EXERCISE OR NOT EXERCISE FOR CARDIOVASCULAR HEALTH

IN COVID-19 PANDEMIC
Dyana Sarvasti, MD, PhD
Faculty Of Medicine
Widya Mandala Catholic University Surabaya
 OUTLINE

01 02 03
THE POWERFUL
IMMUNE SYSTEM EXERCISE AND EXERCISE FOR
IMMUNE SYSTEM CARDIOVASCULAR
AGAINST
HEALTH IN COVID-19
THE POWERFUL PANDEMIC
COVID-19
 01
THE POWERFUL
IMMUNE SYSTEM
AGAINST
THE POWERFUL
COVID-19
 How Immunity Works
When 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 interstitium
amongst 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 signalling
pathways 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 hypoxaemia Nat Rev Cardiol. 2020 May;17(5):259-260
caused by COVID-19, resulting in damage to myocardial cells JAMA Cardiol. 2020 Mar 27. Doi: 10.1001/jamacardio.2020.1096
Cardiovascular Involvement in
Covid-19
Key manifestations and
hypothetical mechanisms

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
 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………..
 “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 COVID-19

from a cigarette”
(Jose-Luis Jimenez, a chemistry professor at the University of Colorado Boulder)
PANDEMIC:
“The findings should not discourage people from (OUTDOOR)
exercising”
(Bert Blocken, affiliated with both Eindhoven University of Technology in the Netherlands and
Exercise or Not
Catholic University Leuven in Belgium)

Exercise is crucial for maintaining physical and

to Exercise ?
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

Trained Active Sedentary Patients/Elderly

Intensity Additional intensity clues
% of % of % of
RPE (0–10) RPE (0–10) RPE (0–10)
HRmax HRmax HRmax
65 60 60
Low 2 (1–3) 2 (1-3) 2 (1-3) Easy, breath is moderate
(50-80%) (50-75%) (50-70%)
80 75 70 Somewhat hard, breath quickens,
Moderate 4 (3-5) 4 (3-5) 3 (2-4)
(70-90%) (70-85%) (65-80%) talking is possible, but not singing

Challenging, breath is deep and

90 85 80
High 6 (5–10) 5 (4–8) 5 (3–7) rapid, only few words can be said
(85-100%) (80–95%) (70–90%)
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