Read on Twitter
1/ Exercise and Covid-19: A troubling story from Eric Topol this AM got me thinking about COVID-19 and the risk of exercise during active infection and recovery. https://twitter.com/EricTopol/status/1302344348755849216?s=20
2/ Four caveats – I don’t know that exercise played a factor here, I am not a cardiologist, this is a personal view not a medical review, and nothing about this constitutes medical advice. Follow my thinking here.
3/ During my training in internal medicine I was fortunate to have Walter Abelmann as an attending at the Beth Israel Hospital. He was a research cardiologist and I remember one memorable day on rounds when he shared this advice – never exercise when you have the cold or a virus
4/ Why not exercise? Because, according to Abelmann, exercise in the setting of viral illness can trigger myocarditis – which physicians know can resolve completely, or damage the heart and lead to congestive heart failure. I have assiduously followed his advice for ~ 40 years
5/ Abelmann should have known, as he published research articles on the effects of exercise during a viral infection, dating back to 1964. These are summarized in his classic review in Circulation on “Virus and the Heart” from 1971. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.325.2102&rep=rep1&type=pdf
6/ So, what about COVID-19 and the heart? One recent article (published online on July 27) showed that 78% of 100 patients had MRI evidence of myocardial involvment including 60% with ongoing myocardial inflammation in “recently recovered” patients. https://bit.ly/2EUnRQl
7/ Prior to this, a JACC expert analysis from May discusses the risk of viral myocarditis and recommends that “those with presumed myocarditis from COVID-19 should also avoid exercise during the acute phase of the disease.” https://www.acc.org/latest-in-cardiology/articles/2020/05/13/12/53/exercise-and-athletics-in-the-covid-19-pandemic-era
8/ With evidence from MRI as discussed, it is hard not to “presume” that every patient has possible myocardial involvement.
9/ The JACC article goes on to say that unhospitalized patients with no prior cardiac history and mild to moderate COVID-19 and no cardiac symptoms should be able to resume recreational exercise at moderate intensity once recovered, starting slowly and gradually.
10/ Now that we have evidence for cardiac inflammation in recovered patients, I wonder how those recommendations should and will change.
11/ Discontinuing exercise during the acute phase of COVID-19 and for some time after recovery won’t interfere with the lifelong benefits of exercise. Certainly, at some point conditioning to return to baseline (or a new baseline) is important, guided by medical advice.
12/
Of note, there are many places where benefits to exercise with COVID-19 are discussed. In fact, in some point to research results which suggest the value of exercise with COVID-19 to protect heart and lung functioning and even prevent ARDS. https://www.everydayhealth.com/coronavirus/research-provides-hints-about-why-exercise-may-help-protect-against-covid-19-complications/
Of note, there are many places where benefits to exercise with COVID-19 are discussed. In fact, in some point to research results which suggest the value of exercise with COVID-19 to protect heart and lung functioning and even prevent ARDS. https://www.everydayhealth.com/coronavirus/research-provides-hints-about-why-exercise-may-help-protect-against-covid-19-complications/
13/ The Mayo Clinic news network has this article recommending exercising as “medicine” with COVID-19 and exclusively URI symptoms. Article from March 22, before recent information, but still searchable. https://newsnetwork.mayoclinic.org/discussion/covid-19-exercise-when-ill-whats-okay-and-whats-not/
14 and end/ As for me, I will continue with my practice of not exercising with a cold or other viral illness. If I have the unfortunate circumstance of getting COVID-19, I might extend that somewhat longer than just the acute illness. But that is just me.
/ Forgot to convert Eric's name to his twitter handle. @EricTopol
