‘ Exercise is a medicine. It should be written on the doctor’s prescription.’
Did people who maintained a high level of Physical Activity or PA during the last year and a half, suffer from COVID19 disease? The other way round, did those infected by COVID19 do PA regularly? If yes, at what level of intensity? How do we quantify a PA and how much PA is safe during COVID19? These are the many questions that came up from some of the readers who read the last blog. An attempt is now being made to discuss these issues in as simple terms as possible.
UNDERSTANDING PHYSICAL ACTIVITY INTENSITY
Before jumping to COVID19, let us examine the various intensities of PA. PA is generally measured by the increase in the rate of our heart beat. Maximum Projected Heartbeat in a healthy person is taken as 220 minus our age. For example, if I am 70 year old, than my maximum projected heart rate is 220- 70 = 150. During my PA period, my heart rate should remain less than 150 at any cost. Another method, used by Sports Medicine specialists and ‘Trained’ sports/ Gym trainers is the Oxygen level (vO2). This is a bit more technical and hence not being discussed here.
For an average person, there are three levels of PA intensity – Light or low level, Medium or moderate level, and Vigorous or strenuous level of exercise. The fourth level of intensity is called HIIT or High-Intensity Interval Training, which is best learned under the supervision of a coach.
- LIGHT PA. These include our routine household chores and leisurely walks. It also includes cooking, washing utensils and doing office work.
- MODERATE PA. This level of intensity of PA makes our heartbeat rise. If we do it for around half an hour our heartbeat may rise to around 50% to 70% of the Maximum projected heartbeat. (220 minus our age). Moderate PA includes:
- Brisk walk
- Bicycle riding for pleasure, including pedaling on a stationary bike
- Routine dancing
- Gardening
- Sweeping or Mopping
- VIGOROUS PA. These exercises should be undertaken by those who have been doing moderate PA for a reasonable period of time. Also, by those above 45 or having a disease are medically declared fit by a doctor. These include
- Jogging
- Calisthenics such as sit-ups, pull-ups, push-ups, rowing and so on
- Skipping
- Hiking or stair climbing
- Shoveling/ Digging in the garden
- Carrying heavy loads
- Sports involving fast movements or long runs.
PHYSICAL ACTIVITY AND COVID19
In a very large study conducted in the US, published last month it was revealed that those who did Moderate PA, 6 days a week and were found COVID19 positive, were less likely to be hospitalized. If hospitalized, were less likely to be admitted to ICU. And if admitted to ICU, were less likely to die.
The people having certain comorbidities (presence of two or more medical conditions in a patient) who were infected with COVID19 had a much worse outcome as compared to others. The number 1 comorbidity was PHYSICAL INACTIVITY! Not obesity or diabetes.
HOW DOES PA PREVENT COVID19? It does by two methods.
Firstly, those who do PA regularly have better immunity. However, for a few hours after a prolonged Vigorous PA session, their immunity is lowered.
Secondly, those who regularly do PA are mentally more fit. They can take rational decisions, suffer less from depression and have better sleep. All reasons for either not getting infected, or if infected, having a better outcome.
COVID19 SCENARIOS – HOW MUCH PA IS ‘JUST RIGHT’?
There are many people scenarios related to COVID19, and each is discussed separately below:
1. QUARANTINED BUT COVID19 NEGATIVE. Even a mentally stable person can lose his mental balance because of sudden isolation. Lack of exercise in an enclosed environment for a week or 10 days will definitely cause muscle wasting, backache, and sleep disturbances. Such people must definitely do moderate PA, once a day, and a Strength/ Suppleness/ Steadiness activity once a day. Yoga and breathing exercises with peaceful music enhance the effects of exercise.
2. COVID19 POSITIVE BUT ASYMPTOMATIC. This person would generally be at home and isolated from the family. Such people may or may not develop serious symptoms. They should do only Low-intensity PA for a week. If they still remain asymptomatic then they can resume brisk walks and other Moderate PA which they did prior to being declared COVID19 positive. Breathing exercises and Yoga with music is beneficial. However, no Vigorous PA.
3. SYMPTOMATIC BUT NOT SERIOUSLY ILL, UNDER HOME TREATMENT. Such people are isolated and require rest. They can be subdivided into two groups.
Those with mild symptoms above the neck. Those who just have a stuffed nose and a sore throat but no fever can continue to do Low-intensity PA, practice breathing techniques and do yoga with music.
Those with Covid symptoms below the neck, ie breathing difficulties, stomach upset or with high fever should avoid any PA.
4. POST HOSPITAL DISCHARGE COVID19 PATIENTS. They should follow the instructions of their physicians. They definitely must not resume Vigorous PA for at least 6 months even if they feel fully fit. Yoga, breathing exercises, and music with PA for Steadiness are better options.
5. POST COVID19 VACCINATION. People who have taken a vaccine should avoid MODERATE or VIGOROUS PA for the next 48 hours. Those who do not experience any side effects of the vaccine can resume their schedule of PA after 48 hours. Those who do develop side effects must consult their physician before resuming PA.
The importance of PA is well understood by those who read or hear about its benefits. Most of them even start doing some of the other PA for a few days. Then, the human nature of laziness takes over our minds. We find 101 reasons for not doing PA, especially in the present era of uncertainty during COVID19.
With the closure of gyms and parks in many places, is there a way of doing Vigorous or even Moderate PA at home? Are their methods of making PA a regular part of our lifestyle?
YES. Let’s find out how, next week!
Maj Gen Krishan Chauhan is a second-generation army officer. He studied in Sainik School Kapurthala, graduated from IG Medical College, Shimla and did his MD from AFMC/Pune University. He has served in the Army Medical Corps for 36 years and retired as the Addl DGMS army. He is an avid marathon runner and a writer. He first wrote articles for children in The Young Chronicles. Later, he started writing his own blog as Genkris, on WordPress where over 25 articles on various subjects can be accessed.
