Andreas Fröberg
Department of Food and Nutrition and Sport Science, University of Gothenburg.
A compelling body of evidence suggests that physical activity, defined as a behavior that involves human movement and increases energy expenditure (Pettee Gabriel, Morrow & Woolsey 2012), is important for health and well-being among people of all age groups (Piercy et al. 2018). For instance, physical activity is associated with improved cardiorespiratory and muscular fitness among children and adolescents, and lower risk of cardiovascular disease and all-cause mortality among adults and older adults (Piercy et al. 2018). Table 1 provides an overview of how health outcomes improve after engaging in moderate intensity aerobic physical activity (equivalent in effort to brisk walking) and vigorous intensity aerobic physical activity (equivalent in effort to running) or a combination thereof. Aerobic physical activities involve large body muscles and increase breathing and heart rate for a sustained period of time (Piercy et al. 2018).
Table 1. Health benefits and recommendations for children, adolescents, adults and older adults (Piercy et al. 2018).
Based on this research, children and adolescents are currently recommended to undertake at least 60 minutes per day of moderate-to-vigorous aerobic physical activity (Piercy et al. 2018). The corresponding recommendations for adults and older adults are at least 150 to 300 minutes per week of moderate intensity aerobic physical activity, 75 to 150 minutes per week of vigorous intensity aerobic physical activity, or an equivalent amount of moderate-to-vigorous aerobic physical activity (Piercy et al. 2018). Recommendations for muscle-strengthening and bone-strengthening physical activity, in addition to balance training have also been established (Piercy et al. 2018). Table 1 provides an overview of the physical activity recommendations for children, adolescents, adults, and older adults.
Despite these recommendations, global estimates suggest that many people do not achieve physical activity recommendations (Guthold, Stevens, Riley & Bull 2018, 2020). As such, physical inactivity, the term used to describe insufficient physical activity levels (Tremblay et al. 2017), has been referred to as a pandemic (Kohl et al. 2012). Physical inactivity has also been acknowledged as a leading risk factor for non-communicable diseases, and is estimated to be the top fourth leading causes of death worldwide (Kohl et al. 2012).
On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus (SARS-CoV-2) disease (Covid-19) outbreak a pandemic (Cucinotta & Vanelli 2020). Ever since its outbreak, Covid-19 has remained a public health concern, and as of September 2020, more than 27 000 000 confirmed cases of Covid-19 and 890 000 deaths have been reported worldwide (WHO 2020a). During the last few months, people in numerous countries and regions have experienced closures of schools and workplaces, restrictions on public events, and even lockdown (Islam et al. 2020). A number of health authorities, including the Public Health Agency of Sweden (2020), have also provided key principles to protect oneself and others from spreading the coronavirus. For instance, WHO (2020b) has recommended that people wash their hands frequently, maintain social distance, avoid crowded places and touching eyes, nose and mouth, and furthermore to stay home when experiencing minor symptoms of illness.
Although protective measures certainly are critical for preventing the spread of the coronavirus, it may have negative consequences for people’s physical activity (Sallis, Adlakha, Oyeyemi & Salvo 2020). For instance, there may be restrictions on outdoor activities, and fitness centers and gyms may have reduced opportunity to offer physical activity programs, such as aerobics classes or other group-based activities. Therefore, people may have limited access to environments in which they usually are physically active (Lim & Pranata 2020). One consequence of these restrictions may be that people spend more time engaging in sedentary behavior, defined as any waking behavior characterized by low energy expenditure while in a sitting, reclining or lying posture (Tremblay et al. 2017). Examples of sedentary behaviors include use of electronic devices, such as television, computer, tablet, and telephone. Research show that some types of sedentary behavior are associated with negative health consequences among children, adolescents, and adults. For instance, different types of screen-time has been associated with unfavorable body composition and lower fitness among children and adolescents (Carson et al. 2016). Some evidence also suggest that sedentary behavior may contribute to morbidity and mortality among adults (Young et al. 2016).
Although some countries and regions have begun to ease coronavirus restrictions, we live in times of uncertainty and unpredictably. While international health authorities have acknowledged the importance of physical activity during the Covid-19 pandemic (Dwyer, Pasini, De Dominicis & Righi 2020; Rodríguez Crespo & Olmedillas 2020), a recent study by Tison and colleagues (2020) demonstrate that people have become less physically active since the Covid-19 outbreak. As physical activity is important for health and well-being among people in all age groups, this work provides information useful for people who want to stay physically active in a safe manner during the Covid-19 pandemic.
In general, it seems appropriate to recommend a multicomponent physical activity program, involving aerobic and muscle-strengthening physical activity, in addition to stretching exercises. Older adults may also include balance training in their activity regimens. In the event that access to indoor and outdoor environments are restricted, home-based physical activity is an appropriate way to stay physically active during the Covid-19 pandemic (Hammami, Harrabi, Mohr & Krustrup 2020). Examples of physical activities, equipment, and alternative equipment that can be used are provided in Table 2 (e.g., Chen et al. 2020; Hammami et al. 2020; Jurak et al. 2020).
Table 2. Some examples of physical activities, equipment, and alternative equipment (e.g., Chen et al. 2020; Hammami et al. 2020; Jurak et al. 2020; Nyenhuis et al. 2020).
It is important to stress that both fitness equipment and everyday household objects, such as books, bottles, broomsticks, and furniture, can be used to perform physical activity. Many home-based physical activities, including abdominal crunches, box jumps and burpees, jump roping, jumping jack, plank, push-ups, squats and split squats, step-up onto a chair, and triceps-dip on a chair, can also be carried out with one’s own bodyweight (e.g., Hammami et al. 2020; Jurak et al. 2020). Table 3 offer examples of home-based exercises provided by the WHO European Region (2020c).
Table 3. Examples of home-based exercises provided by the WHO European Region (2020c).
Note: Illustrations are available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/stay-physically-active-during-self-quarantine
In addition to the examples provided in Table 2 and 3, health technologies may also offer guidance on different physical activity programs (Nyenhuis, Greiwe, Zeiger, Nanda & Cooke 2020). For instance, both online video-sharing platforms, such as YouTube, and smartphone applications allows for people to access free-of-charge exercise programs (Nyenhuis et al. 2020).
Furthermore, Table 4 presents some recommendations on protective measures. Most importantly, people should maintain social distance and avoid crowded environments (e.g., Chen et al. 2020; Dominski & Brandt 2020; Nyenhuis et al. 2020). The importance of adopting hygiene and sanitation protocols has also been emphasized (Hudson & Sprow 2020). In relation to Covid-19, it is furthermore critical to acknowledge that moderate intensity exercise may have beneficial effects on the immune system while vigorous intensity exercise, especially if performed during several hours, may weaken the immune system (Nieman & Wentz 2019). Therefore, it is suggested that prolonged vigorous intensity exercise may be avoided during the Covid-19 pandemic.
Table 4. Some recommendations on protective measures (e.g., Chen et al. 2020; Dominski & Brandt 2020; Nyenhuis et al. 2020).
Although physical activity generally is safe among healthy people, those susceptible to any chronic conditions are recommended to consult a health care practitioner about appropriate physical activity programs (Piercy et al. 2018). In order to reduce the risk of injuries, it is also critical to adopt physical activity programs based on current physical condition and gradually introduce physical activity by beginning at light-intensity physical activity and then progressing toward higher intensities (Piercy et al. 2018). A physical activity program should also be interrupted when experiencing symptoms of Covid-19, such as fever, cough, and fatigue (Grant et al. 2020). In case of any health condition, it is furthermore important to acknowledge that the information provided in this paper does not replace medical guidance from a health-care provider.
Copyright © Andreas Fröberg 2020
Referenser
Carson, V., Hunter, S., Kuzik, N., Gray, C. E., Poitras, V. J., Chaput, J. P., Saunders, T. J., Katzmarzyk, P. T., Okely, A. D., Connor Gorber, S., Kho, M. E., Sampson, M., Lee, H., & Tremblay, M. S. (2016). Systematic review of sedentary behaviour and health indicators in school-aged children and youth: An update. Appl Physiol Nutr Metab, 41(6 Suppl 3), S240-265
Chen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., & Li, F. (2020). Coronavirus disease (Covid-19): The need to maintain regular physical activity while taking precautions. J Sport Health Sci, 9(2), 103-104
Cucinotta, D., & Vanelli, M. (2020). WHO declares Covid-19 a pandemic. Acta Biomed, 91(1), 157-160
Dominski, F. H., & Brandt, R. (2020). Do the benefits of exercise in indoor and outdoor environments during the Covid-19 pandemic outweigh the risks of infection? Sport Sci Health, 1-6
Dwyer, M. J., Pasini, M., De Dominicis, S., & Righi, E. (2020). Physical activity: Benefits and challenges during the Covid-19 pandemic. Scand J Med Sci Sports, 30(7), 1291-1294
Grant, M. C., Geoghegan, L., Arbyn, M., Mohammed, Z., McGuinness, L., Clarke, E. L., & Wade, R. G. (2020). The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; Covid-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One, 15(6), e0234765
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018). Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1.9 million participants. The Lancet Global Health, 6(10), e1077-e1086
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2020). Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health, 4(1), 23-35
Hammami, A., Harrabi, B., Mohr, M., & Krustrup, P. (2020). Physical activity and coronavirus disease 2019 (Covid-19): Specific recommendations for home-based physical training. Managing Sport and Leisure, 1-6
Hudson, M. G., & Sprow, K. (2020). Promoting physical activity during the covid-19 pandemic: Implications for obesity and chronic disease management. J Phys Act Health, 17(7), 685-687
Islam, N., Sharp, S. J., Chowell, G., Shabnam, S., Kawachi, I., Lacey, B., Massaro, J. M., D’Agostino, R. B., & White, M. (2020). Physical distancing interventions and incidence of coronavirus disease 2019: Natural experiment in 149 countries. BMJ, 370, m2743
Jurak, G., Morrison, S. A., Leskošek, B., Kovač, M., Hadžić, V., Vodičar, J., Truden, P., & Starc, G. (2020). Physical activity recommendations during the coronavirus disease-2019 virus outbreak. J Sport Health Sci, 9(4), 325-327
Kohl, H. W., Craig, C. L., Lambert, E. V., Inoue, S., Alkandari, J. R., Leetongin, G., & Kahlmeier, S. (2012). The pandemic of physical inactivity: Global action for public health. The Lancet, 380(9838), 294-305
Lim, M. A., & Pranata, R. (2020). Sports activities during any pandemic lockdown. Ir J Med Sci, 1-5
Nieman, D. C., & Wentz, L. M. (2019). The compelling link between physical activity and the body’s defense system. J Sport Health Sci, 8(3), 201-217
Nyenhuis, S. M., Greiwe, J., Zeiger, J. S., Nanda, A., & Cooke, A. (2020). Exercise and fitness in the age of social distancing during the covid-19 pandemic. J Allergy Clin Immunol Pract, 8(7), 2152-2155
Pettee Gabriel, K. K., Morrow, J. R., Jr., & Woolsey, A. L. (2012). Framework for physical activity as a complex and multidimensional behavior. J Phys Act Health, 9 Suppl 1, S11-18
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The physical activity guidelines for Americans. JAMA, 320(19), 2020-2028
Public Health Agency of Sweden. (2020). Protect yourself and others from spread of infection. Retrieved from: https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/protect-yourself-and-others-from-spread-of-infection/
Rodríguez, M. Á., Crespo, I., & Olmedillas, H. (2020). Exercising in times of Covid-19: What do experts recommend doing within four walls? Rev Esp Cardiol, 73(7), 527-529
Sallis, J. F., Adlakha, D., Oyeyemi, A., & Salvo, D. (2020). An international physical activity and public health research agenda to inform coronavirus disease-19 policies and practices. J Sport Health Sci, S2095-2546(20)30064-8
Tison, G. H., Avram, R., Kuhar, P., Abreau, S., Marcus, G. M., Pletcher, M. J., & Olgin, J. E. (2020). Worldwide effect of covid-19 on physical activity: A descriptive study. Ann Intern Med, M20-2665
Tremblay, M. S., Aubert, S., Barnes, J. D., Saunders, T. J., Carson, V., Latimer-Cheung, A. E., Chastin, S., Altenburg, T. M., & Chinapaw, M. (2017). Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act, 14(1), 75
World Health Organization (2020a). WHO Coronavirus disease (Covid-19) dashboard. Retrieved from: https://covid19.who.int/
World Health Organization European Region. (2020c). Stay physically active during self-quarantine. Retrieved from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/stay-physically-active-during-self-quarantine
World Health Organization. (2020b). Coronavirus disease (Covid-19) advice for the public. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
Young, D. R., Hivert, M. F., Alhassan, S., Camhi, S. M., Ferguson, J. F., Katzmarzyk, P. T., Lewis, C. E., Owen, N., Perry, C. K., Siddique, J., & Yong, C. M. (2016). Sedentary behavior and cardiovascular morbidity and mortality: A science advisory from the American Heart Association. Circulation, 134(13), e262-279
