Effect of physical activity on COVID-19 symptoms: A narrative review
Abstract
In 2019, a new condition caused by the COVID-19, became a global pandemic, presenting a disparate symptomatological picture. The immune response to the virus depends on multiple factors, making the practice of physical exercise an important enhancer of the immune system, but it is unknown what effects it could have on the very different symptoms. In order to achieve and summarize the most outstanding information on the influence of the different types and parameters of physical exercise on the immune system and symptoms presented by COVID-19, it was decided to carry out a review of the literature in the databases PubMed and Medline until August 2020. The results showed that while high intensity and prolonged volume exercise produces counterproductive alterations in the immune system, increasing the possibility of contracting infections; low and moderate intensity exercise reverses these effects, increasing the benefits, providing the body with better protection against viruses. For the symptoms of COVID-19 related to cough, dyspnea, pulmonary obstruction, hypoxia, muscle pain and neuromuscular conditions, exercise at low and moderate intensity is recommended, while those people who present gastrointestinal symptoms and fatigue are recommended to exercise at low intensity. Exercise is completely contraindicated in case of fever and myocarditis.
Keywords
References
Ament, W., & Verkerke, G. J. (2009). Exercise and Fatigue. Sports Medicine, 39(5), 389-422. https://doi.org/10.2165/00007256-200939050-00005
Andersen, C. J., Murphy, K. E., & Fernandez, M. L. (2016). Impact of Obesity and Metabolic Syndrome on Immunity. Advances in Nutrition, 7(1), 66-75. https://doi.org/10.3945/an.115.010207
Aranda, F. (2006). Presentación por escrito de la revisión bibliográfica. Buenos Aires. Universidad Adventista del Plata. Secretaría de Ciencia y Técnica. Available at: http://paveca3.blogspot.com/2010/11/presentacion-por-escrito-dela-revision.html
Ayres, J. S. (2020). A metabolic handbook for the COVID-19 pandemic. Nature Metabolism, 2(7), 572-585. https://doi.org/10.1038/s42255-020-0237-2
Bellar, D. M., Muller, M. D., Barkley, J. E., Kim, C. H., Ida, K., Ryan, E. J., Bliss, M. V., & Glickman, E. L. (2011). The Effects of Combined Elastic- and Free-Weight Tension vs. Free-Weight Tension on One-Repetition Maximum Strength in the Bench Press. Journal of Strength and Conditioning Research, 25(2), 459-463. https://doi.org/10.1519/jsc.0b013e3181c1f8b6
Bossenbroek, L., de Greef, M. H., Wempe, J. B., Krijnen, W. P., & ten Hacken, N. H. (2011). Daily Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review. COPD: Journal of Chronic Obstructive Pulmonary Disease, 8(4), 306-319. https://doi.org/10.3109/15412555.2011.578601
Broom, M. (2007). Physiology of fever. Paediatric Nursing, 19(6), 40-44. https://doi.org/10.7748/paed.19.6.40.s32
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., Xia, J., Yu, T., Zhang, X., & Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), 507-513. https://doi.org/10.1016/s0140-6736(20)30211-7
Chowdhury, M. A., Hossain, N., Kashem, M. A., Shahid, M. A., & Alam, A. (2020). Immune response in COVID-19: A review. Journal of Infection and Public Health, 13(11), 1619-1629. https://doi.org/10.1016/j.jiph.2020.07.001
da Silveira, M. P., da Silva Fagundes, K. K., Bizuti, M. R., Starck, D., Rossi, R. C., & de Resende e Silva, D. T. (2020). Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature. Clinical and Experimental Medicine, 21(1), 15-28. https://doi.org/10.1007/s10238-020-00650-3
Damiot, A., Pinto, A., Turner, J., & Gualano, B. (2020). Immunological Implications of Physical Inactivity among Older Adults during the COVID-19 Pandemic. Gerontology, 66(5), 431-438. https://doi.org/10.1159/000509216
Demoulin-Alexikova, S., Marchal, F., Bonabel, C., Demoulin, B., Foucaud, L., Coutier-Marie, L., Schweitzer, C. E., & Ioan, I. (2017). Down-Regulation of Cough during Exercise Is Less Frequent in Healthy Children than Adults. Role of the Development and/or Atopy? Frontiers in Physiology, 8. https://doi.org/10.3389/fphys.2017.00304
Denay, K. L., Breslow, R. G., Turner, M. N., Nieman, D. C., Roberts, W. O., & Best, T. M. (2020). ACSM Call to Action Statement: COVID-19 Considerations for Sports and Physical Activity. Current Sports Medicine Reports, 19(8), 326-328. https://doi.org/10.1249/jsr.0000000000000739
Dick, N. A., & Diehl, J. J. (2013). Febrile Illness in the Athlete. Sports Health: A Multidisciplinary Approach, 6(3), 225-231. https://doi.org/10.1177/1941738113508373
Egerton, T., Chastin, S. F. M., Stensvold, D., & Helbostad, J. L. (2015). Fatigue May Contribute to Reduced Physical Activity Among Older People: An Observational Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 71(5), 670-676. https://doi.org/10.1093/gerona/glv150
Elgert, K. D. (2009). Immunology: understanding the immune system. John Wiley & Sons.
Eichhorn, C., Bière, L., Schnell, F., Schmied, C., Wilhelm, M., Kwong, R. Y., & Gräni, C. (2020). Myocarditis in Athletes Is a Challenge. JACC: Cardiovascular Imaging, 13(2), 494-507. https://doi.org/10.1016/j.jcmg.2019.01.039
Eckert, D. J., Catcheside, P. G., Stadler, D. L., McDonald, R., Hlavac, M. C., & McEvoy, R. D. (2006). Acute sustained hypoxia suppresses the cough reflex in healthy subjects. American journal of respiratory and critical care medicine, 173(5), 506-511. https://doi.org/10.1164/rccm.200509-1455OC
Ferreira, M. J., Irigoyen, M. C., Consolim-Colombo, F., Saraiva, J. F. K., & De Angelis, K. (2020). Vida Fisicamente Ativa como Medida de Enfrentamento ao COVID-19. Arquivos Brasileiros de Cardiologia. Published. https://doi.org/10.36660/abc.20200235
Gleeson, M., Bishop, N., Oliveira, M., McCauley, T., Tauler, P., & Muhamad, A. S. (2011). Respiratory infection risk in athletes: association with antigen-stimulated IL-10 production and salivary IgA secretion. Scandinavian Journal of Medicine & Science in Sports, 22(3), 410-417. https://doi.org/10.1111/j.1600-0838.2010.01272.x
Guan, W. J., Ni, Z. Y., Hu, Y., Liang, W. H., Ou, C. Q., He, J. X., Liu, L., Shan, H., Lei, C. L., Hui, D. S., Du, B., Li, L. J., Zeng, G., Yuen, K. Y., Chen, R. C., Tang, C. L., Wang, T., Chen, P. Y., Xiang, J., . . . Zhong, N. S. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18), 1708-1720. https://doi.org/10.1056/nejmoa2002032
Guo, Y. R., Cao, Q. D., Hong, Z. S., Tan, Y. Y., Chen, S. D., Jin, H. J., Tan, K. S., Wang, D. Y., & Yan, Y. (2020). The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Military Medical Research, 7(1). https://doi.org/10.1186/s40779-020-00240-0
Guyton, A. C., & Hall, J. E. (2011). Fisiologia Medica (11.a ed.). Elsevier Science Health Science Div.
Halle, M., Binzenhöfer, L., Mahrholdt, H., Johannes Schindler, M., Esefeld, K., & Tschöpe, C. (2020). Myocarditis in athletes: A clinical perspective. European Journal of Preventive Cardiology. Published. https://doi.org/10.1177/2047487320909670
Hammami, A., Harrabi, B., Mohr, M., & Krustrup, P. (2020). Physical activity and coronavirus disease 2019 (COVID-19): specific recommendations for home-based physical training. Managing Sport and Leisure, 1-6. https://doi.org/10.1080/23750472.2020.1757494
Harris, M. D. (2011). Infectious Disease in Athletes. Current Sports Medicine Reports, 10(2), 84-89. https://doi.org/10.1249/jsr.0b013e3182142381
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., . . . Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497-506. https://doi.org/10.1016/s0140-6736(20)30183-5
Kantorowski, A., Wan, E. S., Homsy, D., Kadri, R., Richardson, C. R., & Moy, M. L. (2018). Determinants and outcomes of change in physical activity in COPD. ERJ Open Research, 4(3), 00054-02018. https://doi.org/10.1183/23120541.00054-2018
Katajisto, M., Kupiainen, H., Rantanen, Kilpeläinen, Lindqvist, A., Tikkanen, & Laitinen, T. (2012). Physical inactivity in COPD and increased patient perception of dyspnea. International Journal of Chronic Obstructive Pulmonary Disease, 743. https://doi.org/10.2147/copd.s35497
Lancaster, G. I., Halson, S. L., Khan, Q., Drysdale, P., Wallace, F., Jeukendrup, A. E., Drayson, M. T., & Gleeson, M. (2004). Effects of acute exhaustive exercise and chronic exercise training on type 1 and type 2 T lymphocytes. Exercise immunology review, 10, 91-106.
Lancaster, G. I., Khan, Q., Drysdale, P. T., Wallace, F., Jeukendrup, A. E., Drayson, M. T., & Gleeson, M. (2005). Effect of prolonged exercise and carbohydrate ingestion on type 1 and type 2 T lymphocyte distribution and intracellular cytokine production in humans. Journal of Applied Physiology, 98(2), 565-571. https://doi.org/10.1152/japplphysiol.00754.2004
Liu, J., Li, S., Liu, J., Liang, B., Wang, X., Wang, H., Li, W., Tong, Q., Yi, J., Zhao, L., Xiong, L., Guo, C., Tian, J., Luo, J., Yao, J., Pang, R., Shen, H., Peng, C., Liu, T., . . . Zheng, X. (2020). Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine, 55, 102763. https://doi.org/10.1016/j.ebiom.2020.102763
Maron, B. J., Levine, B. D., Washington, R. L., Baggish, A. L., Kovacs, R. J., & Maron, M. S. (2015). Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 2: Preparticipation Screening for Cardiovascular Disease in Competitive Athletes. Circulation, 132(22). https://doi.org/10.1161/cir.0000000000000238
Martins, W. R., de Oliveira, R. J., Carvalho, R. S., de Oliveira Damasceno, V., da Silva, V. Z. M., & Silva, M. S. (2013). Elastic resistance training to increase muscle strength in elderly: A systematic review with meta-analysis. Archives of Gerontology and Geriatrics, 57(1), 8-15. https://doi.org/10.1016/j.archger.2013.03.002
Mitchell, R. N., Kumar, V., Abbas, A. K., & Aster, J. C. (Eds.). (2017). Compendio de Robbins y Cotran. Patología estructural y funcional. Elsevier Health Sciences.
Mohammadi, S., Moosaie, F., & Aarabi, M. H. (2020). Understanding the Immunologic Characteristics of Neurologic Manifestations of SARS-CoV-2 and Potential Immunological Mechanisms. Molecular Neurobiology, 57(12), 5263-5275. https://doi.org/10.1007/s12035-020-02094-y
Narici, M., Vito, G. D., Franchi, M., Paoli, A., Moro, T., Marcolin, G., Grassi, B., Baldassarre, G., Zuccarelli, L., Biolo, G., di Girolamo, F. G., Fiotti, N., Dela, F., Greenhaff, P., & Maganaris, C. (2020). Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. European Journal of Sport Science, 21(4), 614-635. https://doi.org/10.1080/17461391.2020.1761076
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
Nyenhuis, S. M., Greiwe, J., Zeiger, J. S., Nanda, A., & Cooke, A. (2020). Exercise and Fitness in the Age of Social Distancing During the COVID-19 Pandemic. The Journal of Allergy and Clinical Immunology: In Practice, 8(7), 2152-2155. https://doi.org/10.1016/j.jaip.2020.04.039
Peake, J. M., Della Gatta, P., Suzuki, K., & Nieman, D. C. (2015). Cytokine expression and secretion by skeletal muscle cells: regulatory mechanisms and exercise effects. Exercise immunology review, 21, 8-25.
Peake, J. M., Neubauer, O., Walsh, N. P., & Simpson, R. J. (2017). Recovery of the immune system after exercise. Journal of Applied Physiology, 122(5), 1077-1087. https://doi.org/10.1152/japplphysiol.00622.2016
Pelliccia, A., Solberg, E. E., Papadakis, M., Adami, P. E., Biffi, A., Caselli, S., La Gerche, A., Niebauer, J., Pressler, A., Schmied, C. M., Serratosa, L., Halle, M., Van Buuren, F., Borjesson, M., Carrè, F., Panhuyzen-Goedkoop, N. M., Heidbuchel, H., Olivotto, I., Corrado, D., . . . Sharma, S. (2018). Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). European Heart Journal, 40(1), 19-33. https://doi.org/10.1093/eurheartj/ehy730
Peters, H. P., De Vries, W. R., Vanberge-Henegouwen, G. P., & Akkermans, L. M. (2001). Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut, 48(3), 435-439. https://doi.org/10.1136/gut.48.3.435
Peters, H. P. F. (2001). Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut, 48(3), 435-439. https://doi.org/10.1136/gut.48.3.435
Prompetchara, E., Ketloy, C., & Palaga, T. (2020). Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pacific journal of allergy and immunology, 38(1), 1-9. https://doi.org/10.12932/AP-200220-0772
Puetz, T. W. (2006). Physical Activity and Feelings of Energy and Fatigue. Sports Medicine, 36(9), 767-780. https://doi.org/10.2165/00007256-200636090-00004
Raiol, R. A. (2020). Praticar exercícios físicos é fundamental para a saúde física e mental durante a Pandemia da COVID-19. Brazilian Journal of Health Review, 3(2), 2804-2813. https://doi.org/10.34119/bjhrv3n2-124
Sanchis-Gomar, F., Lavie, C. J., Mehra, M. R., Henry, B. M., & Lippi, G. (2020). Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide. Mayo Clinic Proceedings, 95(7), 1445-1453. https://doi.org/10.1016/j.mayocp.2020.05.006
Shin, K. C. (2018). Physical activity in chronic obstructive pulmonary disease: clinical impact and risk factors. The Korean Journal of Internal Medicine, 33(1), 75-77. https://doi.org/10.3904/kjim.2017.387
Simpson, R. J., Campbell, J. P., Gleeson, M., Krüger, K., Nieman, D. C., Pyne, D. B., Turner, J. E., & Walsh, N. P. (2020). Can exercise affect immune function to increase susceptibility to infection?. Exercise immunology review, 26, 8-22.
Søgaard, K., & Sjøgaard, G. (2017). Physical Activity as Cause and Cure of Muscular Pain: Evidence of Underlying Mechanisms. Exercise and Sport Sciences Reviews, 45(3), 136-145. https://doi.org/10.1249/jes.0000000000000112
Steinacker, J., Bloch, W., Halle, H., Mayer, F., Meyer, T., Hirschmüller, A., Röcker, K., Nieß, A., Scharhag, J., Reinsberger, C., Scherr, J., Niebauer, J., Wolfarth, B., Hannafin, J., Hiura, M., Wilkinson, M., Koubaa, D., Poli, P., Smoljanovic, T., . . . Wilson, F. (2020). Fact Sheet: Health Situation for Athletes in the Current Coronavirus Pandemic (SARS-CoV-2 / COVID-19). Deutsche Zeitschrift für Sportmedizin, 71(4), 85-86. https://doi.org/10.5960/dzsm.2020.431
Svendsen, I. S., Hem, E., & Gleeson, M. (2016). Effect of acute exercise and hypoxia on markers of systemic and mucosal immunity. European Journal of Applied Physiology, 116(6), 1219-1229. https://doi.org/10.1007/s00421-016-3380-4
Ter Steege, R. W. F., Van Der Palen, J., & Kolkman, J. J. (2008). Prevalence of gastrointestinal complaints in runners competing in a long-distance run: An internet-based observational study in 1281 subjects. Scandinavian Journal of Gastroenterology, 43(12), 1477-1482. https://doi.org/10.1080/00365520802321170
Timpka, T. (2020). Sports Health During the SARS-Cov-2 Pandemic. Sports Medicine, 50(8), 1413-1416. https://doi.org/10.1007/s40279-020-01288-7
Troosters, T., Sciurba, F., Battaglia, S., Langer, D., Valluri, S. R., Martino, L., Benzo, R., Andre, D., Weisman, I., & Decramer, M. (2010). Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respiratory Medicine, 104(7), 1005-1011. https://doi.org/10.1016/j.rmed.2010.01.012
Wang, X., Liu, W., Zhao, J., Lu, Y., Wang, X., Yu, C., Hu, S., Shen, N., Liu, W., Sun, Z., & Li, W. (2020). Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China. Journal of Hospital Infection, 105(3), 399-403. https://doi.org/10.1016/j.jhin.2020.04.019
Wu, F., Zhao, S., Yu, B., Chen, Y. M., Wang, W., Song, Z. G., Hu, Y., Tao, Z. W., Tian, J. H., Pei, Y. Y., Yuan, M. L., Zhang, Y. L., Dai, F. H., Liu, Y., Wang, Q. M., Zheng, J. J., Xu, L., Holmes, E. C., & Zhang, Y. Z. (2020). A new coronavirus associated with human respiratory disease in China. Nature, 579(7798), 265-269. https://doi.org/10.1038/s41586-020-2008-3
WHO. World Health Organization. Coronavirus disease (COVID- 19) Pandemic [Internet]. 2020. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Access 1 august 2020.
DOI: https://doi.org/10.14198/jhse.2021.16.Proc4.52
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