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Phys Act Nutr > Volume 27(3); 2023 > Article
Kwak, Han, Lee, and Kim: Physical exercise-intervention can be valuable therapy for COVID-19 confinement and post-COVID-19 periods

Abstract

[Purpose]

The COVID-19 pandemic and its transition into an endemic phase have profoundly impacted physical health, well-being, mental health, education, and various aspects of society, including the economy and social networks. Home confinement, social distancing, and physical inactivity have exacerbated numerous health issues, including obesity, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular diseases, depression, and poor sleep quality. A systematic review has revealed significant findings: Regular aerobic programs (such as cycling or walking at an intensity of 60-80% of HR max for 20-60 minutes per session, repeated 2-3 times a week) have proven effective in improving both physical and mental health, as well as immune function. This type of physical activity has been shown to increase immunological markers, including lymphocytes, leukocytes, neutrophils, monocytes, and interleukin-6 (IL-6), while reducing low-grade inflammation. Therefore, in this study we aimed to assess the impact of tailored exercise interventions on the physical and mental health of COVID-19 patients. Based on the results, we can establish exercise intervention strategies to mitigate the negative health consequences during and after the COVID-19 pandemic.

[Methods]

We conducted a search of the PubMed database from January 2020 to August 2023 using predefined search terms such as “COVID-19 and post-COVID-19,” “exercise intervention and immunity,” and “mental health.” By examining references, we explored the links between exercise interventions and the mental and physical health of COVID-19 patients.

[Results]

A tailored, multifaceted exercise intervention should be developed and implemented to address the existing mental challenges and enhance mental health during both the pandemic and the post-COVID-19 periods.

[Conclusion]

Breathing exercises and respiratory support techniques, including yoga, thoracic expansion exercises, airway clearance methods, and breathing control, are likely to be beneficial.

INTRODUCTION

The COVID-19 pandemic and endemic have affected physical health, physical conditioning, well-being, and mental health status. Moreover, it has caused educational problems and economic, social network, cultural, and psychological issues [1].
This type of home confinement, social distancing, and physical inactivity has an impact on many diseases, such as obesity, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular diseases, and mental health problems such as depression and poor sleep quality [2]. These issues can eventually lead to insomnia and even immunodeficiency syndromes. Young adults and sedentary individuals have shown decreased daily physical activity and increased sedentary time during COVID-19 confinement. Previous studies have reported that the social distancing and lockdown measures implemented due to the COVID-19 pandemic may have influenced general health behaviors [3]. Many individuals suffer from various types of cell damage, including organ injuries and mild to severe COVID-19 syndrome, which is referred to as the post-COVID-19 syndrome.
Angiotensin-converting enzyme-2 upregulation, autonomic nervous system damage, and immune dysregulation account for many symptoms of organ damage in long-term COVID-19 patients. A systematic review reported that regular and repeated aerobic programs (such as cycling or walking with an intensity of 60-80% HR max, 20-60 minutes per session, 2-3 sessions per week) increased physical and mental health, as well as immune functions. This type of physical activity increased immunological markers, such as lymphocytes, leukocytes, neutrophils, monocytes, and interleukin-6 (IL-6), and even reduced low-grade inflammation [4].
Furthermore, exercise and physical activity are well-known preventive measures for many chronic diseases. A previous study has revealed the potential impact of physical exercise on the post-COVID-19 syndrome and the management of pulmonary complications, brain plasticity, cardiovascular health, and psychological well-being [5], which are related to the mechanism of action of irisin [7]. Patients can also recover through regular physical exercise and home-based physical activity during pandemic periods [8].
Therefore, the aim of this study was to analyze the impacts of tailored exercise interventions on the physical and mental health problems of COVID-19 and post-COVID-19 patients. Based on the results of this study, we can establish exercise intervention strategies to reduce the negative health outcomes during both the COVID-19 and post-COVID-19 periods.

METHODS

We conducted a search of the PubMed database from January 2020 to August 2023 using predefined search terms, including “COVID-19 and post-COVID-19,” “exercise intervention and immunity,” and “mental health.” Utilizing the retrieved references, we analyzed the associations between exercise interventions and the mental and physical health of COVID-19 and post-COVID-19 patients.

RESULTS AND DISCUSSION

COVID-19 emerged as a novel, mutating virus that triggered a global pandemic, causing severe cardiovascular and respiratory complications, as well as immunodeficiency syndromes. It is transmitted through respiratory droplets and close contact, with a presence detected in human respiratory epithelial cells. Consequently, it affects the cardiovascular system and lungs, leading to fibrin exudation and the formation of hyaline membranes in the alveoli [9]. Hospitalized COVID-19 patients exhibited a range of symptoms, including persistent cough, fever, difficulty breathing, and muscle pain [10]. Individuals with preexisting cardiovascular conditions and the elderly faced a higher risk of severe symptoms10. Overall, the pandemic led to measures like social distancing (commonly known as “COVID blue”), social isolation, and home confinement, which resulted in varying degrees of disorders, particularly among elderly individuals and patients. Timely physical and respiratory rehabilitation interventions demonstrated improvements in COVID-19 symptoms, quality of life (QoL), and also addressed issues related to the educational system, economy, social networks, culture, and psychological well-being [11]. In this study, we evaluated the effects of 6 weeks of respiratory training on maximal functional outcomes and found that it enhanced prognosis and QoL. COVID-19 disproportionately affected individuals with lower levels of physical fitness and functioning [4], and these conditions persisted for up to 1 to 2 years post-infection.
In general, viral infections have been implicated in the development of chronic fatigue, cognitive dysfunction, and post-traumatic stress disorder. The decline in physical fitness is believed to result from prolonged periods of “COVID blue” and physical inactivity, which, in turn, have been associated with conditions like myopathy, sarcopenia, osteopenia, and acute respiratory distress syndrome. Infected individuals typically presented with mild to moderate disease characterized by fever and respiratory difficulties. Approximately 30% of those infected with COVID-19 required hospitalization and experienced reduced physical fitness during both the acute phase and the post-COVID-19 period [4]. A systematic review shed light on the physical function and fitness outcomes in individuals with COVID-19, highlighting the impact of physical exercise intervention on their recovery [4]. Notably, a Canadian study (Canadian Perspectives Survey Series) reported that maintaining or increasing outdoor exercise had a positive effect on mental and physical health, compared to increased screen time (TV, gaming, or internet use) during periods of confinement [12]. Women, in particular, reported significantly better physical and mental health when engaging in outdoor exercise [12].
Participants reported their self-perceived general and mental health based on whether they exercised outdoors or indoors and whether they maintained, increased, or decreased their screen time (e.g., video games, internet browsing, and TV). These findings were consistent with those obtained from Italian children and adolescent groups, who reported increased screen time and decreased physical activity, along with the negative impact of these behaviors on their mobility during lockdown (similar trends were also observed in Canadian children and youth) [13,14]. Young adults and sedentary individuals experienced reduced daily physical activity and increased sedentary time (screen time) during both the COVID-19 confinement and post-COVID-19 periods [3].
These studies suggest that the social distancing measures and lockdowns implemented during the COVID-19 pandemic may have influenced general health behaviors. Home confinement, social distancing, and physical inactivity contributed to a range of health issues, including obesity, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular diseases, and mental health problems like depression and poor sleep quality, which ultimately led to issues like insomnia and immunodeficiency syndromes [2]. A systematic review indicated that regular and repeated aerobic programs (such as cycling or walking at an intensity of 60-80% of maximum heart rate, for 20-60 minutes per session, 2-3 sessions per week) improved both physical and mental health, along with immune functions [15]. This type of physical exercise resulted in increased immunological markers, including lymphocytes, leukocytes, neutrophils, monocytes, and IL-6, even causing low-grade inflammation [15]. As a result, enhanced immune functions were observed, particularly in patients and elderly individuals [16,17]. Another study showed that regular exercise interventions improved physical fitness (measured by the 30-second sit-to-stand test), work ability, and mental well-being.
Specifically, individuals with COVID-19, including those experiencing long-term effects, often faced airway and pulmonary health issues. Therefore, prescribing pulmonary rehabilitation, including postural adjustments, stretching, manual therapy, physical activity, and breathing exercises, was crucial to improving cardiorespiratory and cardiopulmonary function in post-COVID-19 patients [11]. Physical exercise has also demonstrated its effectiveness in combating microbial infections and managing most chronic diseases due to its anti-inflammatory effects [6], which are associated with the mechanisms of irisin [7]. Patients could recover more effectively with regular physical exercise and home-based physical activity during pandemic periods [7].
Breathing exercises and respiratory support techniques, such as yoga, thoracic expansion exercises, airway clearance methods, breathing control, and regular physical exercise, played a significant role in enhancing both physical and mental health, as well as immune responses [10,16,17]. Breathing exercises like qigong and tai chi appeared to improve both cell-mediated immunity and antibody response [18]. Physical activity contributed to the prevention and treatment of COVID-19 and promoted the recovery of physical function [19]. It is imperative to develop tailored, multifaceted exercise interventions to address existing mental challenges and enhance mental health during pandemic periods.
Furthermore, the continuous epidemiological distribution of physical and mental health problems varied among the general population. Therefore, there is an urgent need for more scientific, interdisciplinary, and cross-cultural studies on exercise interventions for physical and mental health problems (including their pathophysiology) during pandemic periods.

Acknowledgments

This research was supported by the HK plus project of Pukyong National University.

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