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How Exercise May Reduce Your Risk of Death From COVID-19

Analysis by Dr. Joseph Mercola Fact Checked

does exercise boost immune system

Story at-a-glance -

  • Being healthy and having a robust immune system is your primary defense against COVID-19. Aside from old age, people with underlying health conditions such as diabetes and heart disease are at increased risk of complications from the disease, and obesity has been found to be the biggest determinant for whether a patient will require hospitalization
  • Many studies have linked obesity to lowered immune function and increased risk of infection
  • Exercise is a foundational health strategy that will strengthen your immune function via several mechanisms
  • According to recent research, exercising regularly may help prevent acute respiratory distress syndrome (ARDS), a lethal complication and major cause of death among patients with COVID-19
  • Your muscles create and excrete an endogenous antioxidant called extracellular superoxide dismutase (EcSOD), which protects your tissues and prevents disease by eliminating harmful free radicals. You enhance EcSOD secretion by exercising. A decrease in EcSOD is seen in many diseases, including acute lung disease

If the COVID-19 pandemic is teaching us anything, it's the importance of being healthy and having a robust immune response. Aside from old age, people with underlying health conditions such as diabetes and heart disease are at increased risk of complications from the disease, and obesity has been found to be the biggest determinant — after old age — for whether a patient will require hospitalization.1,2 

Obesity Is a Risk Factor for Severe COVID-19 Disease

Obese COVID-19 patients are even at greater risk than those with cardiovascular disease or heart disease, according to NYU Grossman School researchers.3 This shouldn't come as a tremendous surprise, considering previous studies4,5,6,7,8,9 have linked obesity to lowered immune function and increased risk of infection.

As noted in one such study,10 "there is a positive feedback loop between local inflammation in adipose tissue and altered immune response in obesity." Yet another scientific review11 pointed out "There is strong evidence indicating that excess adiposity negatively impacts immune function and host defense in obese individuals," and a 2018 review article explained:12

"Adipose tissue is now considered an extremely active endocrine organ that secretes cytokine-like hormones, called adipokines, either pro- or anti-inflammatory factors bridging metabolism to the immune system.

Leptin is historically one of most relevant adipokines, with important physiological roles in the central control of energy metabolism and in the regulation of metabolism-immune system interplay, being a cornerstone of the emerging field of immunometabolism.

Indeed, leptin receptor is expressed throughout the immune system and leptin has been shown to regulate both innate and adaptive immune responses." 

The good news, of course, is that you have a lot of control over your own health. Obesity, insulin resistance, Type 2 diabetes and heart disease are all reversible, and if you want to prepare for the next pandemic (which is already being promised), you'd be wise to start improving your health rather than simply masking or "managing" your symptoms with drugs.

Exercise May Lower COVID-19 Mortality Risk 

Aside from eating a healthy whole food (ideally organic) diet and implementing time-restricted eating, exercise is a foundational health strategy that will strengthen your immune function.13,14

According to recent research15,16,17 published in the March 19, 2020, issue of Redox Biology, exercising regularly may also help prevent acute respiratory distress syndrome (ARDS), a lethal complication and major cause of death among patients with COVID-19. As reported by the University of Virginia Health System:18

"A review by Zhen Yan, Ph.D., of the School of Medicine, showed that medical research findings 'strongly support' the possibility that exercise can prevent or at least reduce the severity of ARDS, which affects between 3% and 17% of all patients with COVID-19.

Based on available information, the federal Centers for Disease Control and Prevention estimates 20% to 42% of patients hospitalized for COVID-19 will develop ARDS. The range for patients admitted to intensive care is estimated at 67% to 85%.

Research conducted prior to the pandemic suggested that approximately 45 percent of patients who develop severe ARDS will die. 'All you hear now is either social distancing or ventilator, as if all we can do is either avoiding exposure or relying on a ventilator to survive if we get infected,' Yan said.

'The flip side of the story is that approximately 80% of confirmed COVID-19 patients have mild symptoms with no need of respiratory support. The question is why. Our findings about an endogenous antioxidant enzyme provide important clues and have intrigued us to develop a novel therapeutic for ARDS caused by COVID-19."

The endogenous antioxidant (meaning it's made inside your body) in question is extracellular superoxide dismutase (EcSOD), which is made in and excreted from your muscles into your blood circulation. EcSOD protects tissues and prevents disease by eliminating harmful free radicals, and the way you enhance EcSOD secretion is by exercising.

Yan's research shows a decrease in EcSOD is seen in many diseases, including acute lung disease, ischemic heart disease and kidney failure. Even a single exercise session has been shown to increase production of this valuable antioxidant, so Yan urges people to "find ways to exercise even while maintaining social distancing," the University of Virginia writes.19

"We often say that exercise is medicine. EcSOD set a perfect example that we can learn from the biological process of exercise to advance medicine. While we strive to learn more about the mysteries about the superb benefits of regular exercise, we do not have to wait until we know everything," Yan says.

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Exercise Helps Shape Your Immune System

In related news, a review20 published in the journal Nutrients, February 28, 2020, details how physical activity and diet shape your immune system during aging. As summarized in the abstract:

"With increasing age, the immune system undergoes a remodeling process, termed immunosenescence, which is accompanied by considerable shifts in leukocyte subpopulations and a decline in various immune cell functions.

Clinically, immunosenescence is characterized by increased susceptibility to infections, a more frequent reactivation of latent viruses, decreased vaccine efficacy, and an increased prevalence of autoimmunity and cancer.

Physiologically, the immune system has some adaptive strategies to cope with aging … While a lack of physical activity, decreased muscle mass, and poor nutritional status facilitate immunosenescence and inflammaging, lifestyle factors such as exercise and dietary habits affect immune aging positively."

Importantly, the review details how exercise helps improve immunosenescence and slows down the aging processes of both the innate and adaptive arms of your immune system. Studies have shown it improves the function of natural killer (NK) cells and neutrophils (white blood cells), which are part of your innate immune system.

Intervention trials have also demonstrated exercise improves hallmarks of innate immunity, such as reducing certain proinflammatory monocytes (which are indicative of infection).

"Overall, results have indicated that increasing habitual physical activity enhances your innate immune functions, which is indicative of reduced infection risk and inflammatory potential," the review notes.

Exercise has also been shown to improve mitogen-induced T-cell proliferation, which is associated with improved functioning of the adaptive immune system. Importantly, studies have confirmed that "exercise induces cell death in apoptosis-resistant senescent T-cells … Thus … regular physical activity is able to … partially reduce the age-related decline of T-cell functions."

Blood Flow Restriction Training Is Ideal for Most

There are many types of exercise but my absolute favorite is blood flow restriction (BFR) training, which I detail in my special report, "What You Need to Know About Blood Flow Restriction Training." This is largely because it is the nearly perfect strategy for anyone over 50 or 60 to gain muscle mass with minimal risk or injury.

Please review my detailed BFR article from January 2020 (linked above) with many videos that provides you with very specific instructions on how to implement.

This type of training not only will add solid muscle mass — which, again excretes the endogenous antioxidant EcSOD, discussed in the first section of this article — but also will significantly increase your strength and endurance while reducing body fat. For most people who are not competitive athletes, it's really the only form of resistance training they need.

One of the reasons it is so useful is that BFR increases nitric oxide, which is now being studied as a treatment for COVID-19 at Harvard Medical School, according to The New York Times.21 BFR also triggers a metabolic cascade that actually reverses, in some ways, many aging characteristics. For example, it:

  • Stimulates the production of endogenous "fitness" hormones such as human growth hormone and IGF-1.22
  • Causes the release of hypoxia-inducible factor-1 alpha (HIF-1 alpha),23 which in turn increases the hormone vascular endothelial growth factor (VEGF) — one of the most powerful angiogenic signals in your body. Essentially, VEGF acts as "fertilizer" for growing new blood vessels and capillaries to your muscle stem cells. BFR has been shown to raise VEGF levels by 410% in young adults,24 and boost muscle stem cells by 380% after eight days of training.25 
  • Downregulates a hormone called myostatin, which is a negative regulator of muscle growth and mass.26,27,28,29 When your myostatin levels are high you simply are unable to grow muscle. This is important because the elderly have higher levels than the young.30 Since myostatin is a negative regulator of muscle growth that suppresses protein synthesis,31,32 inhibiting myostatin will help increase muscle protein synthesis and thus muscle mass.33,34
  • Raises your lactate level, which your brain uses as fuel.35,36 Lactate also increases brain derived neurotropic factor (BDNF),37 a brain growth factor that contributes to neuroplasticity and enhances cognitive performance.38,39

I have been exercising for over half a century and have never seen a strategy that improves overall metabolic and physical health as well as this strategy, especially in those over 60. I started using BFR a bit over a year ago and have never had as much lean muscle mass as I now have.

It gets even better, as weights are nearly impossible to purchase now and most gyms are closed. You don't even need to use weights with BFR if you don't want to. It can be implemented with bodyweight training, for example, or you could use inexpensive elastic bands in lieu of weights, which you can still purchase, and they are far less expensive than weights.

Resistance Bands Are an Inexpensive Fitness Tool

If you've been looking for fitness paraphernalia lately, you may have noticed it's hard to find hand weights anymore. They're sold out just about everywhere, as more people are looking for exercise tools to use at home while they're sheltering in place. The good news is you don't need weights, especially if you're doing BFR.

A simple and inexpensive alternative is to use resistance bands — elastic rubber bands or ropes available in different shapes, sizes and resistance levels. Most brands offer light, medium and heavy bands that are adjustable, allowing you to be creative with your workouts.

Once you stretch the bands, the resistance increases, particularly at the end of your range of motion where strength is rising or already at its peak. This causes the muscles to be targeted differently and assists in developing functional muscle movements.

Resistance bands also promote changes in your movements' velocity and train muscles to adapt to changes, unlike dumbbells or barbells that partly rely on momentum, rendering a portion of free weight exercises actually weightless.

Resistance bands can be used for a full-body workout, and are helpful if you want to target areas in your upper or lower body, arms, hips, legs and glutes. 

Adding resistance bands to a dynamic routine for ball-and-socket joints like the hips and shoulders can warm up your muscles, challenge them to work against little resistance and increase circulation and movement.

For a sample fitness routine using resistance bands, see the video above. Remember, no matter what exercise you do, something is better than nothing, and when done consistently, over time, you'll improve your health and lower your risk of not only COVID-19 but all viral and infectious disease.

+ Sources and References