Can I exercise during this pandemic?
Yes. There is evidence that moderate exercise performed for 20-30 minutes 3-4 times per week strengthens the immune system and reduces the risk of viral infection. Scientific studies have also shown that regular moderate exercise prior to developing a potentially serious viral infection such as flu protects people from dying from it. There is also evidence that people who continued to remain active during the 1998 Hong Kong flu were more likely to survive compared to people who did not perform any exercise.
The current pandemic means that exercising in gyms and other communal exercising areas or performing team sports is no longer possible.
Individual exercise is recommended. The Government currently permits 1 outdoor sporting activity per day such as walking briskly, jogging or cycling. Avoid jogging or cycling in groups. When jogging outdoors, anticipate and avoid a less than 2-metre distance from other individuals. You may exercise together with members of your own household. It is possible that in the long-term all outdoor activity may become prohibited if the infection continues to surge.
Individuals who have exercising facilities at home such as treadmills, static bicycles or rowing machines should be encouraged to use them to stay physically fit especially if the pandemic has resulted in working from home or social isolation because a household member or close contact is expressing symptoms. All hard surfaces on these machines should be wiped down with a soapy sponge, some other mild detergent or antiseptic wipes. You can perform press-ups and sit-ups in your rooms. There are many online programmes and telephone apps to allow you to perform yoga, strength training or high-intensity exercise in your homes or in the garden.
I am a competitive athlete and need to keep fit for when the competitive season starts again. What advice do you have for me?
Individuals competing at club level and professional athletes need to maintain fitness to return to competition in the foreseeable future. Many elite athletes will have been provided with a remotely supervised training schedule and others may have developed their own exercise programme. Many athletes will have static exercise machines at home to allow them to keep fit. Some clubs from the highest echelons of sport will also provide wearable GPS devices to monitor physical activity remotely. In the current situation, the exercise programmes recommended may not fully reflect your sport e.g. football or rugby. The key is to remain as fit as possible for when the season resumes. Full match fitness is unlikely with most team sports and it is anticipated that a mini pre-season training week will be organised by most clubs before formal competition recommences.
I was going to run a marathon next week, but this has been postponed for 6 months. Shall I continue training as usual?
Most people who were planning to run a marathon in the next few weeks will have trained for several months and will be reaching peak performance. Such individuals would usually rest after the event. It is highly unlikely that any marathon events will take place in Europe for at least 5 months. Indeed, the duration of this pandemic is uncertain therefore you should pace yourself and prevent the risk of overtraining and reducing your immunity (see below). Train as if the event is 4 months away and take at least 3 rest days per week. Try not to attempt a personal best this year and focus on running for a good cause and in celebration of the end of the pandemic. Hospitals are likely to be depleted for several months and medical directors would be keen to keep the number of transfers to hospital to a minimum.
I have heard that if I exercise too much, I will increase my chances of getting the infection. Is this true?
Not necessarily. Although athletes are accustomed to exercising much more intensively than the general population, it is recognised that intensive exercise can cause stress on the body and cause it to become run down and more prone to infections. There is currently no evidence at the moment that athletes are particularly susceptible to COVID-19 infection. The pragmatic position, however, is that an athlete should not try to exceed their usual training programme during this period of uncertainty.
What other precautions should I take to protect myself?
Athletes should respect social isolation guidelines to protect themselves from contracting COVID-19 infection. Consultations with club coaches, physiotherapists, team colleagues and doctors should be via the telephone, skype, Zoom or face time. Face to face consultations is not advised. Do not invite team colleagues to your homes. Wash your hands carefully for 20 seconds if you have been outdoors or handled foreign surfaces such as door handles, petrol pumps, exercise machines etc.
Please take all the other precautions provided below:
- Limit the time you are outdoors and follow Government regulations.
- Avoid people who are sick.
- Keep a minimum of 2-meter (6.6 feet) distance from each other except for household members who do not have symptoms or a positive COVID-19 test.
- Wash your hands thoroughly with soap and warm water for at least 20 seconds after going outdoors or touching foreign surfaces. The virus can survive on cardboard for up to 1 day and on steel surfaces for up to 3 days.
- Cover your mouth with a tissue when you cough or use the inside of your elbow
- Cover your nose with a tissue you sneeze or use the inside of your elbow
- Avoid touching your eyes, nose, and mouth.
- Clean often touched surfaces like doorknobs, handles, steering wheels, or light switches, with a disinfectant to remove the virus.
- Importantly stay at home as much as possible (see government advice https://www.gov.uk/coronavirus).
Will any vitamin supplements protect me from the infection?
The first thing is to eat well and sleep well. Fresh fruit and vegetables are advised but may require queueing. Vitamin C (500 mg daily), D (4000 iu/daily and omega oil supplements (1000 mg daily) have shown benefit in improving the immune system that helps fight infection. Elite sports people should continue with supplements provided by the club nutritionist and seek advice on any additions.
How will I feel if I develop the infection?
Common symptoms of COVID-19 infection include cough, sore throat and temperature (usually above 37.8oC), however, athletes may also note other symptoms during exercises such as easy fatigue, breathlessness, and unusual muscle pain. In such cases, stop training completely and consult the club doctor (if applicable) who may be able to arrange testing COVID-19 infection on a private basis. If you are not in a position to obtain private COVID-19 testing, stop all exercise for 2 weeks and only resume training if you feel completely well again. Never exercise if you have a temperature, a cough, diarrhoea or feel weak, weak unless a doctor has seen you and said that it is OK for you to exercise.
How should I look after myself if I develop these symptoms?
Most individuals (80%) will have mild disease and will need to rest, drink an adequate amount of fluid (2-2.5 litres per day) and treat any fever with Paracetamol (up to 2 x 500 mg tablets) every 6 hours, as required. There are reports that drugs known as non-steroidal anti-inflammatory drugs (NSAIDS) which are effective at treating fever and are commonly prescribed to treat muscle pains, may not allow the immune system to fight the infection adequately. Therefore, it is advised that you do not use them.
I heard that the virus can affect the heart and am worried that exercise may risk my life.
A proportion of individuals will be bedridden for a few days (14%) and others will have very serious disease that requires hospital admission (5%). There is evidence that around 7% of people who need admission to hospital shows signs that the heart muscle is also inflamed. This condition is known as myocarditis. It is unlikely that your heart will be affected if you have mild symptoms such as a common cold. Symptoms of myocarditis include chest pain that may be made worse by breathing in deep, increasing breathlessness and palpitation (racing heart). In such cases, you should contact your doctor or emergency services immediately. Do not exercise if you experience any of these symptoms until you have consulted your doctor.
Is there a test I can have to check if my heart is affected by the virus?
Yes. Individuals with myocarditis can be diagnosed by measuring a protein termed cardiac troponin in the blood. This protein is released by damaged heart muscle and is found in high levels in people with myocarditis. This blood test may be performed by the club doctor (if the club has effective protective clothing for the doctor in stock) or elsewhere where that has the facilities to test you without allowing anyone else to become infected. If the cardiac troponin level in blood is increased, the doctor will also arrange an electrical tracing of the heart (ECG) and a heart scan and an appointment (via facetime, skype or Zoom) with a cardiologist (heart specialist). Elite sports club doctors will have a list of cardiologists that they can liaise with about their athletes.
What will happen if I have myocarditis?
Myocarditis can be serious in some people especially if they continue to exercise. Exercising with myocarditis can cause the heart to become damaged permanently and may even cause sudden death.
The first thing is to rest the heart by stopping exercise completely for at least 3 months. Depending on the results of the heart scan the cardiologist may also prescribe medications to help the heart if it appears to have been weakened by the infection. You will have another assessment after 3 months to determine if your heart is strong enough to go back to play sport and some athletes may need to rest for another 3 months.
I have a known (and possibly) serious heart condition affecting the muscle (or the electrical system) of my heart. I have no symptoms and have decided to continue my sporting career after having a discussion with a heart specialist. Until now I was being carefully monitored by my club doctors and physiotherapist whilst I was training in the event that I had a cardiac arrest. I am now training alone. How much can I do safely?
This is a difficult question to answer with certainty but the fact that your cardiologist has allowed you to continue to train under supervision means that your risk was perceived to be still relatively low (up to 2% per year). In the absence of supervision, it is advised that you do not increase your maximal heart rate above 80% of that predicted for your age. Your maximum heart rate is generally 220 minus your age. You need to exercise at 80% of this. For example, if you are 22, then your maximal heart rate is 220-22 = 198. You should exercise not exercise beyond 80% of this which is 158 beats per minute. You must stop immediately if you experience chest pain, you are more breathless than you think you should beat, if your heart is racing faster than it should be or if you feel you are about to blackout.