COVID-19 has been classified as a pandemic by WHO. To slow infection rates, particularly in groups predisposed to high risks of morbidity and mortality, extensive social distancing and isolation policies have been adopted worldwide, Dr. Magdy Badran says.
The immobilization due to hospitalization and bed rest and the physical inactivity due to sustained quarantine and social distancing can downregulate the ability of organs systems to resist viral infection and increase the risk of damage to the immune, respiratory, cardiovascular, musculoskeletal systems and the brain.
An abrupt reduction in activity levels, as would likely happen with social isolation, is of particular concern in older inpiduals, who are typically more inactive than their younger counterparts and prone to frailty and chronic diseases.
Sarcopenia
Human muscle undergoes constant changes. After about age 50, muscle mass decreases at an annual rate of 1–2%. Muscle strength declines by 1.5% between ages 50 and 60 and by 3% thereafter.
The reasons for these changes include denervation of motor units and net conversion of fast type muscle fibers into slow type fibers with a resulting loss in muscle power necessary for activities of daily living.
Also, lipids are deposited in the muscle, but these changes do not usually lead to a loss in body weight. On average, it is estimated that 5–13% of elderly people aged 60–70 years are affected by sarcopenia.
The numbers increase to 11–50% for those aged 80 or above. Sarcopenia may lead to frailty, but not all patients with sarcopenia are frail—sarcopenia is about twice as common as frailty. Muscle mass is associated with strength, a strong, independent risk factor for all‐cause mortality in older people.
Physical activity has been identified as beneficial for many diseases and health disorders, including sarcopenia. Both physical activities and exercise have shown to decrease the risk of sarcopenia and the onset of functional limitations in older persons.
Mechanical Unloading of Muscles
Prolonged periods of skeletal muscle inactivity or mechanical unloading (bed rest, hindlimb unloading, immobilization, spaceflight, and reduced step) can result in a significant loss of musculoskeletal mass, size, and strength which ultimately lead to muscle atrophy.
Mechanical unloading of muscles resulting from periods of inactivity may lead to a transient exacerbation of age‐related muscle waste, accelerating the progression of sarcopenia and the development of comorbidities.
Bed rest and limb immobilization have served as informative models to investigate the impact of drastic inactivity on muscle health, with literature consistently showing them to induce significantly greater muscle atrophy after only 5 to 10 days than seen annually in the older population.
Physical Inactivity and Morbimortality
The annual number of deaths attributed to physical inactivity has been estimated to be over 5 million globally. It is undisputed that measures of social isolation are required to counter the spread of COVID‐19 and to avoid the collapse of health systems.
However, we should also consider that increased inactivity has the potential to scale up morbimortality among older people, particularly if social isolation persists for longer periods.
Patients' health education should include recommendations to introduce the light activity in their daily routine, focusing on sitting less and moving more, which is particularly relevant for patients with mobility issues or low income with restricted access to adequate equipment/space.
Breaking up prolonged sitting time with light strolling or standing (e.g., during commercial breaks while watching television), household chores (e.g., cleaning and gardening), and physical leisure activities (e.g., dancing and short‐distance walking) also count as physical activity and could prevent excessive sedentary behavior.
The aggravation of physical inactivity emerges as a relevant “adverse effect” of the social isolation measures taken to combat the spread of COVID‐19.
Efforts toward the development of public health actions, clinical interventions, and rigorous top‐quality science on physical inactivity due to imposed quarantine during COVID‐19 are warranted.
Health Benefits of Physical Activity
Some immediate benefits of physical activity happen right after a session of moderate-to-vigorous physical activity. Benefits include improved thinking or cognition for children 6 to 13 years of age and reduced short-term feelings of anxiety for adults.
Regular physical activity can help keep your thinking, learning, and judgment skills sharp as you age. It can also reduce your risk of depression and anxiety and help you sleep better.
Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits. Both diet and physical activity play a critical role in maintaining healthy body weight, losing excess body weight, or maintaining successful weight loss.
You gain weight when you consume more calories through eating and drinking than the number of calories you burn, including those burned during physical activity. It is important to balance calories. You may need to be more active than others to reach or maintain a healthy weight.
Regular physical activity can also lower your blood pressure and improve your cholesterol levels. Regular physical activity can reduce your risk of developing type 2 diabetes and metabolic syndrome.
Research shows that adults who participate in greater amounts of physical activity have reduced risks of developing cancers of the bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach.
Doing aerobic, muscle-strengthening, and bone-strengthening physical activity at a moderately-intense level can slow the loss of bone density that comes with age. Among older adults, physical activity also reduces the risk of falling and injuries from falls.
Daily Steps
Walking is one of the most popular ways to get more physical activity as an adult. It is free, easy to get started, and you can fit it into your day any time you want. Wearable technologies like smartphones and watches can help you track how many steps you take each day.
Many of these devices recommend a goal of 10,000 steps for better health. But that goal may sound like a lot to some people.
Higher step counts were also associated with lower rates of death from heart disease and cancer. Adults who took 8,000 or more steps a day had a reduced risk of death over the following decade than those who only walked 4,000 steps a day.
Compared with people who took 4,000 steps a day, those who took 8,000 steps a day at the start of the study had a 50% lower risk of dying from any cause during follow-up. People who took 12,000 steps a day had a 65% lower risk of dying than those who took only 4,000.
Step intensity (number of steps per minute) did not influence the risk of death, suggesting that the total number of steps per day is more important than intensity.
Reducing daily steps (to 1,500 steps/day) has been shown to reduce leg fat‐free mass by approximately 4% over 14 days in older inpiduals.
Tips for Starting Physical Activity
Staying at home for prolonged periods can pose a significant challenge for remaining physically active. Sedentary behavior and low levels of physical activity can have negative effects on the health, well-being, and quality of life of inpiduals.
Self-quarantine can also cause additional stress and challenge the mental health of citizens. Physical activity and relaxation techniques can be valuable tools to help you remain calm and continue to protect your health during this time.
WHO recommends 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week, or a combination of both.
These recommendations can still be achieved even at home, with no special equipment and limited space. Do strengthening activities twice per week.
Activities that make you push or pull against something may improve your strength and balance. Clinicians should prescribe home‐based, resistance exercises “as medicine” for all older inpiduals
Take short active breaks during the day.
Short bouts of physical activity add up to the weekly recommendations. Playing with children, and performing domestic chores such as cleaning and gardening are other means to stay active at home.
Walking, even in small spaces, walking around, or walking on the spot, can help you remain active. If you have a call, stand, or walk around your home while you speak, instead of sitting down. If you decide to go outside to walk or exercise, be sure to maintain at least a 1-meter distance from other people.
Walk Whenever Possible. Walk instead of drive whenever you can. Walk your children to school. Take the stairs instead of the escalator or elevator. Take a family walk after dinner. Go for a half-hour walk instead of watching TV.
Get off the bus a stop early, and walk. Park farther from the store and walk. Make a Saturday morning walk a family habit. Walk briskly in the mall.
For optimal health, it is also important to remember to eat healthily and stay hydrated. WHO recommends drinking water instead of sugar-sweetened beverages. Avoid alcoholic beverages. Ensure plenty of fruits and vegetables, and limit the intake of salt, sugar, and fat. Prefer whole grains rather than refined foods
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