connective tissue in the lungs which leads to a reduction of the lung capacity) and to the myocardium layer of the heart leading to myocarditis – inflammation of the heart muscle. Granted, majority of the cases are mild and don’t require hospitalisation, nonetheless they cause a fairly severe overload of the immune system. According to Madjid M., Safavi-Naeini P., Solomon SD., et al. (2020), lessons from the previous coronavirus and influenza epidemics suggest that viral infections can trigger acute coronary syndromes, arrhythmias and development of exacerbation of heart failure, primarily owing to a combination of a significant systemic inflammatory response plus localized vascular inflammation.
To simplify – just because your symptoms and the disease did not require hospitalisation, it doesn’t mean you will not develop complications down the line. This unfortunately can be enhanced by a premature return to physical activity. What is even more dangerous is that we don’t know all that much about the virus and we’re only speculating about severity of these potential complications.
Until specific and effective antiviral therapies against SARS-CoV-2 become available, the treatment of COVID-19 will be primarily based on supportive care and treatment of complications. [Madjid M., Safavi-Naeini P., Solomon SD. Et al. (2020)]
Where does it leave us with exercise?
First of all, despite this statement upsetting a lot of fitness professionals, the government are quite right in the way they’re dealing with this. Introducing masks and gloves produces a false sense of security but I’ll get back to this later.
It should go without saying that during the acute phase of Covid-19 you must contact your GP and follow their instructions with utmost diligence. You most likely won’t be able to exercise and nor should you. Upon the full resolution of symptoms, your GP will advise when you’re ready to leave the house and short walks might be in order to build up some capacity. You most likely are going to find these very tiring.
Typically, recovery from respiratory viral infections takes 2–3 weeks, which corresponds with the time it takes your immune system to generate cytotoxic T cells necessary to clear the virus from infected cells says Dr. Jeffrey A. Woods in an interview Zhu W. (2020).
Unfortunately there aren’t any clear guidelines but some principles would apply:
1. Walk before you run.
2. Take plenty of breaks.
3. Start with bodyweight/as low intensity as possible.
4. Gradually build it up.
5. Stay hydrated during exercise.
6. Gauge your fatigue levels – do not overdo it.
What about training with a mask on?
Wearing a mask and gloves might seem like the perfect solution to get back in the gym as quickly as possible and to keep you safe. While it might make the environment safer (note the word SAFER – the environment won’t be entirely safe until a working vaccine has been developed) for the most, it is also creating an illusion of being safe in a very volatile setting.
Person E. et al. (2018) conducted a research on the effects of wearing a surgical mask during a six minute walk. This is a very common test used in pulmonology. Dyspnea (shortness of breath) was significantly higher in the subjects wearing masks. People with underlying respiratory or cardiovascular conditions should be careful in this case. People who have not done any exercise in the past few weeks should be rather careful as well. Masks do hinder your breathing. Under no circumstances should you re-use a mask that has been worn and not properly cleaned or disinfected (assuming it’s multi-use).
It is important to also ask this question when considering training in a gym - how long can the new coronavirus linger on surfaces? The short answer is, we don't know. A new analysis found that the virus can remain viable in the air for up to 3 hours, on copper for up to 4 hours, on cardboard up to 24 hours and on plastic and stainless steel up to 72 hours van Doremalen N. et al. (2020).
Despite the best intentions and efforts it may be very difficult to maintain the right level of cleanliness in a commercial space where perspiration is ever so present.
The safest environment for training includes outdoors whilst maintaining of the social distancing rules, followed by proper hand hygiene protocols.
Conclusion
It is a very unusual situation we are finding ourselves in, it is very difficult indeed to determine what the right course of action is. In times like these, our choice falls down upon our own personal standards. I would like to sum this up by borrowing a formula/method commonly used in economy and finance – the reward/risk formula. Is the reward of going to the gym worth the risk that it imposes? I will leave that with you to consider because at the end of the day, we will do as we please.
References
Nieman, D. C., & Wentz, L. M. (2019). The compelling link between physical activity and the body's defense system. Journal of sport and health science, 8(3), 201–217. https://doi.org/10.1016/j.jshs.2018.09.009
Madjid M., Safavi-Naeini P., Solomon SD, et al. (2020) Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. doi:10.1001/jamacardio.2020.1286
Zhu W. (2020). Should, and how can, exercise be done during a coronavirus outbreak? An interview with Dr. Jeffrey A. Woods. Journal of sport and health science, 9(2), 105–107. https://doi.org/10.1016/j.jshs.2020.01.005
Person E., Lemercier C., Royer A., et al. (2018). Effect of a surgical mask on six minute walking distance. Rev Mal Respir. 2018 Mar;35(3):264-268. doi: 10.1016/j.rmr.2017.01.010
Van Doremalen N. et al. (2020) Aerosol and Surface Stability of SARS-CoV 2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382:1564-1567 DOI: 10.1056/NEJMc2004973