EXERCISE OR NOT EXERCISE FOR CARDIOVASCULAR HEALTH

IN COVID-19 PANDEMIC

Dyana Sarvasti, MD, PhDFaculty Of Medicine

Widya Mandala Catholic University Surabaya

OUTLINE

THE POWERFUL IMMUNE SYSTEM

AGAINST THE POWERFUL

COVID-19

01EXERCISE AND

IMMUNE SYSTEM

02EXERCISE FOR

CARDIOVASCULAR HEALTH IN COVID-19

PANDEMIC

03

01

THE POWERFUL IMMUNE SYSTEM

AGAINST THE POWERFUL

COVID-19

How Immunity WorksWhen a pathogen gets into the body, the immune system reacts in 2 ways……..

1. THE INNATE IMMUNE RESPONSE is a rapid reaction. Innate immune cells recognize certain molecules found on many pathogens. These cells also react to signaling molecules released by the body in response to infection. Through these actions, innate immune cells quickly begin fighting an infection. This response results in inflammation. The cells involved in this reaction can kill pathogens and can also help activate cells involved in adaptive immunity.

2. THE ADAPTIVE IMMUNE RESPONSE is slower than the innate response but is better able to target specific pathogens. There are 2 main cell types involved in this response: T cells and B cells. Some T cells kill pathogens and infected cells. Other T cells help control the adaptive immune response. The main function of B cells is to make antibodies against specific antigens. Antibodies, also known as immunoglobulins, are proteins that attach themselves to pathogens. This signals immune cells to destroy the pathogen.

JAMA. 2015;313(16):1686. doi:10.1001/jama.2015.2940

Coronavirus particle▪

‐‐

▪

▪

J Med Virol. 2020;92:424–432

The innate immune response

and adaptive immune

responses of Coronaviruses (CoV) infection

J Med Virol. 2020;92:424–432

Bivariate Cox Regression of Factors

Associated With ARDS Development or

Progression From ARDS to Death

JAMA Intern Med. Published online March 13, 2020

Immune cells in the resting heart

The majority of immune cells in the resting heart are macrophages, which are found primarily surrounding endothelial cells but are also seen in the interstitiumamongst cardiomyocytes.

Mast cells, dendritic cells (DCs), B cells and regulatory T (TReg) cells are found sparsely in cardiac tissue.

Neutrophils and monocytes are not observed within myocardial tissue, but can be observed as contaminants found in the vasculature during steady state.

Nat Rev Immunol. 2015 Feb;15(2):117-29

COVID-19 AND CARDIOVASCULAR CONSEQUENCES

SARS-CoV-2 could trigger an exaggerated inflammatory response that can cause myocardial injury.

The pathogenesis of cardiac involvement associated with SARS-CoV-2 may reflect a process of replication and dissemination of the virus through the blood or the lymphatic system from the respiratory tract.

There are no reports of influenza virus or coronavirus RNA in the heart, to date.

The mechanism of acute myocardial injury caused by SARS- CoV-2 infection might be related to ACE2.

ACE2 is widely expressed not only in the lungs but also in the cardiovascular system and, therefore, ACE2-related signallingpathways might also have a role in heart injury.

Other proposed mechanisms of myocardial injury include a cytokine storm triggered by an imbalanced response by type 1 and type 2 T helper cells and respiratory dysfunction and hypoxaemiacaused by COVID-19, resulting in damage to myocardial cells

Nat Rev Cardiol. 2020 May;17(5):259-260

JAMA Cardiol. 2020 Mar 27. Doi: 10.1001/jamacardio.2020.1096

ESC Guidance for the Diagnosis and

Management of CV Disease during the

COVID-19 Pandemic, 2020.

https://www.escardio.org/Education

/COVID-19-and-Cardiology

Cardiovascular Involvement in

Covid-19

Key manifestations and

hypothetical mechanisms

02

EXERCISE AND

IMMUNE SYSTEM

Physiol Rev 80: 1055–1081, 2000

Front. Physiol., 24 January 2020

“J-shaped”

model depicting

dose-dependent

effect of exercise

on risk and

severity of

respiratory tract

infections

J Sports Med Phys Fitness. 1989;29(3):289–96

Can exercise affect immune function

to increase susceptibility to infection?

THE YES

The incidence of URI in high-performance athletes

can increase during periods of intense training, in

association with increases in training load and

competitions.

NK cell and neutrophil function, T- and B-

lymphocyte function, salivary IgA output, skin

delayed-type hypersensitivity response, major

histocompatibility complex II expression in

macrophages, and other biomarkers of immune

function are altered for several hours to days

during recovery from prolonged and intensive

endurance exercise.

Exercise has the potential to transiently alter

immune protection, increase the risk of infection,

or induce inflammatory processes in the airways.

THE NO

Exercise induces a bi-phasic response, whereby leukocyte

frequency in blood increases, and then, upon exercise

cessation, the frequency of some cells decreases below

resting levels to a nadir one or two hours later.

The fall in cell number after exercise does not reflect mass

apoptosis. Instead, cells are redistributed out of the

bloodstream to tissues and organs → immune function is

compromised.

The only one-third of illness symptoms reported by athletes

over five-months represented genuine infections . The

three-quarters of illness symptoms reported by athletes

were infectious, likely caused by factors such as allergy,

asthma or non-specific mucosal inflammation, and not

infection due to exercise induced immuno-suppression.

Exercise Immunology Review (2020); 26: pp.8-22

03

EXERCISE FOR CARDIOVASCULAR

HEALTH IN COVID-19 PANDEMIC

Droplet spreading when running at a speed of 14.4 km/h when……..(a,b) running behind each other(c) side-by-side(d) in staggered arrangement

To summarize, based on the trend in the increase of infections, and understanding the basic science of viral infection spread,

we strongly believe that the virus is likely to be spreading through the air………..

COVID-19 PANDEMIC: (OUTDOOR)

Exercise or Not to Exercise ?

“UV light is a natural virucidal agent” (Lytle CD, Sagripanti JL. J Virol. 2005;79(22):14244–14252)

“Viruses may linger in the air much like smoke from a cigarette”

(Jose-Luis Jimenez, a chemistry professor at the University of Colorado Boulder)

“The findings should not discourage people from exercising”

(Bert Blocken, affiliated with both Eindhoven University of Technology in the Netherlands and Catholic University Leuven in Belgium)

Exercise is crucial for maintaining physical and mental health in the midst of a pandemic, as it is at any other time

Recommendations for Doing Physical Activity and Sport in People with Different

Conditions During COVID-19 PANDEMIC

GI, gastrointestinal; URI, upper respiratory tract infection. Asian J Sports Med. 2020 March; 11(1):e102630.

Intensity categories of home-based aerobic exercise training for various target groups

Intensity

Trained Active Sedentary Patients/Elderly

Additional intensity clues% of

HRmaxRPE (0–10)

% of HRmax

RPE (0–10)% of

HRmaxRPE (0–10)

Low65

(50-80%)2 (1–3)

60 (50-75%)

2 (1-3)60

(50-70%)2 (1-3) Easy, breath is moderate

Moderate80

(70-90%)4 (3-5)

75 (70-85%)

4 (3-5)70

(65-80%)3 (2-4)

Somewhat hard, breath quickens, talking is possible, but not singing

High90

(85-100%)6 (5–10)

85 (80–95%)

5 (4–8)80

(70–90%)5 (3–7)

Challenging, breath is deep and rapid, only few words can be said without pausing for breath

MANAGING SPORT AND LEISURE. https://doi.org/10.1080/23750472.2020.1757494

A. Mohamed, M. Alawna . Diabetes & Metabolic Syndrome: Clinical Research & Reviews (2020),

doi:https://doi.org/10.1016/j.dsx.2020.04.038.

SUMMARY

❖ In general, the human immune response is divided into innate immune responses and adaptive immune responses that have a very high ability to fight viral infections.

❖ The SARS-CoV 2 virus is a powerful virus whose mechanism of action in the heart is still unknown.

❖ Exercise can improve the body's immune system to prevent diseases including viruses, which must be done during the COVID-19 pandemic with the right type, intensity, duration and frequency.

❖ The exercise immunology field that regular bouts of short-lasting (i.e. up to 45 minutes) moderate intensity exercise are ‘immunoenhancing’ whereas repeated bouts of long-lasting (i.e. >2hours) arduous intensity exercise can be ‘immunosuppressive’.

❖ Belgian-Dutch Study: For outdoor exercises, the scientist advises that for walking the distance of people moving in the same direction in 1 line should be at least 4–5 meter, for running and slow biking it should be 10 meters and for hard biking at least 20 meters.

❖ The best way: replace outdoors activities with home-based activities, such as bodyweight training and dance-based aerobic exercise, and if possible, aerobic high-intensity exercise using stationary bikes or rowing ergometers, also with selfpaced protocols.

THANK YOU

European Journal of Preventive Cardiology 0(0) 1–3. @The European Society of Cardiology 2020