BJMB
Brazilian Journal of Motor Behavior
Special Issue:
COVID-19 (coronavirus disease): Impacts on motor behavior
!
Marçal, Ciolac
2021
VOL.15
N.1
The importance of promoting physical activity during the COVID-19 outbreak to control
the worsening of old pandemics
ISABELA R. MARÇAL
1
| EMMANUEL G. CIOLAC
1
1
Exercise and Chronic Disease Research Laboratory (ECDR), Departament of Physical Education, School of Sciences, São Paulo State University – UNESP, Bauru, SP,
Brazil.
Correspondence to: Emmanuel Gomes Ciolac. Universidade Estadual Paulista – UNESP, Faculdade de Ciências, Departamento de Educação Física, Laboratório de
Pesquisa em Exercício Físico e Doenças Crônicas. Av. Engenheiro Luiz Edmundo Carrijo Coube 14-06, Bauru, Brazil, 17033-360.
e-mail: emmanuel.ciolac@unesp.br | Twiter: @ProfessorCiolac
https://doi.org/10.20338/bjmb.v15i1.217
HIGHLIGHTS
• The measurements to contain COVID-19 are
changing the daily living activities in the
general population.
• A combination of a past and present
pandemics can be dangerous, and new
strategies are necessary.
• Physical activity is one of the most important
non-pharmacological therapies for health
promotion, and for prevention and
management of diseases.
• There is an urgent need in changing the face-
to-face prescription, management, and
evaluation of exercise to remote tools.
• The transitions from center-based to home-
based training are welcome to control the
worsening of old pandemics.
ABBREVIATIONS
COVID-19 Coronavirus disease 2019
FITT Frequency, intensity, time, and
type
NCDs Non-communicable chronic
diseases
PD Parkinson’s disease
SARS-CoV-2 Severe acute respiratory
syndrome coronavirus 2
WHO World Health Organization
PUBLICATION DATA
Received 09 12 2021
Accepted 17 02 2021
Published 01 03 2021
ABSTRACT: The pandemic of coronavirus disease 2019 (COVID-19) is an unprecedented public health
emergency of global concern. Although the measures to contain the COVID-19 spreading is essential, there are
old pandemics that we are still fighting and cannot be neglected during the current outbreak. Non communicable
chronic diseases (NCDs) remain the leading cause of death worldwide. Indeed, physical inactivity is one of the
most important risk factors for NCDs and it was considered a pandemic matter in 2012. Therefore, we discuss
new strategies (i.e., transition from center-based to home-based training) to increase motivation, participation,
and adherence in physical activity during the COVID-19 to control the worsening of old pandemics.
KEYWORDS: COVID-19 | Non-communicable chronic diseases | Physical activity | Home-based training
INTRODUCTION
The COVID-19 is an emergency that is responsible for 150.814.990 million
infections and 3.171.266 deaths worldwide.
1
The severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) has been shown to affect most individuals with non-
communicable chronic diseases (NCDs) resulting in poorer outcomes and higher
mortality.
2
NCDs has been considered a global health issue by the World Health
Organization (WHO) for the last 15 years.
3
NCDs represented US$ 84 billion of costs in
low-and-middle-income countries whereas it was accountable for 50% of the disease’s
total burden.
3
Indeed, although the measures to contain COVID-19 spreading are urgent
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and welcome, there are old pandemics that we are still fighting and cannot be neglected
during the current outbreak.
Physical inactivity is highly related to NCDs and it was considered a pandemic
matter in 2012.
4
In 2013, it was responsible for US$ 13.7 billion in productivity losses and
13.4 million disability-adjusted life-years worldwide.
5
Therefore, many international and
national organizations were “called to action” to advance global health through physical
activity.
6
Public strategies aimed to reduce at least 10% of physical inactivity until 2025.
7
However, the prevalence of insufficient levels of physical activity has been increasing in
low-income countries during the last years.
5
Therefore, it may not be possible to reach this
goal in the upcoming five years.
8
Furthermore, the measurements due to the COVID-19 (i.e., lockdown, quarantine,
and social isolation) are changing the daily living activities of worldwide population.
9
Preliminary evidence suggests a decrease in physical activity levels and a rise in
sedentary behavior, which may substantially increase the burden of NCDs.
10
Nevertheless,
aging population is an increasingly worldwide phenomenon, and the age-related effects
have been demonstrating to affect motor performance (i.e., slowing of movement) and
cognitive deficits (i.e., working memory) in older individuals. These declines in fine motor
control, gait, and balance affect the ability of older adults to perform activities of daily living
and thus maintain their independence.
11
In addition, the perception of social isolation (i.e.,
loneliness) is also a psychological risk factor for mortality and morbidity.
12
It has been
demonstrated that loneliness and social isolation are strongly associated with
cardiovascular conditions such as hypertension and atherosclerosis. Indeed, this
continuous social stress can influence cognitive function, depression, overactivation of the
sympathetic nervous system, and disturb neuroendocrine mechanisms.
13
Thus, a
combination of the current pandemic and a lockdown environment can be dangerous and
strategies to improve physical and mental health are urgently required.
Physical activity is one of the most important non-pharmacological therapies in
health promotion, prevention, and management of diseases.
6
The numerous benefits in
health-related and psychosocial variables are well established.
6,14
The chronic benefits of
the regular practice of physical activity are constructed by single sessions of exercise. For
example, in neurodegenerative diseases, one single session of a high- and moderate-
intensity aerobic exercise has demonstrated to promote better cognitive performance in
people with Parkinson’s disease (PD).
15
However, regarding to chronic effects, 12 weeks
of high-intensity interval exercise were superior to moderate-intensity continuous exercise
in improving the six-minute walking test and endothelial function in PD.
16
In cardiovascular
diseases, aerobic exercises can acutely reduce systolic/diastolic blood pressure nearly by
8/9mmHg, respectively.
17
In the long-term, a reduction of 36/12 mmHg in systolic/diastolic
blood pressure can be observed.
18
In fact, only a small reduction of 5mmHg in systolic
blood pressure decreases the risk of stroke by 14%, coronary heart disease by 9%, and
all-cause mortality by 7%.
19
Hence, the benefits of exercise initiate with short steps in
different diseases and it should be emphasized to increase the individuals’ participation,
motivation, and adherence to physical activity.
The main recommendations for physical activity are based on the frequency,
intensity, time, and type (FITT) of at least 150 min (30 min, 5 d/wk) of moderate-intensity
exercise (40-60%VO2MAX) or 75 min (25 min, 3 d/wk) of high-intensity exercise (60-85%
ofVO2MAX) per week, in association with 2 to 3 sessions per week of resistance
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exercise.
14
Flexibility and balance training are also recommended (2-3 d/wk), mostly for
older individuals.
6
However, the implementation of the physical activity guidelines’
recommendations in the general population is challenging. The main barriers correlated
with adult’s participation in physical activity are concerning the influence of marital status,
obesity, smoking, lack of time, past exercise behavior, and environmental variables.
20
Hence, access to facilities, neighborhood safety, and access to exercise equipment at
home can be important factors for increasing participation and supporting behavioral
change.
20,21
In recent years, home-based exercise training has been investigated as an
alternative to center-based training programs (i.e., gym, parks, clubs), and has been
shown to be an effective tool for improving cardiometabolic and psychosocial variables,
with no adverse events being reported.
21,22
In addition, it may aid patients in developing
self-management skills for improving and maintaining their physical fitness levels.
23
However, the benefits of home-based exercise training for high-risk individuals (i.e.,
cardiovascular disease) is still not adequately elucidated in the literature and future studies
are needed. Moreover, with the first wave of COVID-19, there was an urgent need to
change the face-to-face prescription, management, and evaluation of exercise to remote
tools (i.e., apps, videos, games, and other technologies).
21,24
With the second wave of the
COVID-19 in different countries, essential transitions from center-based to home-based
were welcomed to be developed and implemented focusing on new alternatives, and thus
increasing motivation, participation, and adherence to physical activity for controlling the
worsening of old pandemics (i.e., physical inactivity).
A recent review demonstrated the usefulness and safety of home-based exercise
training including aerobic, resistance, or combined exercise programs in individuals with
diabetes.
24
Various tools such as heart rate monitors, pedometers, portable oximeters,
questionnaires, diaries, or scales were suggested to control the intensity and duration of
exercise.
24
In addition, the use of equipment such as cycle ergometer, home rowing
ergometer, stairs, chair, rice bags, and bottles of water were mentioned as practical
strategies to implement an adequate exercise program.
24
It is important to note that regular
phone calls, video conferences, reevaluations, visits, cellphone messages, apps advice,
emails, or internet devices are considered important to maintain the development and the
regular feedback.
21,24
A first orientation session with explanations about an exercise
program and self-management education (i.e., call to the emergency in case of an event or
injury) is relevant during a well-guided home-based exercise program.
22
Yet, a
multidisciplinary team is important in the management and security of these programs.
The main advantages of home-based exercise training are expanded access,
individual programs, flexible scheduling, privacy, integration with regular home routines,
and members of the family.
21
Moreover, home-based exercise training has been
associated with higher satisfaction and appears to be more cost-effective than center-
based training.
23
Thus, it should be considered as a fixed option within exercise programs,
based on the preference, sociodemographic conditions, and clinical status of each
participant. Nonetheless, the latest WHO guidelines of physical activity and sedentary
behavior emphasize that “doing some physical activity is better than doing none” and
“every movement count” for all populations.
25
In this context, small actions in daily living,
such as interrupting prolonged sitting every 30 min
26
or regular intermittent bouts of
vigorous-intensity incidental physical activity (i.e., carrying shopping bags, walking uphill,
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and stair climbing) are beneficial for health and should be encouraged in lifestyle behavior
during and beyond home-based exercise training.
27
Finally, while many international strategies are being developed to contain the
COVID-19,
1
it is still necessary to combat old pandemics as the burden of NCDs and
physical inactivity. Despite the lack of studies assessing the health impact during the
COVID-19, physical inactivity can have an important impact, including an increase in the
global burden of NCDs. Therefore, increasing participation, adherence, and maintaining
the levels of physical activity will provide long-term physical, motor, and psychosocial
benefits. Indeed, the transition from center-based to home-based exercise programs may
be a useful and safe strategy during and beyond the COVID-19 outbreak, and future
studies to elucidate these benefits in the general population are welcome. In conclusion,
physical activity should be considered as the key to the past, present, and future which
have important public health implications.
ACKNOWLEDGMENTS
This work was supported in part by the Fundação de Amparo à Pesquisa do
Estado de São Paulo [FAPESP #2018/09695-5 - FAPESP #2019/19596-7], the Conselho
Nacional de Desenvolvimento Científico e Tecnológico [CNPq #303399/2018-0], and the
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES -
Finance Code 001).
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Citation: Marçal IR, Ciolac EG. The importance of promoting physical activity during COVID-19 outbreak to control the
worsening of old pandemics. BJMB. 2021:15(1):20-25.
Editors: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil; Dr José Angelo Barela -
São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia Madalena Rinaldi - Federal University of
Espírito Santo (UFES), Vitória, ES, Brazil.
Copyright:© 2021 Marçal and Ciolac and BJMB. This is an open-access article distributed under the terms of the
Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This work was supported in a part by Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP
#2018/09695-5 - FAPESP #2019/19596-7], Conselho Nacional de Desenvolvimento Científico e Tecnológico [CNPq
#303399/2018-0], and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES - Finance
Code 001).
Competing interests: The authors have declared that no competing interests exist.
DOI: https://doi.org/10.20338/bjmb.v15i1.217
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