COVID-19 and Physical Activity; A call for action from Jim Sallis and Michael Pratt

The text below was sent to ISBNPA by the authors, asking to make it available to the ISBNPA community.

ISBNPA is actively looking into the best way to promote and disseminate the science analysing how an active lifestyle may help to deal with the current pandemic. Posting this op-ed from Jim Sallis and Michal Pratt is one of these initiatives.

This text was also published in the Exercise is Medicine website.

Why Keep This COVID-19 Remedy a Secret?

James F Sallis & Michael Pratt

First, the bad news. There is no vaccine or cure yet for COVID-19. The only approved drug has only modest impacts. What would we give for a drug that would improve immune and inflammation responses to viral infections, reduce psychological and physiological stress from the pandemic, help treat most of the pre-existing chronic conditions that predict COVID-19 deaths, and even enhance effectiveness of an eventual vaccine? Of course, no such drug exists, and that is perhaps too much to expect from a single therapeutic.

Now, the good news. There is a single remedy with evidence of all the benefits stated above [SJ1] . It is not a drug and does not require a prescription. It is not an expensive device. It is not a miracle food. The most common form of this remedy is free. The risk of using it is low for most people, and the “side effects” are[SJ2]  positive and numerous. Sounds too good to be true, doesn’t it? Yet this remedy is taken by millions of Americans every day.

Have you figured out the answer yet? The only remedy with all these benefits is physical activity. That’s right, the action your health care provider has been recommending for years–or should have been recommending[SJ3] . Virtually every health organization in the US and globally recommends that all people be regularly active[SJ4] . The most common activity is walking, which is free.

As longtime physical activity researchers and advocates we are concerned that officials are not educating people about the specific benefits of physical activity for the pandemic. Being active is not likely to reduce risk of becoming infected; that’s what physical distancing, wearing masks, testing, and contact tracing do. But physical activity has documented effects on immune function and inflammation that should reduce the severity of infections[SJ5] . The stress from job loss and social isolation could be relieved by physical activity. Given the absence of effective treatments or preventive strategies to reduce severity of infections, the lack of attention to physical activity seems like a lost opportunity.

Why have public health leaders not explicitly recommended physical activity during the pandemic? We are not sure, but we have some guesses. Though health professionals are well aware of physical activity benefits for chronic diseases such as obesity, diabetes, heart disease, several cancers, and depression, most are likely not familiar with the benefits related to viral infections. Research on physical activity is a relatively young science, and there is no history of promoting physical activity in pandemics. Now is the time to update infectious disease guidelines to incorporate what we now know about physical activity’s potential beneficial roles. Public health officials may be waiting for direct evidence on physical activity’s impact on the severity of COVID-19 infections before they believe action is justified. We agree research on physical activity and COVID-19 is an urgent priority. However, the existing evidence on physical activity’s benefits relevant to the pandemic is already compelling[SJ6] .

It is not too late for education about, and promotion of, physical activity. COVID-19 cases are rising in most states, and if people are active before they become infected, they may have less severe cases. The stresses of the pandemic continue, and the stress reduction benefits of physical activity apply to virtually the entire population. But the biggest opportunity to harness the power of physical activity may lie ahead. There is evidence physical activity before and after vaccinations can improve immune responses. This is especially important for older adults, whose immune systems are much less effective in producing virus-fighting antibodies in response to vaccinations.

In one study with three different influenza vaccinations[SJ7] , older adults assigned to do moderate intensity physical activity, such as walking, were 30% to 100% more likely to have an antibody response sufficient to protect them from infection than a control group. Thus, we recommend that as vaccines are being developed and tested, federal and state governments develop strategies to educate Americans about the benefits of being active, as well as strategies to help them be active. These strategies should be targeted to the most vulnerable population groups of older adults, racial and ethnic minorities, lower-income Americans, and those with chronic conditions. We recommend that vaccine trials experimentally evaluate the impact of physical activity on vaccine responses.

We call on public health leaders to include physical activity education and promotion as an essential part of the pandemic response. Let’s not keep physical activity a secret remedy any longer.

Authors:

James F. Sallis, Ph.D., FACSM is a health psychologist and Michael Pratt, M.D., M.S.P.E., M.P.H., FACSM is a preventive medicine physician at UC San Diego. Both have spent their careers researching physical activity and advocating for greater efforts to help people be active.

References

Sallis, J.F., and Pratt, M. (2020). Multiple benefits of physical activity during the coronavirus pandemic. Brasilian Journal of Physical Activity/Revista Brasileira de Atividade Fisica & Saude, 25, 14268.

Open access: https://rbafs.org.br/RBAFS/article/view/14268

Powell KE, AC King, DM Buchner, WW Campbell, L DiPietro, KI Erickson, et al. The scientific foundation for the Physical Activity Guidelines for Americans, 2nd Edition. J Phys Act Health 2018:1-11.

Exercise Is Medicine. https://www.exerciseismedicine.org/

Piercy KL, RP Troiano, RM Ballard, SA Carlson, JE Fulton, DA Galuska, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320(19):2020-8.

World Health Organization, 2019. https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/

World Health Organization. Be Active during COVID-19; 2020. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/be-active-during-covid-19

Woods JA, Keylock KT, Lowder T, Vieira VJ, Zelkovich W, Dumich S, Colantuano K, Lyons K, Leifheit K, Cook M, Chapman‐Novakofski K. Cardiovascular exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial. J Am Geriatr Soc 2009;57(12):2183-91.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1532-5415.2009.02563.x


 [SJ1]Sallis, J.F., and Pratt, M. (2020). Multiple benefits of physical activity during the coronavirus pandemic. Brasilian Journal of Physical Activity/Revista Brasileira de Atividade Fisica & Saude, 25, 14268.

Open access: https://rbafs.org.br/RBAFS/article/view/14268

 [SJ2]Powell KE, AC King, DM Buchner, WW Campbell, L DiPietro, KI Erickson, et al. The scientific foundation for the Physical Activity Guidelines for Americans, 2nd Edition. J Phys Act Health 2018:1-11.

 [SJ3]Exercise Is Medicine. https://www.exerciseismedicine.org/

 [SJ4]Piercy KL, RP Troiano, RM Ballard, SA Carlson, JE Fulton, DA Galuska, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320(19):2020-8.

World Health Organization, 2019. https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/,

 [SJ5]Nieman DC, LM Wentz. The compelling link between physical activity and the body’s defense system. J Sport Health Sci 2019;8(3):201-17.

 [SJ6]World Health Organization. Be Active during COVID-19; 2020. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/be-active-during-covid-19.

 [SJ7]Woods JA, Keylock KT, Lowder T, Vieira VJ, Zelkovich W, Dumich S, Colantuano K, Lyons K, Leifheit K, Cook M, Chapman‐Novakofski K. Cardiovascular exercise training extends influenza vaccine seroprotection in sedentary older adults: the immune function intervention trial. J Am Geriatr Soc 2009;57(12):2183-91.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1532-5415.2009.02563.x

[SJ7] Nieman DC, LM Wentz. The compelling link between physical activity and the body’s defense system. J Sport Health Sci 2019;8(3):201-17.

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