BENGALURU: Social distancing measures and lockdowns have disrupted many aspects of normal life, including sport and physical activity. Work from home and other similar measures have increased screen times, disrupted sleep patterns, made diets worse, caused weight gain, and reduced physical fitness.
Experts are warning that this sudden change of behaviour toward a more sedentary lifestyle is putting our health at risk.
No data is available whether the level of physical fitness specifically affects the progress of Covid-19 infections. It is, however, well documented that people with co-existing conditions like cardiovascular disease, hypertension, obesity, cancer, etc, are at an increased risk of more severe consequences following Covid-19 infections.
Since exercise has beneficial effects on chronic health conditions as well as immunity, it seems reasonable to assume that exercise has benefits in the context of the Covid-19 pandemic also.
People without Covid-19 infection, who were used to regular exercise prior to the pandemic, should continue to do moderate intensity (and not high intensity) exercise.
However, due to high risk of spread, exercise in private environments with good ventilation and use of personal equipment may be more reasonable. A home exercise programme with safe and simple exercises is suitable.
Outdoor exercise may be undertaken provided all precautions are taken to avoid infection. It is important to respect current social distancing guidelines which includes avoiding exercising in groups. Social distancing requires some changes in perspective while exercising. Some experts feel that maintaining two metres distance may not be enough when exercising.
They recommend maintaining 4-5 metres if walking, 10 metres if running and 20 metres if cycling, to reduce the risk of infection.
For people not used to regular exercise, an exercise program should start at low intensities for short durations and progress slowly to more intense physical activities or exercise periods of longer durations.
Exercise in Covid patients
Covid-19 has direct and indirect effects on the heart and the cardiovascular system. Covid-19 infection increases risk of cardiac damage and cardiac death during exercise and the increased risk may extend into the post infection time period. As such, it is generally recommended to avoid exercise training during active infection.
The recreational exerciser, who experienced only mild to moderate symptoms, was not hospitalised, and had no concerning cardiac symptoms, and seeking to resume activity for general physical fitness after Covid-19, should be able to resume recreational exercise at moderate intensity once completely recovered. However, the individual should start slow and gradually return to their previous levels, while being mindful for any clinical change or new cardiovascular symptoms. This population is not likely to require additional testing unless concerning cardiac symptoms develop upon resumption of activity.
However, patients with pre-existing cardiac disease who are potentially at higher risk of complications with Covid-19 (hypertrophic cardiomyopathy, left ventricular systolic dysfunction, atherosclerotic heart disease) may require additional testing and risk assessment prior to a return to regular exercise levels.
For athletes and highly active people with Covid-19 (with or without symptoms), an initial period of rest during the active infection and for a two-week period after symptom resolution is recommended. In those with demonstrated evidence of myocardial involvement, a more extensive evaluation may be needed. This testing is done 3-6 months after recovery at the time when athletes are considering return to play.
(The author is a consultant cardiologist, Vikram Hospital, Bengaluru)