A Review on the Possibility of Improving Immune Response and Respiratory Function of Patients With COVID-19 Through Increasing Aerobic Capacity

Sadqa Jamal, BSc SRT, Conestoga College

SARS-COV-2, the name given to the new Coronavirus that originated in Wuhan, China near the end of 2019, spread primarily through human-to-human transmission and was declared by the World Health Organization as a Public Health Emergency (Mohamed & Alawna, 2020). As of November 11, 2020, there were 50,810,763 confirmed cases and just over 1.2 million deaths globally (World Health Organization, 2020). The pathogen identified, a novel enveloped RNA betacoronavirus, is similar to the one that caused the 2002-2004 SARS-CoV epidemic, both causing severe acute respiratory syndrome (Guan et al., 2020). The most common symptoms include cough, fever and shortness of breath (Guan et al., 2020). According to the Mayo Clinic (2020), the risk of developing COVID-19 is similar to those linked with other respiratory illnesses; this includes people of older age and people who have other pre-existing health conditions such as cardiovascular issues, immunocompromised systems, severe obesity, and more.  There is no approved vaccine or targeted antiviral therapy available as of yet, management of the disease is usually done through oxygen therapy or invasive or non-invasive mechanical ventilation (Cascella et al., 2020). Looking at previous research, it is predicted that increasing the aerobic capacity on a patient can have positive outcomes for the disease and overall health. A higher level of aerobic capacity is seen to directly impact the immune system, ventilation, and respiratory muscle strength which could be useful in improving prognosis of COVID-19 patients (Mohamed & Alawna, 2020).

Increasing Aerobic Capacity on Immunity and Oxygen Uptake

COVID-19 is described as a self-limiting disease, meaning that the efficiency and strength of the patient’s own immune and respiratory system plays a vital role in decreasing the progression of the disease (Mohamed & Alawna, 2020). According to a thorough review of published data undertaken by the Department of Physiotherapy and Rehabilitation at Istanbul Gelisim University, increasing aerobic capacity can have a direct and immediate impact on immune and pulmonary functions (Mohamed & Alawna, 2020). This is done specifically by increasing the volume and functionality of defensive white blood cells and immunoglobulins, while also regulating C-reactive proteins to fight lung infections (Mohamed & Alawna, 2020). Extended analysis done on the effect of acute aerobic exercises such as walking and cycling, done even in short durations, shows an upward trend in levels of immunological markers; specifically T-lymphocytes, neutrophils, macrophages, and monocytes as well as immunoglobulins (Gonçalves et al., 2020). Increasing aerobic capacity also can be vital in treating cases of pneumonia and acute respiratory distress syndrome (ARDS), both of which are manifested in COVID-19 positive patients (Mohamed & Alawna, 2020). A 2008 study in Cologne, Germany looked at pneumonia and fever rates in 36 high-dose chemotherapy (HDC) patients who participated in supervised endurance exercise sessions. The study showed a significantly higher risk of pneumonia and fever developing in the control group (p=0.060) as compared to the intervention arm (Baumann et al., 2012).  A similar study done with chronic obstructive pulmonary disease (COPD) patients who had undergone 12 weeks of supervised aerobic training, showed higher levels of oxygen uptake by the lungs of those in the intervention group (Leite et al., 2015). As noted here, mild to moderate aerobic exercise positively influences immune function – however it is not recommended to patients already presenting with high fever as it may lower immunity and worsen symptoms (Mohamed & Alawna, 2020).

Increasing Aerobic Capacity and Respiratory Muscle Strength

Increasing aerobic capacity is also linked to increased strength of respiratory muscles and restoration of lung elasticity, all of which are affected greatly in COVID-19 positive patients (Mohamed & Alawna, 2020). One study looked at adding aerobic exercise to the daily routines of patients with cystic fibrosis (CF) for 3 months. Respiratory muscle strength in both the control and intervention group was evaluated by non-invasive pressure time index, a measure of muscle efficiency  (Dassios, Katelari, Doudounakis & Dimitriou, 2013).  Analysis through standard pulmonary function testing showed a significant increase in lung recruitment/ventilation and airway clearance (Dassios et al., 2013).  Respiratory muscle endurance was also seen to increase in those individuals who participated in the exercises, which makes sense since the muscles used for ventilation are skeletal and are directly affected by exercise in all parts of the body (Dassios et al., 2013).

Concluding Statement

This ongoing pandemic is stimulating new research and developments worldwide, as scientists and medical professionals come together to try to contain the virus. As Respiratory Therapists, our job has never been more vital. While we are looking into treating the patients who have been infected, it is also important to look to the future in terms of having principles in place to make the general population less susceptible to respiratory illnesses. One of the ways we can do that is through encouraging everyone to incorporate a small amount of interval training into their schedules, 3-4 times a week, to increase their aerobic capacity (Mohamed & Alawna, 2020). With so many respiratory and cardiovascular health benefits associated with it, working on increasing aerobic capacity is highly recommended for those in self isolation due to testing positively for the virus while being asymptomatic or having minor symptoms as well as those healthy individuals in lockdown, so that they may improve immunity and respiratory muscle strength to greater their chances of a quick recovery if they are exposed and infected.

References

Baumann, F. T., Zimmer, P., Finkenberg, K., Hallek, M., Bloch, W., & Elter, T. (2012). Influence of endurance exercise on the risk of pneumonia and Fever in leukemia and lymphoma patients undergoing high dose chemotherapy. A pilot study. Journal of sports science & medicine, 11(4), 638–642.

Cascella M, Rajnik M, Cuomo A, Dulebohn S, Napoli, R.  Features, Evaluation, and Treatment of Coronavirus (COVID-19) [Aug 2020]. Retrieved September 25^th, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK554776/

Dassios, T., Katelari, A., Doudounakis, S., & Dimitriou, G. (2013). Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis. Respiratory Medicine, 107(5), 684-690. https://doi.org/10.1016/j.rmed.2013.01.016

Gonçalves, C. A., Dantas, P. M., Santos, I. K., Dantas, M., Silva, D. C., Guilherme De Araújo Tinoco Cabral, B., Júnior, G. B. (2020). Effect of Acute and Chronic Aerobic Exercise on Immunological Markers: A Systematic Review. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.01602

Guan, W., Ni, Z., Hu, Y., Liang, W., Ou, C., He, J., Zhong, N. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18), 1708-1720. https://doi.org/10.1056/nejmoa2002032

Leite, M. R., Kalva-Filho, C. A., Freire, A. P., Silva, B. S., Nicolino, J., Toledo-Arruda, A., Ramos, E. M. (2015). Effects of 12 weeks of aerobic training on autonomic modulation, mucociliary clearance, and aerobic parameters in patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 2549. https://doi.org/10.2147/copd.s81363

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Mayo Clinic. (2020, August 21). COVID-19: Who’s at higher risk of serious symptoms? Retrieved September 25, 2020 from https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-who-is-at-risk/art-20483301

World Health Organization; Coronavirus Disease (COVID-19) Dashboard. (n.d.). Retrieved September 25, 2020 from https://covid19.who.int/

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