The health crisis caused by SARS-CoV-2 (covid-19) has meant that extraordinary measures have had to be taken to prevent transmission of the virus and not to exceed the capacity of health systems. Among them is the confinement to which a large part of the world population has been subjected, more or less restrictive depending on the country. Thus, while in some countries it has been more relaxed, allowing the population to go out to exercise, always respecting social distancing measures, in others such as Spain, all sports have been suspended since March 14.
Ángel Durántez Prados is a doctor of Medicine and Surgery. Graduated in Age Management Medicine in the USA, he is a pioneer in its application in Spain.RELATED
“We are facing two pandemics simultaneously: that of covid-19 and that of physical inactivity”
And precisely one of the main consequences of confinement is being the restriction of people’s mobility, with the health risks that this situation entails. Hence, some authors have been quick to affirm that we are facing two pandemics simultaneously: the covid-19 pandemic and a pandemic of physical inactivity. Just two weeks undergoing a reduction in the number of daily steps (that is, the equivalent of reducing daily physical activity levels) is enough to produce significant musculoskeletal and metabolic impairment. To minimize it, as the World Health Organization recommends, it is important to stay active during the covid-19 pandemic.
Acute respiratory distress syndrome (ARDS) is one of the main causes of death secondary to covid-19. This respiratory complication affects 17% of patients with SARS-CoV-2 disease, 42% of those who require hospitalization for the disease, and of these, between 67% and 85% require follow-up in a Intensive Care Unit (ICU). However, Dr. Zhen Yan, from the University of Virginia, suggests that doing physical exercise could help prevent, or at least mitigate, ARDS. A single exercise session increases the release of extracellular superoxide dismutase, an antioxidant enzyme that is produced endogenously by our muscles and that reduces oxidative stress, protecting our tissues and helping to prevent disease. Precisely oxidative stress in lung tissue is implicated in the pathogenesis of various lung diseases, including ARDS, so Dr. Yan argues that it is reasonable to think that exercise could be effective in preventing ARDS secondary to covid-19. .
Cardiorespiratory fitness, popularly known as ‘endurance’, has been shown to be an important prognostic factor for many diseases such as cardiovascular or some types of cancer, and general health. Being in good physical shape could protect against some of the factors that seem to be associated with an increased risk of hospitalization and mortality in patients with covid-19, such as excess body weight, diabetes, hypertension, cardiovascular disease and COPD. Furthermore, some authors have begun to consider whether a good cardiorespiratory capacity could attenuate the proinflammatory state associated with a worse prognosis in patients with covid-19.
Obesity does indeed seem to aggravate the prognosis of the disease. Thus, in a small study carried out in a hospital in Lille (France), it w as observed that 48% and 28% of patients with covid-19 requiring admission to an ICU were obese and severely obese, respectively, while more than 50% of those who required mechanical ventilation, an indicator of impaired respiratory function, were also obese. For this reason, exercise as the main weapon, together with food, in the fight against obesity should be part of our daily life in the coming months.
Physical exercise strengthens the immune system, our main defense barrier. However, some studies have suggested that prolonged and intense training is associated with acute depression of the immune system that can last for hours or days, although there are more shadows than lights in this regard. In this way, the evidence on the ‘open window’ theory (period after a session of intense exercise in which it seems that the organism is more susceptible to a possible infection) is limited and inconsistent, and it really seems that it is not it produces a lymphopenia, but a mobilization of the lymphocytes to the peripheral tissues, where they are probably most needed at that time. In any case, and as we have been emphasizing from this space of opinion, it is best to always put yourself in the hands of training professionals to control the load and evolution of our state of health.
According to the ‘Plan for the transition to a new normality’ of April 28, starting from phase 0 or preparation of the de-escalation already established that day, “common relief measures are established for the entire country … allowing mobility outside the home, mainly in the private sphere, and measures with an associated risk of very low or no contagion, provided that the safety instructions are complied with, based on the responsibility and self-protection of citizens … For this, measures such as the next May 2 allow individual outings and exercises for adults. A necessary measure given the enormous benefits that, as we have just read, exercise has on some of the symptoms and prognosis of covid-19 disease.
Photo: Unsplash / @ iyolanda.
However, we must not let our guard down and one of the main protection measures that we must continue to maintain is that of social distancing. However, in those cases in which we go for a run or go on a bicycle, the distance of 1.5 meters that has been recommended to us since the beginning of the crisis does not seem to suffice. Thus, the data of a recent study advise keeping a safe distance with people who go in our same direction of at least 4-5 meters if walking, 10 meters if running or cycling, and 20 meters if He goes fast on the bike. This has been determined by the aerodynamic analyzes that have been carried out and which invite one to think that going to slip can be one of the main triggers of contagion, since the particles that a person releases when coughing or breathing during exercise are kept in the air for a few seconds, leaving the person behind it exposed.
The measures for de-escalation that will start tomorrow with the possibility of going out to do physical activity will allow us, in addition to enjoying the feeling of exercising outdoors, staying fit and with a strengthened immune system with which to cope with the virus. However, the risk of contagion remains high, so we must be tremendously responsible in complying with preventive measures, bearing in mind that not only our life is at stake, but also that of those around us.