COVID-19: Lifestyle, CoVesity and ExerciseTime to Identify and Defeat the Real Culprits with Clinical Physiological Interventions

Abstract

Coronavirus Disease-2019 (COVID-19) is a global pandemic. Morbidity-mortality is related with hyper-immuno-thrombo-inflammation. Unhealthy lifestyle and obesity with high inflammation, should be prone for increased morbidity-morbidity in COVID-19. Hence, physical-activity, exercise and positive lifestyle are beneficial. The review explored this relationship. Literature search was done for association of physical-inactivity, obesity, fitness, exercise and other lifestyle-factors with COVID-19. Relevant articles (~43) were selected, the core-information was then incorporated. The complications of COVID-19 are associated with modifiable lifestyle riskfactors: physical-inactivity, obesity and low-fitness etc, which are the real culprits. There is bidirectional, reciprocal and positive association between pandemic of physical-inactivity/obesity and that of COVID-19. Obesity and inactivity are associated with high COVID-19 incidence, viral shedding-duration, vaccine-inefficiency; hospital and Intensive Care Unit (ICU) admission, duration-ofstay and death. These real culprits need effective management using various Clinical Physiological Interventions (CPIs) including fitness, nutritional and lifestyle improvement. Cardiorespiratory-fitness (CRF), physical-activity and exercise have protective role in COVID-19. Moderate aerobic-exercise of ≥150-300 minutes/week, or ≥75 minutes/week of vigorous-activity (or combination), with ≥2 days/week of strength-training should be done. Unexplained alterations in physical-activity Ratings-of-Perceived-Exertions (RPE) may indicate Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) infection. Early mobilisation from passiveto-active movements to light-to-moderate activity should be part of multidisciplinary, phased, and symptom-led rehabilitation. Asymptomatic positives should restrain from intense-exercise for ≥2 weeks. Return-to-Play (RTP), with ≥2 weeks of minimalexertion reaching preCOVID activity after ≥4-5 weeks, may be done for recovered players (no-symptoms for ≥7-10 days and ≥10 days of symptom-onset). There should be no sports for ≥3 and ≥6 months for players with pericarditis and myocarditis, ≥4 weeks for pneumonia, and ≥2-4 weeks for symptomatic players with no myocarditis and pneumonia. Medical evaluation and relevant cardiac-pulmonary-ergometry-biochemical and other investigations are needed before RTP. Optimal, individualised, nutrient-dense, natural and whole food based chrono-nutrition with no metaflammation is a must. Good sleep, healthy circadian-rhythm, limiting sedentary-behaviour, coping-skills with no mental/ psychological/ emotional stress and addiction, meditation, healthy-relationship and positive social-connections are other key lifestyle-factors to be prioritised.