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Exercising During the Pandemic
- 1. Exercising During the Pandemic DrGoh Ping Ping Asian Heart & Vascular Centre
- 2. Benefits of Exercise Regularphysical activity in the correct intensity: • Reduces risk of heart disease by 40% • Lowers risk of stroke by 20% • Reduces incidence of diabetes by almost 50% • Reduces incidence of hypertension by almost 50% • Can reduce risk and recurrence of breast cancer by almost 50% • Can reduce risk of colon cancer by almost 60% • Can reduce risk of developing Alzheimer’s disease by one third • Can decrease risk of depression as effective as Prozac or behavioural therapy “ Tremendous health benefits are seen with even low levels of exercise; Amount of exercise needed to benefit health is much lower than amount needed for fitness ”
- 3. Another Earlier Pandemic PhysicalInactivity is the fourth leading cause of death worldwide Evidence of health benefit of physical activity available since 1950s Efforts to promote PA to improve population health has lagged behind (Ref: Kohl HW et al. The Pandemic of Physical Inactivity: global action for public health Lancet. 2012;380(9838):294–305) Ref: The Global Obesity Pandemic: shaped by global drivers and local environments Prof Boyd A Swinburn, WHO Collaborating Centre for Obesity Prevention. The Lancet. August 27, 2011
- 4. Benefits of ExerciseHold True Even During Pandemic • Individuals, especially those at higher risk of COVID complications, should exercise at home or outdoors while remaining socially distanced • Those choosing to exercise inside a fitness facility should follow appropriate safety guidelines • Moderate-intensity physical exercise is a/w better immune function -- Exercise Is Medicine American College of Sports Medicine Greatest risk for severe COVID complications: • older adults (>=age 65) • people with chronic diseases (e.g. diabetes, heart disease and lung disease) • compromised immune systems (e.g. going through cancer treatment or with HIV)
- 5. Adverse Prognostic Factorsin COVID-19 Patients (Literature review of 51 articles on physical exercise and COVID-19 in PUBMed, April –June 2020) increased risk of hospitalization and mortality in COVID-19 patients • overweight/obesity • diabetes mellitus and insulin resistance • arterial hypertension and its comorbidities • coronary heart and cerebrovascular disease • sedentary behaviour, poor dietary habits, and physical inactivity (characterized by chronic and high inflammation, leading to more serious forms of COVID)
- 6. Exercise has benefitsin immunity • moderate levels of physical exercise has positive effects on many immune markers and could provide an immuno-protective effect • High cardiorespiratory fitness boost Immunity and attenuate the proinflammatory state induced by COVID-19 • ? reduce severity of cytokine storm • Animal studies – exercise reduces lung damage caused by COVID binding to ACE2 receptors. marked increases in potent anti-inflammatory cytokines such as IL-10, IL-1 receptor antagonist, IL-6 (“myokine”) and IL-37 Downregulation of the expression/activation of proinflammatory TLRs (Toll-like receptors) 8 8 8 . Obesity (2020) 28, 1378-1381
- 7. Physical Activity a/wBetter Outcome in Severe COVID Infection • 48,440 adults from Kaiser Permanente Southern California • Diagnosed COVID in 2020 • Consistently meeting physical activity guidelines vs consistently inactive • Inactive group had a greater risk of hospitalisation (OR 2.26;95% CI 1.81 to 2.83), admission to the ICU (OR 1.73; 95% CI 1.18 to 2.55) and death (OR 2.49; 95% CI 1.33 to 4.67) due to COVID-19 • Similar benefit in patients who were doing some physical activities vs inactive Sallis R, et al. Br J Sports Med 2021;55:1099–1105
- 8. 3 categories ofPA based on The Physical Activity Guidelines for Americans consistently meeting guidelines EVS >150 min/week at all assessments during the study period consistently inactive EVS 0–10 min/week at all assessments some activity EVS 11–149 min/week or those with variability in EVS measures. EVS = Exercise Vital Sign days per week and number of minutes per day engaged in moderate to strenuous exercise Ref: The Physical Activity Guidelines for Americans (JAMA 2018;320:2020-8) Highest risk of Hospitalisation ICU admission Death
- 9. Physical Activity a/wBetter Outcome in Severe COVID Infection (Kaiser Permanente Study) Conclusions: 1. Consistently meeting physical activity guidelines was strongly associated with a reduced risk for severe COVID-19 outcomes among infected adults 2. Recommend efforts to promote physical activity be prioritised by public health agencies and incorporated into routine medical care. Sallis R, et al. Br J Sports Med 2021;55:1099–1105
- 10. Vigorous exercise maysuppress immune system? • High exercise training workload, competitive events linked to physiological, metabolic and psychological stress • Early exercise immunology studies reported that heavy exertion was a/w elevated inflammatory markers and upper respiratory infections. • preliminary data suggest that transient immune dysfunction from exercise- induced suppression of metabolic function of immune cell (may be countered by increased intake of carbohydrate and polyphenols.) • Moderate and vigorous exercise bouts of < 60 minutes a/w enhanced immunosurveillance Journal of Sport & Health Science 8 (2019) 201-207
- 11. Vigorous exercise maysuppress immune system? Journal of Sport & Health Science 8 (2019) 201-207 Comparison of magnitude of immune responses between 30- to 45-min walking bout and 42.2-km marathon race J curve relationship between exercise and URTI
- 12. How Much ToExercise During the Pandemic? • 150-300 minutes per week • Cardio/aerobic physical activity: • moderate-intensity exercise 5 times a week • High-intensity exercise 3 times a week • 2 sessions per week of muscle strength training (5-20 min/session) – upper body/lower body/core
- 13. Moderate Intensity PhysicalExercise Indoor Activities • Put some music on and walk briskly around the house or up and down the stairs for 10- 15 minutes, 2-3 times per day • Dance to your favourite music • Jump rope • Exercise video • Home cardio machines Outdoor Activities • Walk or jog around your neighbourhood with safe distancing • Spending time in nature • Bicycle ride • Gardening and lawn work • racket games, golf 6 665555555
- 14. Moderate Intensity PhysicalExercise Peak Heart Rate = 220 minus age Resting Heart Rate 6 665555555 . 220 -50 170 Heart Rate Reserve = Peak - Resting Target Heart Rate = 50-70% of HRR Add back to Resting HR 170 -60 110 110 X 0.6 66 60 + 66 126
- 15. Negative Impact ofCOVID on Exercise – A Vicious Cycle? Boston Marathon postponed for first time in history in 2020, returned in early October 20210000 postponed grounded
- 16. Reduced Level ofPhysical Activity during COVID-19 Pandemic is a/w Depression and Anxiety Levels (Puccinelli et al. BMC Public Health (2021) 21:425) • Internet survey of 2140 Brazilians, both gender, mean age 38.6 yrs • March to June 2020, Brazilian government adopted emergency measures nationwide, including closure of schools and universities, parks, commercial activities and non-essential services Results: • reduction of physical activity level (IPAQ) due to social distancing compared to pre-pandemic • 30% of participants exhibit moderate to severe symptoms of depression (PHQ-9), 23% moderate to severe symptoms of anxiety (GAD-7) compared to pre-pandemic prevalence of 5-10% • More symptoms of depression and anxiety is a/w reduction in physical activity, greater adherence to social distancing measures, lower income and younger age (? Greater exposure to social media)
- 17. How Did PandemicAffect Exercise? Generally decrease in Physical Exercise • Work from home • Gym closure • Safe distancing • Mask wearing More physically and mentally vulnerable Negative impact on fighting infection
- 18. Perception and Behaviourof “Fitness Freaks” during Lockdown in COVID-19 Pandemic (Harleen Kaur et al. Frontiers in Psychology. October 2020, vol 11) 22 subjects, mostly male, mean age 26, frequent gym goers • Initial negative situational perception and lack of motivation for fitness exercise • psychological health concerns and overdependence on social media in spending free time • Followed by gradual increase in positive self-perception and motivation to overcome dependence on gym and fitness equipment and to continue fitness exercises at home • Common activities - yoga and meditation, high-intensity workout, lifting heavy buckets/ big water bottles, and skipping • listening to music and social media help adherence to home workout. • regular home workout during lockdown greatly helped to overcome psychological issues and fitness concerns
- 19. Sedentary behaviour isan independent risk factor • any waking behaviour characterized by an energy expenditure ≤ 1.5 METs, while in a sitting, reclining or lying posture • “screen time” (TV viewing, videogame playing, computer use), car-driving, and reading
- 20. Sedentary Behaviour isa/w Adverse Outcomes • meta-analysis of 34 studies (up to 2016) • 1,331,468 community-dwelling participants • total sitting time > 6 - 8 h/day ; TV viewing time > 3–4 h/day were associated with increased risk of all-cause death and CV death in PA adjusted analyses Patterson R et al. Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol. (2018) 33:811–29
- 21. If you arehomebound (QO) or need to sit for long period (WFH) • Get up and walk around the house or do some active chore • 5 minutes after every hour of sitting • During every commercial break if watching TV • Build a Home-based Physical Activity Routine Need to increase Physical Activity, but also decrease Sedentary Behaviour!
- 22. Setting up aHome Based Routine (I) Strengthening Activity • squats, single-leg balancing, push-ups, sit-ups and side planks • Can be done using own body weight • Equipment: barbells, ankle weights and exercise bands Conditioning Activity • Calisthenics, such as jumping jacks, jogging in place • Dancing to fast music • stationary exercise bike • YouTube exercise videos
- 23. Setting up aHome Based Routine (II) Flexibility Activity • Daily stretching exercise • 2-3 times a week after aerobic/strength exercises Sport-specific exercise • skills used in running track, soccer, basketball and other sports √ x
- 24. Home-based exercises recommendedby WHO Knee to elbow • 1-2 minutes, rest 30-60 sec, repeat up to 5 times Plank • Hold at least 20-30 sec, rest 30-60 sec, repeat up to 5 times
- 25. Home-based exercises recommendedby WHO Back extension • 10-15 times or more, rest 30-60 sec, repeat up to 5 times Squats • 10-15 times or more, rest 30-60 sec, repeat up to 5 times
- 26. Home-based exercises recommendedby WHO Side knee lifts. • 1-2 min, rest 30-60 sec, repeat up to 5 times Superman • 20-30 times or more, rest 30-60 sec, repeat up to 5 times
- 27. Home-based exercises recommendedby WHO Bridge • 10-15 times, rest 30-60 sec, repeat up to 5 times Chair dips • 10-15 times or more, rest 30-60 sec, repeat up to 5 times
- 28. Home-based exercises recommendedby WHO Chest opener • hold 20-30 sec • Stretches chest and shoulder Seated meditation • Straight back, close eyes, relax body • Concentrate on breathing and progressively deepen breathing • 5 minutes Legs up the wall • Concentrate on breathing and progressively deepen breathing • 5 minutes • Relax, destressing
- 29. Post-Pandemic: Easing Backinto Exercise Safely • Avoid .rapid change in activity level • Ensure regular work on flexibility, strength and conditioning at home before jumping back into a sport • Introduce outdoor activities such as jogging or biking to prepare for more intensive sports activity • Ease in: start slowly and work up to the prepandemic level • Apply the “10 percent rule” to avoid overuse/excessive stress on bone, muscle or joint e.g. if someone is running 10 km per week, increase the distance to 11 km the following week • Listen to your body: any type of pain is a sign to take a break
- 30. Returning to theGym after Lockdown There is likely a difference from pre-COVID fitness level 1. less is more: be prepared to take 1-2 days break in between 2. start slow, focus on movement quality over quantity, address muscle imbalances Able to engage your core and maintain a neutral spine when performing a plank? Able to keep your hip, knee, and ankle aligned when balancing on one leg? Able to get your thighs parallel to the ground when doing a squat? Able to bring your arms overhead without arching through your lower back? 3. Plan ahead – strength/ conditioning/ flexibility 4. Seek help from fitness professional
- 31. General advice forpatients about exercising outdoors • Avoid crowded area • Keep 2 m from others, assume everyone is potentially infectious • Solo exercising is preferred • Avoid making conversation during exercise • Do not travel for exercise – start from your front door • At-risk group, exercise inside or in own compound • Limit hand-to-face contact • When outdoors, minimise touching common surfaces e.g. left hand to press crossing button, right hand to hold towel/water bottle/ adjust glasses etc, wash hands thoroughly when reach home • Do not take risk, avoid busy road and risky form of exercise
- 32. Does wearing facemask affect exercise performance • Randomised trial to study effect of cloth mask, surgical mask and no mask during bicycle ergometry • 7 men and 7 women, young healthy subjects • No difference in time to exhaustion, peak power, blood oxygen saturation, tissue oxygenation index, perceived exertion, heart rate during exercise • Conclusion - wearing a face mask during vigorous exercise had no discernable detrimental effect on blood or muscle oxygenation, and exercise performance in young, healthy participants Shaw et al. Int. J. Environ. Res. Public Health 2020, 17, 8110
- 33. Take Home Points •Encourage your patients to exercise • Exercise benefits health even without achieving high fitness level • Moderate-intensity physical exercise is a/w better immune function
- 34. Exercising During the Pandemic DrGoh Ping Ping Asian Heart & Vascular Centre