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The case for promoting physical activity amidst the COVID-19 pandemic

2020; Elsevier BV; Volume: 24; Issue: 4 Linguagem: Inglês

10.1016/j.jsams.2020.11.019

1440-2440

George Siopis,

COVID-19 and Mental Health

The coronavirus disease-2019 (COVID-19) pandemic has reportedly resulted in more than one and a half million deaths worldwide. It has been proposed that people of older age and those with certain medical conditions are at higher risk of adverse outcomes, including death. Yet, a plethora of people that have surpassed the average life expectancy have recovered from COVID-19 infections, including more than fifty centenarians.1Gerontology Wiki. List of oldest people with Covid-19. Available from https://gerontology.wikia.org/wiki/List_of_oldest_people_with_COVID-19. (Accessed 19 November 2020).Google Scholar Interestingly, these older survivors do not phenotypically manifest signs of metabolic syndrome, as their BMI appears to be within the normal range. It is important to shine light in what prevents adverse outcomes in survivors with COVID-19. A meta-analysis described an increased risk of mortality for overweight (BMI > 25.0 kg m−2) people with COVID-19.2Hussain A. Mahawar K. Xia Z. et al.Obesity and mortality of COVID-19. Meta-analysis.Obes Res Clin Pract. 2020; 14: 295-300Crossref PubMed Scopus (263) Google Scholar These accumulating data raise the question whether obesity and its associated comorbidities, such as diabetes, hypertension and cardiovascular disease may be better predictors of adverse outcomes for COVID-19 infections, than the ageing-associated immunosenescence. Reports indicate that, of the deceased due to COVID-19, only 6% in the US,3Centers for Disease and Control Prevention. National Center for Health Statistics. Weekly Updates by Select Demographic and Geographic Characteristics. Provisional Death Counts for Coronavirus Disease 2019 (COVID-19). Updated September 16 2020. Available from https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm?fbclid=IwAR3-wrg3tTKK5-9tOHPGAHWFVO3DfslkJ0KsDEPQpWmPbKtp6EsoVV2Qs1Q&_ga=2.83596054.1497558416.1598967201-386365132.1598967194#Comorbidities. (Accessed 19 November 2020).Google Scholar 9% in Australia4COVID-19 National Incident Room Surveillance Team. COVID-19, Australia: Epidemiology Report 20. Fortnightly reporting period ending 5 July 2020.Google Scholar and 3.9% in Italy5Statista. Number of comorbidities observed in COVID-19 deceased patients in Italy as of July 22, 2020. Available from https://www.statista.com/statistics/1110906/comorbidities-in-covid-19-deceased-patients-in-italy/. (Accessed 19 November 2020).Google Scholar had no known comorbidities. The case fatality ratio is also higher in American, European, and Middle Eastern countries that exhibit higher prevalence rates of obesity and metabolic syndrome, compared with African countries.6Johns Hopkins. Coronavirus Resource Center. Mortality Analysis. Mortality in the most affected countries. Available from https://coronavirus.jhu.edu/data/mortality?fbclid=IwAR14OFu1-qNvOCHuctDoRp6s0_rImbxBN83sU0dEHn8Ogp1tce7hKytPXg8. (Accessed 19 November 2020).Google Scholar A possible explanation is the likely greater production of Vitamin D due to increased sun exposure in the African continent. Vitamin D is known to possess immunomodulatory properties and its deficiency has been linked to COVID-19 hospitalisations.7Hernández J.L. Nan D. Fernandez-Ayala M. et al.Vitamin D status in hospitalized patients with SARS-CoV-2 infection.J Clin Endocrinol Metabolism. 2020; (dgaa733)Crossref PubMed Scopus (188) Google Scholar Another explanation is a possible link between obesity prevalence and adverse outcomes. Lifestyle can affect weight management and it has been discussed in terms of its effect on COVID-19 hospitalisations, with physical inactivity, increased body fat and smoking all independently increasing hospital admissions in COVID-19 patients.8Hamer M. Kivimäki M. Gale C.R. Batty G.D. Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK.Brain Behav Immun. 2020; 87: 184-187Crossref PubMed Scopus (333) Google Scholar Low grade inflammation has been proposed as a possible mechanism. A chronic state of low-grade systemic inflammation characterises obesity due to an increase in the production of reactive oxygen species. Visceral adipose tissue inflammation has been linked to the development of insulin resistance. The concomitant hyperglycaemia results in an impaired immune system function and an increased susceptibility to infections (Fig. 1). Diet, physical activity and sleep can all independently improve body composition, lower chronic inflammation and boost the immune system's function. Data demonstrate that elite athletes, such as professional basketball players, appear protected from the adverse effects of COVID-19 infections. During the resumption of the National Basketball Association (NBA) league between July and October 2020, at least 41 elite basketball players tested positive for COVID-19.9CBS Sports. Coronavirus: Russell Westbrook, Nikola Jokic, Eric Bledsoe among NBA players who tested positive. Available from https://www.cbssports.com/nba/news/coronavirus-russell-westbrook-nikola-jokic-eric-bledsoe-among-nba-players-who-tested-positive/. (Accessed 19 November 2020).Google Scholar They all reportedly recovered successfully, with no signs of loss in performance or other adverse effects. Some of these players achieved career high performances following recovery from the infection,10NBA.com. Donovan Mitchell's 57 points rank third in NBA single-game playoff history. Available from https://www.nba.com/article/2020/08/17/donovan-mitchell-third-most-points-playoff-history#:∼:text=Though%20it%20wasn't%20enough,most%20in%20NBA%20postseason%20history (Accessed 19 November 2020).Google Scholar, 11Essentially sports. Nikola Jokic sets multiple records during historic performance in game 7 against clippers. Available from https://www.essentiallysports.com/nba-news-basketball-denver-nuggets-nikola-jokic-sets-multiple-records-during-historic-performance-in-game-7-against-la-clippers-orlando-bubble/. (Accessed 19 November 2020).Google Scholar indicating no decline in acceleration, endurance or reaction rate and therefore suggesting no adverse effects on the anaerobic and aerobic capacity and on the nervous system of elite basketball players. Athletes exhibit an improved maximal aerobic capacity and a favourable body composition compared to sedentary people, with the latter being evident even when the two populations have the same total amount of body fat. A recent review highlighted the effect of the differential fat distribution on cardiometabolic outcomes.12Stefan N. Causes, consequences, and treatment of metabolically unhealthy fat distribution.Lancet Diabetes Endocrinol. 2020; 8: 616-627Abstract Full Text Full Text PDF PubMed Scopus (312) Google Scholar Physical activity promotes reduction in visceral adipose tissue, decreasing thus the risk of adverse cardiometabolic outcomes. The COVID-19 pandemic presents an opportunity to raise awareness on the importance of leading a healthy lifestyle to reduce morbidity and mortality and to increase lifespan and improve quality of life. In addition to the spread of infectious diseases, it has been demonstrated that obesity can too be spread through social connections, with chances of becoming obese increasing by 57% for people who have an obese friend.13Christakis N.A. Fowler J.H. The spread of obesity in a large social network over 32 years.N Engl J Med. 2007; 357: 370-379Crossref PubMed Scopus (3557) Google Scholar The development of an effective and safe COVID-19 vaccine is necessary to address the urgent short-term problem, however, given the worldwide obesity prevalence, the population will remain prone to all the chronic and other communicable risk factors if emphasis is not placed on treating the underlying cause for most of the global morbidity and mortality. The increasing obesity prevalence also poses an opportunity for more potent communicable agents, as it has been demonstrated that the chance of more virulent strains is increased in obese populations due to prolonged viral shedding that may increase the overall mortality rate.14Luzi L. Radaelli M.G. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic.Acta Diabetol. 2020; 57: 759-764Crossref PubMed Scopus (257) Google Scholar The World Health Organisation laid down the principles of health promotion in the "Ottawa Charter" in 1986. Thirty-four years later, obesity rates have been increasing and physical activity has been decreasing. A 2009 review indicated declining rates of fitness and physical activity in young people, raising the alarm for the future.15Knuth A.G. Hallal P.C. Temporal trends in physical activity: a systematic review.J Phys Act Health. 2009; 6: 548-559Crossref PubMed Scopus (231) Google Scholar It is recommended that strong physical activity initiatives are employed on a population level. The education on maintaining hygienic practices, such as washing hands regularly, wearing a mask and socially distancing, should be followed by education on the importance of physical activity and achieving a favourable body composition. The unique opportunity for a drastic and sustainable change in public health that COVID-19 presents should not be wasted. Nil for this study. George Siopis is a recipient of the University of Sydney International Scholarship Strategic Fund and of the Neville Whiffen Scholarship. Neither of these bodies had any role in the preparation, writing or approval of the manuscript; or decision to submit the manuscript for publication.