The Coronavirus (Covid-19) was introduced this past December 2019 in China (Wuhan)
and the infection has spread throughout the world despite strategies adopted by the
Chinese government to stop this epidemiological phenomenon. Three months later, Covid-19
has become a worldwide pandemic with more than 353,000 cases confirmed on March 23th
2020, 15,000 deaths and more than 100,000 recovered around the world.
The evolution of this pandemic can be followed at different official websites, such
as the interactive web-based dashboard to track Covid-19 in real time developed by
the Johns Hopkins University Center for Systems Science and Engineering (https://www.eficiens.com/coronavirus-statistics/)
or the HealthMap provided by the Boston Children's Hospital (https://www.healthmap.org/Covid-19/
). Additionally, the New England Journal of Medicine provides free access for a collection
of articles and other resources on the Covid-19 outbreak, including clinical reports,
management guidelines, and commentaries (https://www.nejm.org/coronavirus?cid=DM88311&bid=165326853).
Actually, China has managed to stop the number of daily infections for several days.
The next two countries to suffer the most intense impact of the pandemic were Italy
and Spain, having already exceeded, in the case of Italy, the number of total deaths
reached by China. However, many other countries around the world, including the United
States, are developing new cases at alarming rates.
Most of the epidemiological experts agree that much of the success in containing the
virus in China and elsewhere has been due to rapid measures adopted by the authorities
to impose quarantine status for the majority of population. Therefore, many of the
most seriously affected countries after China, such as Italy and Spain, adopted similar
strategies several weeks later. In addition, based on the worldwide information from
the Covid-19 pandemic, some characteristics of the population at higher risk for Covid-19
have been identified, such as being older people, those with hypertension, diabetes
or cardiovascular disease (CVD) risk factors and CVD, and patients with respiratory
diseases or conditions.
On the one hand, despite that a period of quarantine is the best option and recommendation
to stop the rapid spread infections, this may have collateral effects on other dimensions
of the isolated patients´ health, and especially in those mentioned as being at higher
risk. Initiating a sudden quarantine state implies a radical change in the lifestyle
of the population. These lifestyles and behaviors in many cases include a certain
level of physical activity (PA) and exercise to maintain an adequate health status,
1
to counteract the negative consequences of certain diseases,
2
such as diabetes, hypertension, CVD, respiratory diseases, or even simply to guarantee
an active aging by reducing the risk of frailty, sarcopenia and dementia, as associated
diseases in older people.
3
,
4
Moreover, the psychological impact of quarantine has been recently reviewed
5
and negative psychological effects, including post-traumatic stress symptoms, confusion,
and anger has been reported. The stressor factors suggested included longer quarantine
duration, infection fears, frustration, boredom, inadequate supplies, inadequate information,
financial loss, and stigma.
On the other hand, PA and exercise have shown to be an effective therapy for most
of the chronic diseases with direct effects on both mental and physical health.1.,
2., 3., 4.
,
6., 7., 8., 9. In fact, exercise has been considered the real polypill based on epidemiological
evidence of its preventive/therapeutic benefits and considering the main biological
mediators involved.
1
,
7
,
9
Special attention is deserved for the elderly population group, because in older people
PA and exercise impact the mentioned benefits on many diseases but also has additional
effects on hallmarks of aging and associated diseases.
10
In this sense, exercise in older people positively affects and prevents frailty, sarcopenia/dynapenia,
risk of falls, self-esteem and cognitive impairment or decline.
10
,
11
Therefore, to not totally interrupt or change the lifestyle of people during quarantine
and to maintain an active lifestyle at home is very important for the health of the
overall population but, especially, for those with additional risk factors and older
people.
Although outdoor activities are typically more available, varied, and have more facilities
and infrastructures to perform any type of physical exercise, there still are many
possibilities for exercising at home during a quarantine. Clearly, we would support
the message of “doing at least some exercise is better than nothing”, however, a more
precise prescription and recommendation are needed to guarantee an appropriate exercise
program aimed to maintain or improve the principal health-related physical fitness
components. Briefly, the reason to promote PA and exercise for improving physical
fitness components is that these (cardiorespiratory fitness or CRF, muscular strength,
coordination-agility) are directly related with the physiological functions of the
main organ systems (respiratory, circulatory, muscular, nervous and skeletal systems)
and indirectly implicated in the appropriate functioning of other systems (endocrine,
digestive, immune or renal systems).1., 2., 3., 4.
,
7
,
9
These relationships are even more interesting from the point of view of physiologic
functional reserve of organ systems, for example, to increase the CRF is not only
directly related with improvements in the circulatory and respiratory systems capacities
but also with increases in its functional reserve. For all this, PA/exercise become
especially essential for older people during quarantine because to maintain physiological
function and reserve of most of the organ systems could contribute to the fight against
the mental and physical consequences and severity of Covid-19 (Fig 1
).
Fig 1
illustrates how physical exercise enhances the health of older people by acting on
the different organ systems.
Fig 1
The principal elements we should consider to design a proper exercise program for
older people confined at home are exercise modality, frequency of practice, volume
and intensity (among others).
Exercise modality
A multicomponent exercise program is considered the most adequate for older people
10
,
11
from both settings of free-living and community-dwelling. A multicomponent exercise
program includes aerobic, resistance, balance, coordination and mobility training
exercises. Recently, some researchers have also suggested to integrate the concept
of cognitive training during the exercise training session.
Exercise frequency
The international guidelines of PA for older people recommend 5 days per week, which
in this particular quarantine situation could be increased to 5–7 days per week with
adaptation in volume and intensity.
Exercise volume
The guidelines recommend at least 150 to 300 min per week of aerobic exercise and
2 resistance training sessions per week. Under the quarantine it could be suggested
to increase to 200–400 min per week distributed among 5–7 days to compensate for the
decrease in the normal daily PA levels. Moreover, a minimum of 2–3 days per week of
resistance exercise could be recommended. Mobility training exercises should be performed
on all the training days and balance and coordination should be distributed among
the different training days (at least twice).
Exercise intensity
The guidelines suggest moderate intensity for most of the sessions and some amount
of vigorous exercise per week. It is well-known that exercise at moderate intensity
improves the immune system, but vigorous intensity may even inhibit it, especially
in sedentary people. Thus, during quarantine times, moderate intensity (40–60% heart
rate reserve or 65–75% of maximal heart rate) should be the ideal choice for older
people to enhance the protective role of exercise.
Examples of home exercises
In case one does not have large equipment or specific materials for training, the
following options are available in any house; resistance training through bodyweight
exercises such as squats holding a chair, sitting and getting up from the chair or
going up and down a step, transporting items with light and moderate weights (vegetables,
rice, water, etc), aerobic exercises like walking inside the house, dancing or balance
exercise such as walking on a line on the floor, walking on the toes or heels, walking
heel-to-toe, and stepping over obstacles.
Statement of conflict of interest
There is no conflict of interest of any of the listed authors.
Funding
Current research activities of DJP are supported by a grant from the Spanish Ministry
of Science and Innovation - MINECO (RYC-2014-16938) and the Spanish Ministry of Economy
and Competitiveness – MINECO/FEDER (DEP2016-76123-R); the Government of Andalusian,
Integrated Territorial Initiative 2014–2020 for the province of Cádiz (PI-0002-2017);
the European Union's ERASMUS+SPORT programme (grant agreement: 603121-EPP-1-2018-1-ES-SPO-SCP);
and the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005-00046/ACTI).