By Dr. John R. Mishock, PT, DPT, DC
COVID-19 has challenged our world in many ways. One significant change is the strict social distancing and quarantine which has led to feelings of loneliness, hopelessness, and panic. This quarantine has also led to an inability to exercise and stay active lending to poor quality of life and potential health consequences. The virus is particularly challenging because it is new with no individual immunity, vaccines, or treatment. COVID-19 enters through our eyes, nose, or mouth from a contaminated water drop via person-to-person or from a fomite. The fomite is a non-living object (doorknob, cell phone, car doors…) that transmits the virus. The virus is transmittable from these surfaces for up to 3 days depending on the surface type. If you touch the fomite then your face the virus can be exchanged. Once the virus enters our respiratory system (nose and mouth) our immune system (T-cells, macrophages) is activated which sets up an immune response (fever, cough, fatigue, shortness of breath). If our immune system has seen the virus (antigen) before it would have antibodies (immune cells) to recognize the virus and quickly dispose of it with minimal symptoms. Because COVID-19 is novel, few people have this acquired immunity. In order for our bodies to best defend against COVID-19 and other infectious agents, it is imperative that our immune system is functioning optimally. With COVID-19, influenza, and other viruses it is well known that those individuals who have impaired immunity have a much greater risk of severe symptoms and even death. However, there are ways we can enhance and optimize our immunity at home. In this article, I will review the science behind exercise, nutrition, and mindfulness (meditation, optimism, and prayer) in enhancing our cellular immunity to give us the best chance to combat COVID-19 and other diseases.
COVID-19 and Exercise:
Scientific evidence has shown that exercise can improve or prevent many health conditions such as; mental health issues (reduced depression, anxiety, and stress), obesity, insulin sensitivity, and type 2 diabetes, heart disease, hypertension, some types of cancers, brain health/dementia, and acute/chronic pain. ( Curr Opin Cardiol 2017)
There is mounting evidence that exercise and a physically active lifestyle diminishes the risk of contracting a range of communicable diseases including viral and bacterial infections. (Sci Sports Exerc, 2016) In a study of 1,509 men and women aged 20–60 years found that those who performed regular moderate exercise (30-45 min) had a lower incidence of upper respiratory tract infections by up to 60%. (Sports Exerc (2011) Exercise has been shown to neutralize viruses and bacteria that have entered the nasopharynx and oropharynx (nose and mouth) via increased immune cell activity (increased IgA immunoglobulin protein). (Exerc Immunol Rev 2011) Exercise can cause a dramatic influx of certain white blood cells (natural killer T cells, by up to 10 times and CD8+ T cells by 2.5 times) in the blood enhancing our immune defense system. (Brain Behav Immun 2009).
Beyond cellular immunity, exercise can help reduce emotional stress and anxiety by releasing brain chemicals (dopamine, enkephalins) giving us a feeling of happiness and euphoria, AKA “the runners high”. Studies have shown that repeated emotional stress reduces immunity. During this time of great anxiety and panic exercise can be a great way to combat those negative feelings while improving our immunity and overall health.
Recommended Exercise for School-Aged Children and Adolescents (ages 6 through 17 years) (CDC, 2020)
Sixty minutes of moderate-to-vigorous physical activity each day. Two days per week of exercise that strengthens bones and builds muscle.
Recommended Levels for Adults (CDC, 2020)
One hundred and fifty minutes of moderate exercise (getting the heart rate elevated to the cardiac zone) each week. The cardiac zone (220-age x .60= cardiac zone) is the heartbeats per minute during exercise. A rough estimate of the cardiac zone would be walking at a pace in which the breathing is elevated while still being able to carry on a conversation that is slightly labored. This aerobic exercise could be done for 30 minutes a day, 5 days a week. If needed, exercise could be broken into 10-minute chunks of time. Two of those days should be resistance training to build muscle and strengthen bones.
For cardiovascular fitness brisk walks or runs can be performed. Exercise such as soccer or basketball could be performed as long as social distancing is maintained. Bodyweight exercises are a great way to train at home with the family. Simple exercises could consist of; push-ups, planks, crunches, bridges, lunges (front, side, back), squats (double, single leg), heel raises (double, single leg), balance exercises, jumping jacks, burpees, jumps (forward, side, box).
COVID-19 and Nutrition:
It is well known that proper nutrition can lead to optimal health. There are many health providers who tout supplements to prevent or reduce symptoms of cold, flu, and even COVID-19, however, to date there is limited or no scientific evidence that supplements can prevent infection of coronavirus or any other virus. Nevertheless, supplements such as vitamin C, vitamin E, vitamin D, zinc, selenium, resveratrol, and curcumin could be utilized, however, it is best to get these nutrients through food. Antioxidants and phytochemicals, which promote cellular function and enhance the immunity, have the best evidence. The top foods that are scientifically proven to be packed with large amounts of vitamins, minerals, and phytochemicals are; Berries fruit (elderberry, blueberry, raspberry, strawberry), Citrus fruit (oranges, grapefruits, tangerines, lemons), Other fruits (tomatoes, apples, watermelon), Leafy greens (spinach, Swiss chard, kale, collard greens, or mustard greens), Cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale, kohlrabi, mustard greens, radishes, and turnips), Nuts (hazelnuts, walnuts, almonds, pecans, whole grains (oatmeal, quinoa, brown rice, wheat bread), Legumes (kidney, black, red, and garbanzo beans, soybeans, and peas), Tea and coffee, Mushrooms, Sweet potatoes. If for some reason you are unable to eat a healthy diet a multivitamin could be utilized.
COVID-19 and Mindfulness (Meditation, Prayer, and Positive Thinking):
Science has shown the powerful link between the brain and the immune system. It has been shown that mindfulness and prayer can decrease; cortisol, blood pressure, resting heart rate, blood glucose, and cholesterol. (Epub 2016) It can also bolster anti-viral immune responses and decrease markers of inflammation especially in those experiencing high levels of psychological stress (Psychoneuroimmunology, 2018). The regular practice of yoga has been shown to improve psychological well-being and improve immunity by increasing white blood cell counts in patients suffering from chronic viral exposure such as HIV. Studies have shown that a positive attitude, versus pessimism, can increase mucosal and blood level immunity. (J Pers Soc Psychol. 1998, Brain Behav imun, 2005) When negative thoughts of fear, anxiety and panic strike, turn those thoughts into an encouraging positive mindset. For those looking for meditation routines, search the app store for yoga nidra.
Keep in mind that this crisis will end and there will be better days. Using the above techniques can complement; social distancing (> 6 feet), washing hands, not touching your nose, eyes, and face (without washing hands first), and cleaning frequently touched surfaces give you and your family the best chance to stay healthy.
We can help!
If pain or function is limiting you from doing the activities you enjoy, call Mishock Physical Therapy for a Free Phone Consultation (610)327-2600. Email your questions to firstname.lastname@example.org. Visit our website to learn more about our treatment philosophy, our physical therapy staff, and our 6 convenient locations in Gilbertsville, Skippack, Phoenixville, Barto, Limerick, and Pottstown at www.mishockpt.com.
Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania.