How Exercise Beats Covid-19

3d-abstract-medical-background-depicting-coronavirus-cells_1048-11870.jpg

Because whilst people can, and will, debate on best practice, what to do, who’s to blame, and why Boris and Donald should be doing more (at the same time furiously buying up a whole continents’ supply of toilet paper and paracetamol before their neighbour does), I am going to talk about what I do know.

And this, ladies and gentlemen, is fact.

This article is a long one, and let’s face it, you probably aren’t going anywhere so you have time to read it! 


Stick with it, because it might just change your current thought process.
 

I have included a lot of reference to studies to show this is not opinion but fact; fact that comes from years of research done by people with massive brains. That this is not new thinking, but considered, evolved, scientific fact.

I also wanted to write this because whilst you may be scared by what is going on, you can help yourself. You can give yourself a better chance. You don’t have to sit, re-hydrate your carb rich meal and wait for something to happen.

In fact, it might be better for you, and your family, if you read this, and please feel free to share. 

For those who do make it to the end of this, I hope it will give you some peace of mind, as many of the recommendations in this article were common practice many years before today's outbreak; pay attention to the section on recommendations for good health practices for athletes.

I also wanted to put out there that if you are housebound, voluntarily or involuntarily, perhaps now is not the best time to be carb loading - stock piling and consuming large amounts of high energy foodstuffs at a time when you are least active might not be the best strategy…..just a thought.

So here it is.

Exercise and Immune Function - Why you should be exercising in the midst of Covid 19.

I am going to look at 4 main areas of this: 

  1. Acute and chronic effects of exercise on the immune system

  2. Clinical benefit of exercise

  3. Nutritional influences on the immune response to exercise

  4. Exercise effect on immunosenescence

Introduction

Scientific discoveries on and development in exercise and immune function can be organised into time periods. The earliest studies took place between 1900-1979, and  focused on exercise-induced changes in basic immune cell counts and function.

Then came Aids. Probably as big a scare as we have right now, I was just a child but can remember talk of it, adverts to practice safe sex, etc.The human immunodeficiency virus was identified as the cause of AIDS in 1984.

One of the markers for AIDS was the CD4 antigen on helper T cells that required a flow cytomer for detection. As a result many universities acquired flow cytomers in the 80’s and so they became available to exercise researchers, and this was the birth of the modern era of exercise immunology research.

In the Journal Of The American Medical Association for the 1984 Olympic Games it was concluded:

“That there was no clear experimental or clinical evidence that exercise will alter the frequency or severity of human infections...Further studies will be needed before it can be concluded that exercise affects the host response to infection in any clinically meaningful way.” (1)

This provided a framework for future research investigations.

At the same time many papers were published evidencing that heavy exertion was associated with transient immune dysfunction, elevated inflammatory biomarkers, and increased risk of upper respiratory tract infections (URTI’s). (2, 3, 4)

This gave rise to what some of you may have been told:

Exercise can suppress your immune system

Or:

Perhaps more accurately:  acute bouts of intense and prolonged exercise were linked by some EARLY exercise immunology investigators to suppressed salivary immunoglobulin A (IgA), decreased natural killer cell (NK) lytic activity, reduced T- and B cell function and increased URTI risk. (5)

So, in 1989 the International Society of Exercise Immunology was founded.

From 1990 - 2009 investigative focus went on to  include the effect of nutrition on exercise immunology. (6, 7)

Advances in science from 2010 have led to mass spectrometry and genetic testing, which in turn led to study of gut microbiome characterization, lipidomics, protcomics and metabolomics, with the gathered information being used to understand and provide sophisticated exercise and nutrition guidelines. (8, 9)

Worthy of note at this point is that through this research it was concluded that exercise-induced immune changes are now widely accepted as important for reduced cancer and heart disease risk, both of which are far bigger killers than COVID 19. (10, 11)

  1. Acute and Chronic Effects Of Exercise On the Immune System

Acute (short term) effects of exercise on the immune system depend upon the intensity and duration of effort. 

Initially studies in this defined intensity with a threshold of 60% of oxygen uptake and heart rate reserve, and a duration of 60 minutes, but more attention is now being focused on the (immune) response to bouts of less than 60 minutes. (12, 13, 14, 15)

Research shows that during moderate and intense exercise bouts of less than 60 min, antipathogen activity occurs in parallel with enhanced re-circulation of immunoglobins, anti-inflammatory cytokines, neutrophils, NK cells, cytotoxic T cells, and B cells - all of which play a critical role in immune defense. (16, 17)

Studies also show that acute bouts of exercise mobilise NK cells and CD8 T lymphocytes which have high cytotoxicity - Basically, exercise sessions less than 60 minutes mobilise your good guys which kill the bad guys. (18, 19)

Further, stress hormones, which can suppress the immune cell function and are often found in high levels during prolonged (chronic) bouts of exercise, do not reach high levels during short duration bouts. (20) 

Short really is sweet!

Importantly, it seems these increases work cumulatively over time, enhancing immune surveillance and lowering inflammation (21, 22). Which means, the more you do, the better it is for you.

In fact, acute (short term) exercise bouts are considered vital if you want to ensure ongoing interaction of the exchange of leuokycytes (a white blood cell involved in counteracting disease) between the circulation and tissues. (23)

Short exercise sessions are a simple immune boosting strategy that everyone can do that will flush your blood with T-cell and NK cells. More of the good guys. (24, 25)

Metabolically speaking, exercise induces elevations in IL-6 that have anti-inflammatory effects, as well as improving glucose (sugar) and lipid (fat) metabolism, again, if done regularly over time. (26, 27)

So, if you have diabetes - get exercising! You will be at decreased risk of illness….

Exercise is so good for your immune system it has even been suggested that you should exercise after a vaccination to enhance your response to it. (28)

Exercise And Immunity Suppression

Evidence suggests that high exercise workloads, such as those associated with elite level competition, are associated with immune dysfunction; tested biomarkers of immune function are altered for between several hours to days after an event. 

The physiological response between 30 min session and longer are clearly documented. (29, 30, 31, 32, 33, 34). So, you do not need to worry about your sessions in the gym, unless you intend to go on the treadmill for 2 hours!

Research in exercise immune function, specifically metabolomics, protomics, and lipidomics, has revealed the inextricable link between metabolism and immunity to the extent that a new area of research has been founded: 

Immunometabolism. (35, 36)

So, with it being accepted that there is a profound perturbation in your immune function after prolonged exercise, if you are looking to avoid contraction of an illness perhaps now is not the best time to undertake long bouts of exercise. (37)

However, if you do, thanks to this relatively new area of study, increased intake of carbohydrate and polyphenols has been shown to counter the exercise-induced detrimental effects. (38, 39)

But studies do show detrimental effects to the immune system form prolonged bouts of exercise:

In a large group of 2311 endurance runners, nearly 13.0% reported illness during the week after the Los Angeles Marathon race compared with 2.2% of control runners; 

Forty percent of the runners reported at least one illness episode during the 2-month winter period before the marathon race;

And those running more than 96 km/week vs less than 32 km/ week, they doubled their odds for illness. (40)

And it is not just prolonged exertion that was found to compromise immune systems in these studies; athlete's concern over their event led to mental stress and lack of sleep which further compromised their immune system function (41). Perhaps high levels of stressing over contraction of Covid 19 may ironically increase your susceptibility to contracting it.

As data was gathered, such was the magnitude of the findings that several major athletic organisations including the  IOC and IAAF initiated systems to prevent illness and improve treatment. (42, 43) Interestingly, they also found amongst the illnesses high levels of anxiety and depression. (44, 45)

Why am I citing studies of elite level cases of illness? 

Because this is where immune system function and exercise data is primarily gathered, much like Formula One technology, eventually you and I, the general public, get the benefit.

 

Athletes are interested in strategies to keep their immune systems robust, staying healthy and keeping illness rate as low as is possible. If we follow their training, hygiene, nutritional and psychological strategies then we too can stay as healthy as we possibly can.

I was luckily enough to see Sir Clive Woodward discuss the protocol for the London 2012 Team GB. He left no stone unturned including sleep, hygiene systems, nutrition and of course training to ensure our greatest ever medal count.

Can we learn from this?

Here are some of the findings for improving athlete health long before Covid 19 was ever a considered sniffle:

Hygiene, Lifestyle, Nutritional and Behavioural Strategies

  • Minimise pathogen exposure by avoiding close contact with infected individuals in crowded, enclosed spaces, and not sharing drinking or eating implements.

  • Avoid exercise sessions in poorly ventilated clubs and gymnasium facilities.

  • The medical staff should isolate infected athletes.

  • Limit hand-to-face contact (i.e., self-inoculation) 

  • Wash Hands regularly and effectively. 

  • The medical staff should educate the athletes to minimise pathogen spread to others(e.g., sneezing and coughing into the crook of the elbow).

  • Follow other hygienic practices to limit all types of infections including safe sex and the use of condoms, wearing open footwear when using public facilities to limit skin infections, using insect repellents, and covering the arms and legs with clothing at dawn or dusk.

  • Maintain vaccines needed for home and foreign travel,with a focus on annual influenza vaccination.

  • Follow strategies that facilitate regular, high-quality sleep.

  • Avoid excessive alcohol intake.

  • Consume a well-balanced diet with sufficient energy to maintain a healthy weight, with a focus on grains, fruits,and vegetables to provide sufficient carbohydrate and polyphenols that reduce exercise-induced inflammation and improve viral protection.

 

Psychological Load Management. 

  • Follow stress management techniques that decrease the extraneous load of life hassles and stresses. 

  • Develop coping strategies that minimise the internalised impact of negative life events and emotions.

  • Periodically monitor psychological stresses using available instruments. (46)

Surprised by any of these - how about the washing hands one?

Each bout of acute exercise you do promotes improved immune resistance, and when repeated on a regular basis provides you with decreased illness incidence and dampens systemic inflammation. The protective effect of regular exercise is well documented. (47)

Covid 19 symptoms start with a sore throat and cough. There are numerous studies that clearly show the reduction of UTRI symptoms after bouts of exercise (49, 50, 51, 52).

 A group of 1002 adults (aged 1885 years; 60% female and 40% male) studied for 12 weeks (one-half during the winter, one-half during Autumn), with monitoring of URTI symptoms and severity using the validated Wisconsin Upper Respiratory Symptom Survey. (53)

The number of days with URTI was 43% lower in subjects engaging in an average of 5 or more days per week of aerobic exercise (20 min bouts or longer) compared with those who were largely sedentary (1 day/week), and 46% lower when comparing subjects in the highest vs. lowest tertile for perceived physical fitness. 

This relationship persisted, even after adjustment for confounders such as age, education level, marital status, gender, body mass index, and perceived mental stress. (54)

Massive! Acute exercise sessions lowers the time you suffer with UTRI.

Other studies even show a decreased mortality rate for those with influenza and pneumonia. (55, 56, 57)

Exercise  increases support for anti-body responses to influenza immunisation for the elderly population who engage in regular training (58, 59)

As an aside, it is worth highlighting that obesity induces a constant low-grade state of inflammation. (60, 61) And exercise without weight loss does not reduce the inflammation (62, 63, 64).

Nutrition

Gut health.

Gut microbiota has a significant impact on health and immune function. 

The gastrointestinal tract is colonised by trillions of micro-organisms. Approximately one third of adult gut microbiota is reckoned to be the same, with diversity associated with health status. 

Research shows that exercise and level of fitness diversifies gut microbiota, enhancing the number of mircobial communities. (65, 66)

Nutritional support of exercise immune function is well researched (67) and there is plenty of evidence demonstrating that the ingestion of carbohydrate during chronic bouts of exercise leads to lower stress markers post exercise (68, 69, 70)

Polyphenols

These are mirconutrients that we get through certain plant-based foods, packed with anti-oxidants. And evidence suggests that they act as countermeasures to exercise-induced immune changes (71, 72)

If you are undertaking prolonged bouts of exercise, or are concerned your sessions are compromising your immune health, it is not only prudent to consume these during and post your session, but also ensure you consume plenty of vegetables in your diet as through a complex absorption process polyphenols become readily available to exert their immune boosting properties (73). Bananas are great for this (74) as are dates and raisins.

Immunosenescence - Exercise And Anti-Ageing

Defined as immune dysregulation with ageing. It is related to increased susceptibility to infections, autoimmune diseases, neoplasias, metabolic diseases, osteoporosis and neurologic disorders. 

Evidence suggests that exercise can help remodel the ageing process with relation to your immune system (75).

A study showed that immune cell function in elderly regular exercisers contrasted to sedentary individuals was higher in the exercisers (76). Don’t take my word for it, another study found the same (77).

Data supports that regular exercise supports the ageing immune system and delays the onset of immunosenesence, with regular exercisers displaying: (78)

  • Enhanced vaccination responses

  • Lower numbers of exhausted/senescent T cells

  • Increased T-cell proliferative capacity

  • Lower circulatory levels of inflammatory cytokines (i.e.,decreased “inflamm-ageing”)

  • Increased neutrophil phagocytic activity

  • Lowered inflammatory response to bacterial challenge

  • Greater NK cell cytotoxic activity

  • Longer leukocyte telomere lengths

In Conclusion

In times such as now it is even more important to maintain, or start, your exercise regime.

There are many research papers supporting exercise to boost your resistance to disease. Regular exercise training has an anti-inflammatory influence and enhances your immune system.

We all know gyms can be less than hygienic, A Tribe Called Sweat prides itself on our levels of hygiene.

We installed a state of the art air purification system that removes particulates as small as 0.3 micron (10 times smaller than those measured to gauge air pollution) in 2018. Our air is sterile.

The same machine also disperses probiotics throughout the gym - these are the good kind to kill the bad kind, which means all surfaces are being constantly “wiped”. 

We have been doing this long before Corona and will continue to do so for long after, because we believe that whilst exercising to boost your immune system, your environment should not be detrimental to your immune system - one step forward, one step back…..

Wanna get fit and well in a clinically clean space? Join our Tribe 😅.
 

Lastly, this is not common knowledge, but should be, especially now. Right now.

Please send this to anyone you care about. Even better, send it to Boris so we can get  help making exercise better understood.

As always, dedicated to your success,

Ben.

  1. https://jamanetwork.com/journals/jama/article-abstract/395248

  2. https://journals.lww.com/acsm-msse/Citation/1986/10000/To_the_Editor_in_Chief.18.asx

  3. https://www.nrcresearchpress.com/doi/10.1139/y88-230#.XmzL6qj7SiM

  4. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-3083.1989.tb01137.x

  5. (Niceman DC, Johanssen LM, Lee JW,  Infectious episodes in runners before and after a roadrace. J Sports med Phys Fitness 1989:29: 289-96).

  6. https://academic.oup.com/ajcn/article-abstract/57/2/170/4715217?redirectedFrom=fulltext

  7. https://journals.physiology.org/doi/full/10.1152/jappl.1997.82.5.1662

  8. https://scholar.google.com/scholar_lookup?title=Upper%20respiratory%20symptoms%2C%20gut%20health%20and%20mucosal%20immunity%20in%20athletes&author=C.%20Colbey&publication_year=2018&pages=S65-S77

  9. https://www.annualreviews.org/doi/10.1146/annurev-food-032818-121316

  10. https://www.sciencedirect.com/science/article/abs/pii/S0378512213001941

  11. https://scholar.google.com/scholar_lookup?title=Exercise%20in%20regulation%20of%20inflammation-immune%20axis%20function%20in%20cancer%20initiation%20and%20progression&author=G.J.%20Koelwyn&publication_year=2015&pages=908-920

  12. https://journals.sagepub.com/doi/10.1177/1534735415580681

  13. https://www.sciencedirect.com/science/article/abs/pii/S0024320518301887

  14. https://www.sciencedirect.com/science/article/pii/S1877117315001842

  15. https://www.sciencedirect.com/science/article/pii/S0889159109000610

  16. https://www.sciencedirect.com/science/article/pii/S0889159111000079

  17. https://www.sciencedirect.com/science/article/pii/S0889159118301223

  18. https://www.sciencedirect.com/science/article/pii/S0889159113005291

  19. https://www.sciencedirect.com/science/article/pii/S0889159109000610

  20. Niemann DC, Henson DA, Austin MD, Brown VA, Immune response to a 30min walk. Med Sci Sports Exerc 2005; 37:57-62).

  21. https://journals.sagepub.com/doi/10.1177/1534735415580681

  22. https://www.sciencedirect.com/science/article/abs/pii/S0024320518301887

  23. https://www.sciencedirect.com/science/article/pii/S0889159111000079

  24. https://www.sciencedirect.com/science/article/pii/S0889159113005291

  25. https://www.sciencedirect.com/science/article/pii/S1877117315001842

  26. https://onlinelibrary.wiley.com/doi/abs/10.1038/icb.2015.101

  27. https://onlinelibrary.wiley.com/doi/full/10.1111/eci.12781

  28. Grande AJ, Reid H, Thomas EE, Nunan D, Foster C. Exercise prior to influenza vaccination for limiting influenza incidence and its relatedcomplications  in adults.Cochrane Database Syst Rev2016;22:CD011857. doi:10.1002/14651858. CD011857.pub2.

  29. https://journals.physiology.org/doi/full/10.1152/japplphysiol.00971.2016

  30. https://journals.physiology.org/doi/full/10.1152/japplphysiol.00622.2016

  31. https://www.sciencedirect.com/science/article/pii/S1877117315001842

  32. https://www.sciencedirect.com/science/article/pii/S1877117315001842

  33. https://www.sciencedirect.com/science/article/pii/S088915911630099X

  34. Niemann DC, Henson DA, Austin MD, Brown VA, Immune response to a 30min walk. Med Sci Sports Exerc 2005; 37:57-62).

  35. https://www.annualreviews.org/doi/10.1146/annurev-food-032818-121316

  36. https://www.sciencedirect.com/science/article/pii/S1074761317303679

  37. Peters EM, Bateman ED, Ultramarathon running and upper respiratory tract infections. An epidemiological survey. S Afr Med J 1983;64:582-4

  38. Nieman DC, Gillitt ND, Sha W, Esposito D, Ramamoorthy S. Metabolicrecovery from heavy exertion following banana compared to sugar bev-erage or water only ingestion: a randomized, crossover trial.PLoS One2018;13:e0194843. Doi: 10.1371/journal.pone.0194843

  39. https://www.annualreviews.org/doi/10.1146/annurev-food-032818-121316

  40. Niemann DC, Johanssen LM, Lee JW, Arabatzis K. Infectious episodes in runners before and after the los Angeles marathon. J Sports Med Phys Fitness 1990;30:316-28

  41. KonigD, Grathwohl D, Weinstock C, Northoff H, Berg A. Upperrespiratort tract infection in athletes,:influence of lifestyle, type of sport, training effort and immunostimulantintake Exerc Immunol Rev 2000:6:102-20

  42. https://bjsm.bmj.com/content/50/17/1043

  43. https://bjsm.bmj.com/content/51/4/271

  44. https://bjsm.bmj.com/content/50/17/1043

  45. https://bjsm.bmj.com/content/50/15/939

  46. https://reader.elsevier.com/reader/sd/pii/S2095254618301005?token=7B3EB17DC0830DDD10FFEE4DDE425CA9AAB0B0CA12A43095F356F6B1FE4E130A263FC5CE056A1800EC5C898583CC6029

  47. Niemann DC, Is infection risk linked to exercise workload? Med Sci Sports Exerc 2000;32(Suppl. 7):S406-11

  48. https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2007-1024839

  49. http://www.annfammed.org/content/10/4/337

  50. Barrett B, Hayney MS, Muller D, Rakel D, Brown R, Zgierska AE, et al.Meditation or  exercise for preventing acute respiratory infection(MEPARI-2): a randomized controlled  trial.PLoS One2018;13:e0197778.

  51. https://bjsm.bmj.com/content/45/12/987

  52. Zhou G, Liu H, He M, Yue M, Gong P, Wu F, et al. Smoking, leisure-time exercise and frequency of self-reported common cold among thegeneral population in northeastern China: a cross-sectional study.BMCPublic Health2018;18:294. 

  53. https://www.sciencedirect.com/science/article/pii/S089543560400349X

  54. https://www.sciencedirect.com/science/article/pii/S089543560400349X

  55. https://journals.lww.com/acsm-msse/Fulltext/2014/05000/Reduced_Total_and_Cause_Specific_Mortality_from.11.aspx

  56. Wu S, Ma C, Yang Z, Yang P, Chu Y, Zhang H, et al. Hygiene behaviors associated with influenza-like illness among adults in Beijing, China: alarge,  population-based survey.PLoS One2016;11: e0148448.

  57. Wong CM, Lai HK, Ou CQ, Ho SY, Chan KP, Thach TQ, et al. Is exer-cise protective against influenza-associated mortality?PLoS One 2008;3:e2108.

  58. https://www.sciencedirect.com/science/article/pii/S0264410X03008181

  59. de Araujo AL, Silva LC, Fernandes JR, Matias Mde S, Boas LS,Machado CM, et al. Elderly men with moderate and intense training life-style present sustained higher antibody responses to influenza vaccine.Age (Dordr)2015;37:105

  60. https://onlinelibrary.wiley.com/doi/abs/10.1002/mnfr.201500272

  61. https://academic.oup.com/cardiovascres/article/113/9/1009/3952694

  62. https://www.sciencedirect.com/science/article/abs/pii/S0021915009004043

  63. https://link.springer.com/article/10.1007%2Fs40279-013-0023-3

  64. https://www.sciencedirect.com/science/article/abs/pii/S0009898110001646

  65. Estaki M, Pither J, Baumeister P, Little JP, Gill SK, Ghosh S, et al. Cardiorespiratory fitness as a predictor of intestinal microbial diversity and distinct metagenomic functions.Microbiome2016;4:42

  66. https://onlinelibrary.wiley.com/doi/abs/10.1038/icb.2015.108

  67. https://www.annualreviews.org/doi/10.1146/annurev-food-032818-121316

  68. https://academic.oup.com/ajcn/article/66/1/153/4655646

  69. https://journals.humankinetics.com/view/journals/ijsnem/9/2/article-p213.xml

  70. https://pubs.acs.org/doi/10.1021/acs.jproteome.5b00909

  71. https://www.annualreviews.org/doi/10.1146/annurev-food-032818-121316

  72. Nieman DC, Gillitt ND, Sha W, Esposito D, Ramamoorthy S. Metabolicrecovery from heavy exertion following banana compared to sugar bev-erage or water only ingestion: a randomized, crossover trial.PLoS One2018;13:e0194843

  73. https://onlinelibrary.wiley.com/doi/abs/10.1002/ptr.5208

  74. Nieman DC, Gillitt ND, Sha W, Esposito D, Ramamoorthy S. Metabolicrecovery from heavy exertion following banana compared to sugar bev-erage or water only ingestion: a randomized, crossover trial.PLoS One2018;13:e0194843.

  75. https://www.sciencedirect.com/science/article/pii/S1568163712000438

  76. https://www.sciencedirect.com/science/article/pii/S1568163712000438

  77. https://journals.lww.com/acsm-msse/Abstract/1995/11000/Physical_activity_and_immune_senescence_in_men.8.aspx

  78. https://reader.elsevier.com/reader/sd/pii/S2095254618301005?token=7B3EB17DC0830DDD10FFEE4DDE425CA9AAB0B0CA12A43095F356F6B1FE4E130A263FC5CE056A1800EC5C898583CC6029

Lukasz Surma