Namey/Burnett Preventive Medicine Writing Award submission
By Adrienne Law, DO, MS, and Elliot Sklar, PhD, MS

As many primary care physicians return to clinics from several months of inpatient medicine, strict telehealth, or quarantine, the decline of preventive medicine is obvious. COVID-19 has made it more difficult for patients to manage chronic diseases such as diabetes, hypertension, chronic kidney disease, various types of cancers and obesity. Some experts suggest that chronic diseases, overall health and well-being have worsened during the coronavirus pandemic, but it might be too soon to know the true impact.

For some communities, actively dying patients at the peak of the pandemic were staying at home, refusing to call the ambulance for emergency room transportation while having chest pain or shortness of breath. A good amount of telephone encounter patients still fear leaving the comforts of their homes to see their primary care physician or even to obtain labs and imaging as part of their wellness exam.

The coronavirus will not go away immediately. Therefore, preventive medicine needs to adapt. Physicians and all health professionals need to consider the benefits of physical activity for their personal health, and for the health of the public.

Physical inactivity is a major concern during the coronavirus pandemic. A good number of people feel uncomfortable going to the gyms despite their reopening with social distancing precautions, making this an excuse to stop routine physical activity. It has been difficult to change the habits of patients whose daily life routine has been turned upside down. This is especially true for those who would go to the gym before going to work when work is now all at home. There are also issues of caregiving for children, or for older family members that are stretching many people ‘thin’ as their waistlines grow.

Despite health professionals stressing the importance of establishing a routine to help in coping with coronavirus-life, is it difficult to establish a routine in an evolving environment. Many people are experiencing depression and isolation during their experience of the coronavirus pandemic, and though we know that physical activity can ease depression, it is hard to take that ‘first step.’ Decisions related to our personal and public health must also consider the health benefits of exercise, and the need to be able to engage in physical activity safely.

COVID-19 has impacted each of us in different ways. Even if we have not had COVID-19, we are likely not feeling quite like ‘ourselves.’ The stress, fear, uncertainty and grief in our environment have taken a toll on our collective and individual sense of wellbeing. Until a vaccine or treatment are found, we need something to help us feel better.

Before COVID-19, the Centers for Disease Control and Prevention reported that only 53 percent of American adults met physical activity guidelines for aerobic physical activity, which include 150 minutes of moderate to intense physical activity per week.1 Many people have felt greater challenges in meeting physical activity guidelines and maintaining routines under “safer at home” orders.

Primary care physicians have encountered a surge in patient complaints of anxiety, depression and significant weight gain secondary to the pandemic (also known as the “Quarantine 15”). In the absence of a vaccine or targeted treatment for COVID-19, we need to consider the benefits of physical activity in promoting good health and preventing many of the chronic illnesses we have learned to be risk-factors for COVID-19 complications.

Aerobic Exercise with a Face Mask

The thought of engaging in exercise can be daunting for most. The additional requirement of a face mask in many parts of the country is adding to our list of excuses for not exercising. Face masks are not meant to limit our airflow—they are meant to limit the spread of the virus by keeping respiratory droplets out of the air and off surfaces. Face masks have always been made of breathable materials, but there are now several manufacturers who are creating masks specifically for physical activity. It is important to look for moisture-wicking materials that will wick away perspiration. There are specific face masks that are best for doing aerobic exercise at the gym that should also keep you safe, comfortable and dry. It is also important to find a mask that fits your nose and mouth snugly, and to remember that the mask should fully cover your nose and mouth. A face mask should help in making us feel safer—they should not be seen as a further barrier to fitness.

Consider Your Environment and Type of Activity

Despite restrictions and encouragement of social distancing, indoor exercise carries different risks than exercising outdoors. There are undoubtedly more risks attached to exercising in a gym which is why additional precautions are being taken. Additionally, aerobic exercise (i.e., the treadmill or elliptical machine) and anaerobic exercise (i.e., weightlifting) cause different responses in our breathing. Given that COVID-19 is a respiratory virus, we should be considering which environment is safest for engagement in activity. If you are considering a return to the gym, you may want to limit your time in the gym for weightlifting and stick to exercising outdoors for biking or jogging where you are better able to contain your breaths and maintain your distance from others.

Pay Attention to Your Surroundings During Outdoor Physical Activity

Explore walking paths and open-air venues that offer as much social distance as possible. Pay attention to your environment and not your mobile phone. Now is not a good time to suffer a fall and injure yourself. Part of doing “our part” right now includes supporting our health care system by avoiding preventable injuries and emergencies wherever possible.

During our COVID-19 existence, exercise is not only good for maintaining physical health, but it is a critical component of maintaining mental fitness. Get moving.

References

Centers for Disease Control and Prevention. (2016). Current Physical Activity Guidelines. Available at: https://www.cdc.gov/physicalactivity/index.html  [Last accessed 17 September 2020].

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