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Returning to sports or exercise after recovering from COVID-19

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As COVID-19 affects everyone differently and the long-term effects are hard to predict, returning to exercise once recovered should be undertaken with great care, especially in the case of moderate to severe cases of COVID-19, says an expert from a top American hospital, Cleveland Clinic.

Sports medicine physician Marie Schaefer, MD, says: “The truth is, the disease can affect everyone differently. Anyone, including young athletes, could experience a severe case or have long-term damage, which is why it is so important to take this seriously.”

While experts know that in some people the virus can lead to damage of the heart, brain, lungs and kidneys, she says there is no way to pinpoint or predict who exactly these individuals will be. Some might also experience lingering symptoms, including shortness of breath, muscle aches, loss of stamina and exhaustion.

For many athletes and active people, Dr. Schaefer says, returning to activity will likely be a slow process and will require patience. Individuals should work with a physician to make sure they are progressing appropriately and to monitor their symptoms.

Timelines determined by severity of COVID-19

When an athlete or active individual is sick with COVID-19, they should not engage in any physical activity. During this time, they should focus on rest, good hydration, proper nutrition and following the advice of their physician or healthcare provider.

After this, the timeline of return to exercise or sport will be determined by how mild, moderate or severe the case was.

If an active individual or athlete only has a mild illness or tests positive without experiencing any symptoms, he or she can consider returning to activity after a 10-day isolation period. Once that window has passed, the athlete may consider a gradual return to physical activity, but must not have symptoms.

If an active individual or athlete had a moderate or a severe illness, or had to be hospitalized, he or she should be evaluated by a physician prior to restarting any type of exercise. Dr. Schaefer says these people may need to have additional tests, including ECGs, heart imaging or blood work before they are cleared to start a progression back into activity.

Myocarditis in athletes and active people

Dr. Schaefer points to the possibility of myocarditis, which is an inflammatory response of the heart due to a viral infection, such as COVID-19. It can cause swelling in the heart muscle making rigorous activity more difficult and sometimes, even deadly.

“Myocarditis is more likely to be found in people who had a moderate or severe case of the virus, but it can happen to anyone who was infected,” says Dr. Schaefer.

Given this increased potential risk for myocarditis, athletes or active people returning after COVID-19 infections need to be cleared by a healthcare provider who will determine if any additional testing is needed. Because of the risk of myocarditis, athletes and anyone who exercises should follow a graduated return to physical activity over the course of a week to monitor for signs and symptoms of this serious complication.

Advice for easing back into fitness

While serious athletes should follow a Return to Play (RTP) schedule supervised by a professional trainer or physician, Dr. Schaefer has three pieces of advice for anyone planning to reintroduce exercise into their routine.

1. Listen to your body. If someone is experiencing symptoms like chest pain or heart palpitations, they should stop exercising immediately and consult with a doctor. Exercise and movement are important for overall health, but for COVID-19, things can change overnight as we learn more about the virus, she says. People should keep monitoring themselves and if something feels more serious than just a consequence of being out of shape, they need to stop exercising and talk to a physician.

If individuals experience any of the follow red flag symptoms, they stop exercising immediately:

  • chest pain or heart palpitations
  • nausea
  • headache
  • high heart rate not proportional to exertion level or prolonged heart rate recovery.
  • feeling lightheaded or dizzy
  • shortness of breath, difficulty catching breath or abnormal, rapid breathing
  • excessive level of fatigue
  • swelling in the extremities
  • syncope (passing out)
  • experiencing tunnel vision or loss of vision.

2. Take it easy. Recovered patients should not try to “power through” as they did in the past. Athletes of all ages should follow a gradual progression to get back into exercise. They will need to build up the time and intensity of their workouts. Dr. Schaefer advises starting with a slow walk and if that feels alright, trying a brisk walk the next day. They will need to gradually increase the time they spend walking, building this up for about one to two weeks before returning to HIIT training or CrossFit, for example.

3. Be patient. Dr. Schaefer points out that even if someone the recovered patients were training for a marathon prior to becoming infected, they will likely discover that their body has changed a bit, which warrants extra caution. “Do not push too hard on a body that is still trying to recover,” she concludes.

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Fitness

How exercise interventions could help people with asthma

Research has shown that people living with asthma engage in less physical activity and are more sedentary than people without asthma.

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Interventions aimed at promoting physical activity in people with asthma could improve their symptoms and quality of life – according to new research from the University of East Anglia.

Researchers looked at whether interventions such as aerobic and strength or resistance training, had helped participants with asthma.

Although they found that these interventions worked, patients with asthma may have had difficulty undertaking them because of their difficulty travelling to fitness groups or because the interventions were not suitable for people with additional health conditions.

But the team say that digital interventions – such as video appointments, smartwatches and mobile apps – could remove some of these barriers and enable patients to carry out home-based programmes in future.

Prof Andrew Wilson, from UEA’s Norwich Medical School, said: “Being physically active is widely recommended for people with asthma. Doing more than 150 minutes a week of moderate to vigorous physical activity has extensive benefits including improved lung function and asthma control.

“But research has shown that people living with asthma engage in less physical activity and are more sedentary than people without asthma.

“We wanted to find out whether interventions – such as being asked to perform aerobic exercise a few times a week in group sessions, together with ‘goal setting’ – are effective in helping people with asthma be more active.”

The team studied interventions that were designed to promote physical activity in adults with asthma. They looked at 25 separate studies from around the world involving 1,849 participants with asthma, to see whether their symptoms and quality of life were changed thanks to the interventions.

Postgraduate researcher Leanne Tyson, also from UEA’s Norwich Medical School said: “We found that interventions that promote physical activity had significant benefits in terms of increasing physical activity, decreasing time spent sedentary, improving quality of life, and decreasing asthma symptoms.

“This is really important because helping patients make significant behaviour changes could really improve their outcomes in the long term.

“Our review also highlights the potential use of digital interventions, which were notably absent.

“This is important now more than ever as patients have not been able to attend face-to-face support during the Covid-19 pandemic, and services will likely become overwhelmed. Therefore, alternative interventions and methods of delivery need to be considered.”

This study was funded by the Asthma UK Centre For Applied Research.

‘A Systematic Review of the Characteristics of Interventions that Promote Physical Activity in Adults with Asthma’ is published in the Journal of Health Psychology.

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Fitness

Study: Exercising at the start of fast can help people reach ketosis 3.5 hours faster

Exercise made a big difference: when participants exercised, they reached ketosis on average three and a half hours earlier in the fast and produced 43% more BHB. The theory is that the initial exercise burns through a substantial amount of the body’s glucose, prompting a quicker transition to ketosis. Without exercise, the participants hit ketosis about 20 to 24 hours into the fast.

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A new Brigham Young University study published in the journal Medicine & Science in Sports & Exercise finds that exercising intensely at the start of a fast may help maximize health benefits of temporarily foregoing food.

“We really wanted to see if we could change the metabolism during the fast through exercise, especially how quickly the body enters ketosis and makes ketones,” said BYU Ph.D. student Landon Deru, who helped design the study for his thesis.

Ketosis occurs when the body runs out of glucose — its first, preferred fuel — and begins breaking down stored fat for energy, producing chemicals called ketones as a byproduct. In addition to being a healthy energy source for the brain and heart, ketones combat diseases like diabetes, cancer, Parkinson’s and Alzheimer’s.

For the study, the researchers asked 20 healthy adults to complete two 36-hour fasts while staying hydrated. Each fast began after a standardized meal, the first fast starting without exercise and the other with a challenging treadmill workout. Every two hours while awake, the subjects completed hunger and mood assessments and recorded their levels of B-hydroxybutyrate (BHB), a ketone-like chemical.

Exercise made a big difference: when participants exercised, they reached ketosis on average three and a half hours earlier in the fast and produced 43% more BHB. The theory is that the initial exercise burns through a substantial amount of the body’s glucose, prompting a quicker transition to ketosis. Without exercise, the participants hit ketosis about 20 to 24 hours into the fast.

“For me, the toughest time for fasting is that period between 20 and 24 hours, so if I can do something to stop fasting before 24 hours and get the same health outcomes, that’s beneficial,” said study coauthor Bruce Bailey, a BYU exercise science professor. “Or if I do fast for my usual 24 hours but start with exercise, I’ll get even more benefits.”

There are a few caveats to the proposed strategy, however.

“If you carb load or eat a huge meal before you fast, you may not reach ketosis for days, even if you do exercise, so you should eat moderately before fasting,” Bailey said. “We also don’t know the ideal frequency for fasting. There are definitely certain people who shouldn’t fast, such as those with Type 1 diabetes, and obviously it’s detrimental to fast 24/7. But for most people it’s perfectly safe and healthy to fast once or even twice a week for 24 or more hours.”

The study, which required participants to run on a treadmill for an average of 45 to 50 minutes, also didn’t establish an ideal amount or type of exercise for every person. Overall, though, the researchers believe the more energy a person can burn, the better.

“You can get a pretty good estimation of how many calories you’re burning in most exercises, and the more carbohydrates you burn off (without overdoing it or injuring yourself), the better you set the stage for starting ketosis early in your fast,” Deru said.

Also important to note is that, according to the participants’ reports, exercise didn’t seem to aggravate hunger or affect moods during the fast.

“Everyone’s going to be a little grumpier when they fast, but we found that you aren’t going to feel worse with the intervention of exercise — with exercise, you can get these extra benefits and be the exact same amount of grumpy as you would be if you didn’t exercise,” said Deru.

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Fitness

Study finds moderate-vigorous physical activity is the most efficient at improving fitness

Dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

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In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness.

“By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course,” explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.

He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the “gold standard” measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.

They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. “Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health,” said Nayor, a cardiologist at Boston Medical Center.

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