Exercise against SARS-CoV-2 (COVID-19): Does workout intensity matter? (A mini review of some indirect evidence related to obesity)
Identifieur interne : 000504 ( Pmc/Corpus ); précédent : 000503; suivant : 000505Exercise against SARS-CoV-2 (COVID-19): Does workout intensity matter? (A mini review of some indirect evidence related to obesity)
Auteurs : Saleh Rahmati-Ahmadabad ; Fahimeh HosseiniSource :
- Obesity Medicine [ 2451-8476 ] ; 2020.
Abstract
SARS-CoV-2 (COVID-19) is a new virus causing respiratory illness outbreak. Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. It appears that no certain effective pharmaceutical agent is currently available for it. It seems that obesity is one of the biggest risk factors related to COVID-19 hospitalization and critical illness. The strengthening of the body systems by non-drug ways is very important especially in obese people. On the basis of some indirect evidence, it seems that moderate physical activity can be recommended as a non-pharmacological, inexpensive, and viable way to cope with corona. On the other hand, recommending higher intensity exercise needs further consideration to make final decision in this regard.
Url:
DOI: 10.1016/j.obmed.2020.100245
PubMed: 32342019
PubMed Central: 7184978
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PMC:7184978Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Exercise against SARS-CoV-2 (COVID-19): Does workout intensity matter? (A mini review of some indirect evidence related to obesity)</title>
<author><name sortKey="Rahmati Ahmadabad, Saleh" sort="Rahmati Ahmadabad, Saleh" uniqKey="Rahmati Ahmadabad S" first="Saleh" last="Rahmati-Ahmadabad">Saleh Rahmati-Ahmadabad</name>
<affiliation><nlm:aff id="aff1">Department of Physical Education, Pardis Branch, Islamic Azad University, Pardis, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hosseini, Fahimeh" sort="Hosseini, Fahimeh" uniqKey="Hosseini F" first="Fahimeh" last="Hosseini">Fahimeh Hosseini</name>
<affiliation><nlm:aff id="aff2">Exercise Biochemistry Division, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Mazandaran, Iran</nlm:aff>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Exercise against SARS-CoV-2 (COVID-19): Does workout intensity matter? (A mini review of some indirect evidence related to obesity)</title>
<author><name sortKey="Rahmati Ahmadabad, Saleh" sort="Rahmati Ahmadabad, Saleh" uniqKey="Rahmati Ahmadabad S" first="Saleh" last="Rahmati-Ahmadabad">Saleh Rahmati-Ahmadabad</name>
<affiliation><nlm:aff id="aff1">Department of Physical Education, Pardis Branch, Islamic Azad University, Pardis, Iran</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Hosseini, Fahimeh" sort="Hosseini, Fahimeh" uniqKey="Hosseini F" first="Fahimeh" last="Hosseini">Fahimeh Hosseini</name>
<affiliation><nlm:aff id="aff2">Exercise Biochemistry Division, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Mazandaran, Iran</nlm:aff>
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<series><title level="j">Obesity Medicine</title>
<idno type="eISSN">2451-8476</idno>
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<front><div type="abstract" xml:lang="en"><p>SARS-CoV-2 (COVID-19) is a new virus causing respiratory illness outbreak. Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. It appears that no certain effective pharmaceutical agent is currently available for it. It seems that obesity is one of the biggest risk factors related to COVID-19 hospitalization and critical illness. The strengthening of the body systems by non-drug ways is very important especially in obese people. On the basis of some indirect evidence, it seems that moderate physical activity can be recommended as a non-pharmacological, inexpensive, and viable way to cope with corona. On the other hand, recommending higher intensity exercise needs further consideration to make final decision in this regard.</p>
</div>
</front>
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</TEI>
<pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Obes Med</journal-id>
<journal-id journal-id-type="iso-abbrev">Obes Med</journal-id>
<journal-title-group><journal-title>Obesity Medicine</journal-title>
</journal-title-group>
<issn pub-type="epub">2451-8476</issn>
<publisher><publisher-name>Elsevier Ltd.</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">32342019</article-id>
<article-id pub-id-type="pmc">7184978</article-id>
<article-id pub-id-type="publisher-id">S2451-8476(20)30065-8</article-id>
<article-id pub-id-type="doi">10.1016/j.obmed.2020.100245</article-id>
<article-id pub-id-type="publisher-id">100245</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Exercise against SARS-CoV-2 (COVID-19): Does workout intensity matter? (A mini review of some indirect evidence related to obesity)</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" id="au1"><name><surname>Rahmati-Ahmadabad</surname>
<given-names>Saleh</given-names>
</name>
<email>salehrahmati@pardisiau.ac.ir</email>
<xref rid="aff1" ref-type="aff">1</xref>
<xref rid="cor1" ref-type="corresp">∗</xref>
</contrib>
<contrib contrib-type="author" id="au2"><name><surname>Hosseini</surname>
<given-names>Fahimeh</given-names>
</name>
<email>f66hosseini@gmail.com</email>
<xref rid="aff2" ref-type="aff">2</xref>
</contrib>
<aff id="aff1"><label>1</label>
Department of Physical Education, Pardis Branch, Islamic Azad University, Pardis, Iran</aff>
<aff id="aff2"><label>2</label>
Exercise Biochemistry Division, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Mazandaran, Iran</aff>
</contrib-group>
<author-notes><corresp id="cor1"><label>∗</label>
Corresponding author. Department of Physical Education, Pardis Branch, Islamic Azad University, Tehran Province, Bumehen Highway, Pardis, Iran, Post Office Box: 1658174583, <email>salehrahmati@pardisiau.ac.ir</email>
</corresp>
</author-notes>
<pub-date pub-type="pmc-release"><day>27</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>27</day>
<month>4</month>
<year>2020</year>
</pub-date>
<elocation-id>100245</elocation-id>
<history><date date-type="received"><day>17</day>
<month>4</month>
<year>2020</year>
</date>
<date date-type="rev-recd"><day>23</day>
<month>4</month>
<year>2020</year>
</date>
<date date-type="accepted"><day>24</day>
<month>4</month>
<year>2020</year>
</date>
</history>
<permissions><copyright-statement>© 2020 Elsevier Ltd. All rights reserved.</copyright-statement>
<copyright-year>2020</copyright-year>
<copyright-holder>Elsevier Ltd</copyright-holder>
<license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p>
</license>
</permissions>
<abstract id="abs0010"><p>SARS-CoV-2 (COVID-19) is a new virus causing respiratory illness outbreak. Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. It appears that no certain effective pharmaceutical agent is currently available for it. It seems that obesity is one of the biggest risk factors related to COVID-19 hospitalization and critical illness. The strengthening of the body systems by non-drug ways is very important especially in obese people. On the basis of some indirect evidence, it seems that moderate physical activity can be recommended as a non-pharmacological, inexpensive, and viable way to cope with corona. On the other hand, recommending higher intensity exercise needs further consideration to make final decision in this regard.</p>
</abstract>
<abstract abstract-type="graphical" id="abs0015"><title>Graphical abstract</title>
<p><fig id="undfig1" position="anchor"><alt-text id="alttext0010">Image 1</alt-text>
<graphic xlink:href="fx1_lrg"></graphic>
</fig>
</p>
</abstract>
<abstract abstract-type="author-highlights" id="abs0020"><title>Highlights</title>
<p><list list-type="simple" id="ulist0010"><list-item id="u0010"><label>•</label>
<p id="p0010">There is some indirect evidence to take a conservative approach in which high intensity exercise is not recommended against COVID-19 virus.</p>
</list-item>
<list-item id="u0015"><label>•</label>
<p id="p0015">On the basis of indirect evidence, it seems that moderate intensity exercise can be recommended as a way to cope with COVID-19.</p>
</list-item>
<list-item id="u0020"><label>•</label>
<p id="p0020">The 'open window' theory and 'J curve' concept explain the effect of exercise intensity on immune system.</p>
</list-item>
</list>
</p>
</abstract>
<kwd-group id="kwrds0010"><title>Keywords</title>
<kwd>High-intensity exercise</kwd>
<kwd>moderate-intensity exercise</kwd>
<kwd>obesity</kwd>
<kwd>SARS- CoV-2 (COVID-19)</kwd>
</kwd-group>
</article-meta>
</front>
<body><sec id="sec1"><label>1</label>
<title>Introduction</title>
<p id="p0025">SARS-CoV-2 (COVID-19) is a new virus causing respiratory illness outbreak (Ghinai <italic>et al.</italic>
). Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. It seems that COVID-19 is a disease the risk of which is higher for obese people.</p>
<p id="p0030">COVID-19 affects immune cells (<xref rid="bib17" ref-type="bibr">Thevarajan <italic>et al.</italic>
, 2020</xref>
). Thevarajan <italic>et al.</italic>
showed that the blood levels of antibody-secreting cells (ASCs), follicular helper T cells (T<sub>FH</sub>
cells), activated CD4<sup>+</sup>
T cells and CD8<sup>+</sup>
T cells and immunoglobulin M (IgM) and IgG increased in a COVID-19 patient (<xref rid="bib17" ref-type="bibr">Thevarajan <italic>et al.</italic>
, 2020</xref>
).</p>
<p id="p0035">Today, people are following ways that improve immune ability i.e. nutrition and exercise. There are several investigations regarding the effects of nutrition supplementation on immune cells and inflammation in obesity condition (<xref rid="bib3" ref-type="bibr">Chinchu, Mohan, & Prakash Kumar, 2020</xref>
; <xref rid="bib12" ref-type="bibr">Mousavi, Saboori, & Asbaghi, 2020</xref>
; <xref rid="bib16" ref-type="bibr">Tavvafian <italic>et al.</italic>
, 2020</xref>
). Previous studies have shown that physical activity can improve immune health via an increase in immune cells (<xref rid="bib13" ref-type="bibr">Nieman & Wentz, 2019</xref>
). Therefore, it is suggested that the immune function should be increased by appropriate physical activity before the disease, which will boost the body against the virus. It is very useful in the present condition that there is no certain effective pharmaceutical agent against this virus (<xref rid="bib5" ref-type="bibr">Fisher & Heymann, 2020</xref>
). Physical activities with different intensity have different effects on the immune system (<xref rid="bib13" ref-type="bibr">Nieman & Wentz, 2019</xref>
; <xref rid="bib14" ref-type="bibr">Romeo, Warnberg, Pozo, & Marcos, 2010</xref>
). The present study reviews the studies about the effect of exercise intensity on inflammatory factors and immune cells in obesity condition (as indirect evidence against viruses).</p>
</sec>
<sec id="sec2"><label>2</label>
<title>Exercise intensity considerations</title>
<p id="p0040">Different physical activities in terms of intensity and type have different effects on immune system and inflammation (<xref rid="bib13" ref-type="bibr">Nieman & Wentz, 2019</xref>
; <xref rid="bib14" ref-type="bibr">Romeo <italic>et al.</italic>
, 2010</xref>
). Several studies have shown that high intensity exercise has positive effect on inflammatory factors in obesity conditions (<xref rid="bib9" ref-type="bibr">Khaleghzadeh, Afzalpour, Ahmadi, Nematy, & Sardar, 2020</xref>
; <xref rid="bib15" ref-type="bibr">TaheriChadorneshin, Cheragh-Birjandi, Goodarzy, & Ahmadabadi, 2019</xref>
). For example, Khaleghzadeh <italic>et al.</italic>
showed that eight weeks of high intensity interval training (HIIT) led to a significant decrease in plasma interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and aspartate aminotransferase (AST) in male obese Wistar rats with non-alcoholic fatty liver disease (<xref rid="bib9" ref-type="bibr">Khaleghzadeh et al., 2020</xref>
). Some studies compared the effects of high intensity and moderate intensity exercise on inflammatory factors. de Souza <italic>et al.</italic>
showed that a single high intensity interval session is able to decrease interferon gamma-/interleukin-4 (IFN-γ/IL-4) ratio (indicating an anti-inflammatory response), without alterations in the function of the mucosal immune system and lipoperoxidation. On the other hand, a session of moderate-intensity continuous exercise induced changes in the pattern of cytokines associated with increased cellular immune function (<xref rid="bib4" ref-type="bibr">de Souza <italic>et al.</italic>
, 2018</xref>
). Gerosa-Neto <italic>et al.</italic>
showed that long-term HIIT (90% maximum heart rate, 3 times a week) increased TNF-α, while moderate-intensity continuous training (70% maximum heart rate, 5 times a week) decreased TNF-α in overweight/obese adults (<xref rid="bib6" ref-type="bibr">Gerosa-Neto <italic>et al.</italic>
, 2016</xref>
). In healthy young men, it was shown that moderate-intensity continuous training but not HIIT improved immune function biomarkers (<xref rid="bib10" ref-type="bibr">Khammassi <italic>et al.</italic>
, 2020</xref>
). Another study showed that HIIT induced inflammatory response and suppressed immune functions (<xref rid="bib18" ref-type="bibr">Zwetsloot, John, Lawrence, Battista, & Shanely, 2014</xref>
). The results of one review article showed that intense long exercise can lead to higher levels of inflammatory mediators, and consequently might increase the risk of injury and chronic inflammation, while moderate or vigorous exercise with appropriate resting periods can achieve maximum benefit (<xref rid="bib2" ref-type="bibr">Cerqueira, Marinho, Neiva, & Lourenço, 2020</xref>
).</p>
<p id="p0045">There is a theory that may explain the risk of high intensity exercise (<xref rid="fig1" ref-type="fig">Figure 1</xref>
). The 'open window' theory is characterized by suppression of the immune system following high intensity exercise (<xref rid="bib8" ref-type="bibr">Kakanis <italic>et al.</italic>
, 2010</xref>
). This window of opportunity may allow for an increase in susceptibility to upper respiratory illness (<xref rid="bib8" ref-type="bibr">Kakanis <italic>et al.</italic>
, 2010</xref>
). 'J curve' concept explains that individuals that regularly perform moderate intensity exercise improve their immune system, excessive bouts of prolonged training can impair immune function (<xref rid="fig2" ref-type="fig">Figure 2</xref>
) (<xref rid="bib1" ref-type="bibr">Campbell & Turner, 2018</xref>
). High intensity exercise due to the production of oxidants and suppression of immune system may be dangerous (especially, in obesity condition). The lipid peroxidation in obesity is higher than non-obesity condition (<xref rid="bib11" ref-type="bibr">Marseglia <italic>et al.</italic>
, 2014</xref>
). These are some indirect evidence that make a conservative approach regarding the use of high intensity exercise in COVID-19 outbreak. In addition, COVID-19 disease may be asymptomatic in several days and hence, severe high-intensity exercise may be more dangerous.<fig id="fig1"><label>Figure 1</label>
<caption><p>The 'open window' theory. It is characterized by suppression of the immune system following the intense exercise.</p>
</caption>
<alt-text id="alttext0015">Figure 1</alt-text>
<graphic xlink:href="gr1_lrg"></graphic>
</fig>
<fig id="fig2"><label>Figure 2</label>
<caption><p>"J curve" concept. It suggests that, individuals that regularly perform moderate intensity exercise improve their immune system. Excessive bouts of prolonged training can impair immune function.</p>
</caption>
<alt-text id="alttext0020">Figure 2</alt-text>
<graphic xlink:href="gr2_lrg"></graphic>
</fig>
</p>
</sec>
<sec id="sec3"><label>3</label>
<title>Conclusion</title>
<p id="p0050">On the basis of indirect evidence and a conservative approach, high intensity exercise probably due to the production of oxidants and suppression of immune system may be dangerous (especially, in obese people) and help to exacerbate the COVID-19 virus. It is also noted that COVID-19 disease may be asymptomatic in several days and hence, severe high-intensity exercise may be more dangerous. The present study suggests a conservative approach on the basis of some evidence regarding use of high intensity exercise on inflammatory and immune factors. It means that moderate intensity exercise (and not high-intensity physical activity) should be recommended as a non-pharmacological, inexpensive, and viable way to cope with COVID-19 virus.</p>
</sec>
<sec id="sec4"><title>Authors’ contribution</title>
<p id="p0055">SRA wrote the first draft of the manuscript. FH revised and improved the quality of the manuscript. All authors read and approved the final version of the manuscript.</p>
</sec>
<sec id="sec5"><title>Declaration of conflicting interests</title>
<p id="p0060">The authors declare no potential conflicts of interests with respect to the research, authorship, and/or publication of this article.</p>
</sec>
<sec id="sec6"><title>Funding</title>
<p id="p0065">The authors received no financial support for the research, authorship, and/or publication of this article.</p>
</sec>
<sec id="sec7"><title>Uncited References</title>
<p id="p0070"><xref rid="bib7" ref-type="bibr">Ghinai et al.,</xref>
.</p>
</sec>
</body>
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