Regular exercise and healthy eating enhances our overall health, improves quality of life and reduces risk factors for disease.
How does this relate to Covid-19?
We know that Covid-19 is a contagious viral infection spread through inhalation or ingestion of droplets through coughing, sneezing and touching infected surfaces. Once it has entered the body, the virus hijacks cells in the lungs and then repeatedly replicates itself whilst destroying healthy cell tissue around the alveoli and attacking oxygen in haemoglobin. In serious cases, the immune system becomes suppressed and starts to attack healthy cells too.
No one actually dies of Covid-19, but they can die of the secondary causes that happen in the wake of the damage caused by the virus. Having more co-morbidities puts you at a higher risk as the immune system is already in a weakened state, and it has been found that conditions such as cardiovascular disease, COPD, diabetes, hypertension and cerebral vascular diseases are a major risk factor (Wang et al, 2020). Once the virus has taken affect in the lungs, often 9-10 days after the initial onset of the virus, the immune system response and the disruption brought about by the virus can exasperate underlying health conditions and lead to issues with cardiac function, damage to vital organs and blood, neurological disfunction and general fatigue.
Reduction of T-Cells in severe Covid-19 cases
It has been found that people who have had a more severe response to Covid-19 have had a decreased number or lack of T-cells in the body, and those T-cells have become exhausted (Diao et al., 2020). T-cells play a vital role in viral clearance as they attack the virus and help to provide antiviral immunity. Chronic diseases and cancers lead to T-cell depletion, however behaviour change and lifestyle modifications can help to boost T-cell production (Nieman & Wentz, 2019) and give the immune system more of a fighting chance against viruses such as Covid-19.
Exercise, moving more, and behaviour change all improve T-Cell production
Staying active and reducing sedentary time, as well as following a progressive exercise programme with the aim of improving cardiovascular endurance, strength and functional movement, are all factors which contribute towards optimising our overall fitness and health.
Does being overweight or obese put you at higher risk?
Purely from a scientific standpoint, the fact is that obesity alters the physiology of the body and a person who classified as obese (BMI >30) is more at risk of developing chronic diseases such as Type 2 Diabetes, cardiovascular disease and certain cancers (Abdelall et al. 2017) and have a significantly higher risk of all-cause mortality (Flegal et al. 2013). This is particularly relevant in the current climate, if you are obese you are more susceptible to having a more severe response to Covid-19 (Diets & Santos-Burgoa, 2020) and (Stefan, Birkenfield & Schulz, 2021). This appears to be due to the immune system being already overworked and increased inflammation levels before the onset of Covid-19, causing a more serious response once the virus has taken hold and altered the body.
It is also important to note that research also suggests the location of stored bodyfat can have an impact on the risk factors of developing a more severe response to Covid-19 (Foldi et al, 2020). It may therefore be more important to look at body composition and in particular visceral adiposity (body fat stored around your waist) as a more influential factor, compared to the more generalised BMI scale. For example, you could have two people both with a BMI of 30 but with very different body compositions – one person may have a much higher level of bodyfat particularly around their waist, whereas the other person may have a more even fat distribution, putting them at a lower risk.
However, it will never be as clean cut as that, many individual factors such as their activity level, level of stress, quality of diet, amount and quality of sleep, alcohol intake, smoking, work/life situation, environment and many other lifestyle factors also play a role in contributing to overall health. We can therefore say that BMI and body composition aren’t the only things to think about, but it can be used as a factor for the general population.
“Everything in excess is opposed to nature.”
Hippocrates
As with most things, excess usually comes with higher risks in general, the higher up the BMI scale a person is, the higher the risk, and the higher the level of visceral adipose tissue, the higher the risk. There are always extremes on every scale for example, a person who is extremely underweight is at risk of having a weakened immune system and other health issues which could contribute to a more severe response to diseases/viruses.
And this is where I disagree with misleading, extreme blanket statements which have been used on social media or in television/magazine interviews recently, suggesting that all diets are unhealthy, being overweight is healthy or that any form of intentional weight loss or fat loss advice is a bad thing.
Negative past experiences with diets and weight loss strategies most likely come from being given incorrect or unhelpful nutrition or dietary advice in the past. There are many experienced coaches, nutritionists, and health professionals out there who can help people achieve their sustainable weight loss goals, whilst acknowledging the impact that weight stigma may have on the individual with the overall goal of improving their health and quality of life. This really shouldn’t be overlooked by those who believe that weight loss strategies do not work or are harmful.
We need to take an evidence based approach when looking at health promotion.
Are these claims that you see in the media backed by science?
I’ve seen people who have spoken out about the relationship between obesity and disease, backed by scientific research, being accused of ‘fat-shaming’ by activists and being discouraged from addressing the topic of bodyweight at all. I find it worrying that even with the abundance of scientific research showing the link between excess bodyweight and all-cause morbidities and mortality (references below), that this is happening.
Equally on the other extreme, we have ‘influencers’ promoting fat loss supplements/foods, extreme diet strategies and quick fix solutions to either gain followers or because they are being paid to advertise them. Such things can lead to eating disorders, unhealthy relationships with food and failed attempts at achieving weight loss goal, all of which can have a huge psychological impact on the individual. It is disappointing yet completely understandable that the promotion of weight loss has gained such a negative association.
If we were to move away from these extreme ideas and beliefs around dieting, going back and forth arguing about who is right or wrong when it comes to being healthy, and instead focus on promoting and educating the basics of good nutrition, exercise and healthy lifestyle choices, then surely we can all work together to become healthier and happier without the need to take sides.
It all comes down to reducing risk factors for chronic diseases, which are backed by scientific research, and putting the population in a better position to be able to deal with future health threats.
What can I do to reduce risk factors and improve my overall health?
- Move more and work on improving your cardiovascular health – exercising until you feel out of breath at least once per week
- Improve your strength and work on your functional movement
- Eat whole foods and reduce intake of processed foods and refined carbs
- Take a Vitamin D supplement and Omega-3, and achieve adequate protein intake
- Stay hydrated, try and get into a regular sleep pattern, think about methods of reducing stress
- Consider weight loss to achieve a healthy bodyweight if appropriate, especially look to reduce visceral adipose tissue (excess bodyfat around your waist)
Everyone is different and there is no one-size-fits-all when it comes to finding an effective route to improving your health and wellbeing. For some people, weight loss/calorie restriction will be a suitable strategy to improve their health, for example, for people with Type 2 diabetes, weight loss has been shown to significantly improve health markers (Anderson et al., 2003).
Other people may see health benefits from focusing on exploring strategies to reduce their overall stress such as improving their fitness levels, cardiovascular health, mobility and strength and improving their relationship with food and many other such strategies. This may put them in a stronger position and mental state to gain more control over their lifestyle choices, and weight loss may come as a by-product of healthier eating and being more active, rather than focussing on calorie counting.
We need to take ownership of our health.
Covid-19 will not be disappearing completely any time soon and now is the time for us all to take ownership of our health and lifestyle choices – let’s give ourselves the best fighting chance against the virus by improving our overall fitness and providing our body with the nutrition it requires to be in the strongest, most optimal position.
I want to clarify that yes, there is still a chance that a generally healthy person may be severely affected or even die from a response to the virus, and I’m not saying that no one would end up in hospital with COVID if everyone was fit and healthy, but the number would be significantly lower, therefore reducing the overall strain on the health service.
I’ve written this blog after spending time looking into the current research and recently published articles (you can find these easily on Google Scholar), as well as research from my degree, and more recently completing an accredited course on exercise rehabilitation after COVID-19 (CAWS Rebuild). With my Masters in Exercise & Nutrition Science, it doesn’t mean I know everything but it does mean I have spent many years learning how to research and analyse scientific evidence along with data from published journal articles and reviews relating to physical activity and nutrition in health and disease. It worries me that there is so much misinformation and opinion taken as fact from news reports and social media, I just want to encourage everyone who reads this blog to take the time to learn how to research and look at the bigger picture. This means not just looking at one paper but as many as you can, especially systematic reviews and meta-analysis which review multiple studies and research papers.
Moving forward, let’s take the right steps out of Lockdown to become happier, healthier and fitter.
In my opinion, it is worrying that instead of promoting the health benefits of an active healthy lifestyle in relation to Covid-19 recovery, the lockdown strategies and government public health promotions have generally encouraged a more sedentary lifestyle (locking down and staying indoors, gym and sports facility closures including outdoor facilities). There has been little emphasis on promoting the importance of physical activity and getting outside, not only to improve fitness and activity level, but also to increase Vitamin D levels and increase endorphins (which can help combat stress and low mood). Fast food takeaways have been able to stay open and we are continually presented with easy options of eating quick, convenient, highly-processed and calorie dense foods.
Instead of, or as well as, an eat out to help out scheme, why not have a work out to help out scheme when lockdown is eased? I completely understand that gym memberships, PT sessions, gym/sports equipment, bikes etc cost money, extra money that many people may not have right now. This sort of scheme could really help to open up the opportunity for more people to get involved with physical activity, and there really is no long-term disadvantage of getting more of the population fitter and healthier, especially with the threat of future waves of the virus or other pandemics in years to come.
Have you had Covid-19 and are unsure about how to safely get back into exercise again? Look out for my next blog about rebuilding your body and managing fatigue after Covid-19 or get in touch to have a chat or book in some PT sessions – email alice@amhealth.co.uk
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Aman, Faseeha, and Sadia Masood. “How Nutrition can help to fight against COVID-19 Pandemic.” Pakistan Journal of Medical Sciences 36.COVID19-S4 (2020): S121.
Anderson, J. W., Kendall, C. W., & Jenkins, D. J. (2003). Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. Journal of the American college of nutrition, 22(5), 331-339.
Balanzá–Martínez, Vicent, et al. “Lifestyle behaviours during the COVID‐19–time to connect.” (2020): 399-400.
Carter, Stephen J., Marissa N. Baranauskas, and Alyce D. Fly. “Considerations for obesity, vitamin D, and physical activity amid the COVID‐19 pandemic.” Obesity 28.7 (2020): 1176-1177.
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Flegal, Katherine M., et al. “Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis.” Jama 309.1 (2013): 71-82.
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Stefan, N., Birkenfeld, A.L. and Schulze, M.B., 2021. Global pandemics interconnected—obesity, impaired metabolic health and COVID-19. Nature Reviews Endocrinology, pp.1-15.
Wang, B., Li, R., Lu, Z., & Huang, Y. (2020). Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging, 12(7), 6049–6057. https://doi.org/10.18632/aging.103000
