A Possible Preventive Role of Physically Active Lifestyle during the SARS-CoV-2 Pandemic; Might Regular Cold-Water Swimming and Exercise Reduce the Symptom Severity of COVID-19?
Viktor Bielik, Marian Grendar, Martin Kolisek
International Journal of Environmental Research and Public Health, doi:10.3390/ijerph18137158
The objective of this study was to investigate the incidence and course of COVID-19 and the risk of an upper respiratory tract infection in a group of people with physically active lifestyles. Data were collected anonymously using an online survey platform during December 2020. The age of participants ranged from 18 to 65 years. Out of 2343 participants, 11.5% overcame COVID-19 infection. Relative to the control group (CTRL), physically active, cold-water swimmers (PACW) did not exhibit a lower risk of incidence for COVID-19 (RR 1.074, CI 95% (0.710-1.625). However, PACW had a higher chance of having an asymptomatic course of COVID-19 (RR 2.321, CI 95% (0.836-6.442); p < 0.05) and a higher chance of only having an acute respiratory infection once or less per year than CTRL (RR 1.923, CI 95% (1.1641-2.253); p < 0.01). Furthermore, PACW exhibited a lower incidence of acute respiratory infection occurring more than twice per year (RR 0.258, CI 95% (0.138-0.483); p < 0.01). Cold-water swimming and physical activity may not lessen the risk of COVID-19 in recreational athletes. However, a physically active lifestyle might have a positive effect on the rate of incidence of acute respiratory infection and on the severity of COVID-19 symptoms.
Conflicts of Interest: The authors declare no conflict of interest.
References
Bentlage, Ammar, How, Ahmed, Trabelsi et al., Practical Recommendations for Maintaining Active Lifestyle during the COVID-19 Pandemic: A Systematic Literature Review, Int. J. Environ. Res. Public Health,
doi:10.3390/ijerph17176265Brandt, Pedersen, The role of exercise-induced myokines in muscle homeostasis and the defense against chronic diseases, J. Biomed. Biotechnol,
doi:10.1155/2010/520258Brawner, Ehrman, Bole, Kerrigan, Parikh et al., Inverse Relationship of Maximal Exercise Capacity to Hospitalization Secondary to Coronavirus Disease 2019, Mayo Clin. Proc,
doi:10.1016/j.mayocp.2020.10.003Checinska-Maciejewska, Miller-Kasprzak, Checinska, Korek, Gibas-Dorna et al., Gender-related effect of cold water swimming on the seasonal changes in lipid profile, ApoB/ApoA-I ratio, and homocysteine concentration in cold water swimmers, J. Physiol. Pharmacol
Chen, Xu, Liu, Wang, Li et al., Irisin protects mitochondria function during pulmonary ischemia/reperfusion injury, Sci. Transl. Med,
doi:10.1126/scitranslmed.aao6298Colaianni, Cinti, Colucci, Grano, Irisin and musculoskeletal health, Ann. N. Y. Acad. Sci,
doi:10.1111/nyas.13345Core, R: A Language and Environment for Statistical Computing
Craig, Marshall, Sjöström, Bauman, Booth et al., International physical activity questionnaire: 12-country reliability and validity, Med. Sci. Sports Exerc
Da Silva, Cella, Testa, De, Testa et al., Mild-cold water swimming does not exacerbate white adipose tissue browning and brown adipose tissue activation in mice, J. Physiol. Biochem,
doi:10.1007/s13105-020-00771-zDe Frel, Atsma, Pijl, Seidell, Leenen et al., The Impact of Obesity and Lifestyle on the Immune System and Susceptibility to Infections Such as COVID-19, Front. Nutr,
doi:10.3389/fnut.2020.597600De Oliveira, De Sibio, Mathias, Rodrigues, Sakalem et al., Irisin modulates genes associated with severe coronavirus disease (COVID-19) outcome in human subcutaneous adipocytes cell culture, Mol. Cell. Endocrinol,
doi:10.1016/j.mce.2020.110917Dwyer, Pasini, De Dominicis, Righi, Physical activity: Benefits and challenges during the COVID-19 pandemic, Scand. J. Med. Sci. Sports,
doi:10.1111/sms.13710Ehrlinger, ggRandomForests: Visually Exploring Random Forests
Eklund, Beeswarm, The Bee Swarm Plot, an Alternative to Stripchart
Elias, Wyckelsma, Varley, Mckenna, Aughey, Effectiveness of Water Immersion on Postmatch Recovery in Elite Professional Footballers, Int. J. Sports Physiol. Perform,
doi:10.1123/ijspp.8.3.243Filgueira, Castoldi, Santos, De Amorim, De Sousa Fernandes et al., The Relevance of a Physical Active Lifestyle and Physical Fitness on Immune Defense: Mitigating Disease Burden, with Focus on COVID-19 Consequences, Front. Immunol,
doi:10.3389/fimmu.2021.587146Gentil, De Lira, Souza, Jimenez, Mayo et al., Resistance Training Safety during and after the SARS-Cov-2 Outbreak: Practical Recommendations, BioMed Res. Int,
doi:10.1155/2020/3292916Gibas-Dorna, Checinska, Korek, Kupsz, Sowinska et al., Cold Water Swimming Beneficially Modulates Insulin Sensitivity in Middle-Aged Individuals, J. Aging Phys. Act,
doi:10.1123/japa.2015-0222Hamer, Kivimäki, Gale, Batty, Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: A community-based cohort study of 387,109 adults in UK, Brain Behav. Immun,
doi:10.1016/j.bbi.2020.05.059Hills, Street, Byrne, Physical Activity and Health: "What is Old is New Again, Adv. Food Nutr. Res
Ho, Celis-Morales, Gray, Katikireddi, Niedzwiedz et al., Modifiable and non-modifiable risk factors for COVID-19, and comparison to risk factors for influenza and pneumonia: Results from a UK Biobank prospective cohort study, BMJ Open,
doi:10.1136/bmjopen-2020-040402Junker, Syväri, Weidlich, Holzapfel, Drabsch et al., Investigation of the Relationship between MR-Based Supraclavicular Fat Fraction and Thyroid Hormones, Obes. Facts,
doi:10.1159/000507294Khan, Syed, Kim, Siddiqui, Mitochondrial dynamics and viral infections: A close nexus, Biochim. Biophys. Acta Mol. Cell Res
Knechtle, Waśkiewicz, Sousa, Hill, Nikolaidis, Cold Water Swimming-Benefits and Risks: A Narrative Review, Int. J. Environ. Res. Public Health,
doi:10.3390/ijerph17238984Kovaničová, Kurdiová, Baláž, Štefanička, Varga et al., Cold Exposure Distinctively Modulates Parathyroid and Thyroid Hormones in Cold-Acclimatized and Non-Acclimatized Humans, Endocrinology,
doi:10.1210/endocr/bqaa051Kunutsor, Laukkanen, High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there potential implications for COVID-19?, Eur. J. Clin. Investig,
doi:10.1111/eci.13490Liepinsh, Makarova, Plakane, Konrade, Liepins et al., Low-intensity exercise stimulates bioenergetics and increases fat oxidation in mitochondria of blood mononuclear cells from sedentary adults, Physiol. Rep,
doi:10.14814/phy2.14489Manolis, Manolis, Manolis, Manolis, Apostolaki et al., Winter Swimming: Body Hardening and Cardiorespiratory Protection Via Sustainable Acclimation, Curr. Sports Med. Rep,
doi:10.1249/JSR.0000000000000653Mcneill, Morton, Stimson, Substrate Utilization by Brown Adipose Tissue: What's Hot and What's Not? Front, Endocrinol,
doi:10.3389/fendo.2020.571659Monlun, Hyernard, Blanco, Lartigue, Faustin, Mitochondria as Molecular Platforms Integrating Multiple Innate Immune Signalings, J. Mol. Biol,
doi:10.1016/j.jmb.2016.10.028Motta-Santos, Santos, Santos, Angiotensin-(1-7) and Obesity: Role in Cardiorespiratory Fitness and COVID-19 Implications, Obesity,
doi:10.1002/oby.22949Nunn, Guy, Brysch, Botchway, Frasch et al., SARS-CoV-2 and mitochondrial health: Implications of lifestyle and ageing, Immun. Ageing,
doi:10.1186/s12979-020-00204-xNyenhuis, Greiwe, Zeiger, Nanda, Cooke, Exercise and Fitness in the Age of Social Distancing During the COVID-19 Pandemic, J. Allergy Clin. Immunol. Pract,
doi:10.1016/j.jaip.2020.04.039Poppendieck, Faude, Wegmann, Meyer, Cooling and Performance Recovery of Trained Athletes: A Meta-Analytical Review, Int. J. Sports Physiol. Perform,
doi:10.1123/ijspp.8.3.227Rodríguez, Becerril, Ezquerro, Méndez-Giménez, Frühbeck, Crosstalk between adipokines and myokines in fat browning, Acta Physiol,
doi:10.1111/apha.12686Sallis, Young, Tartof, Sallis, Sall et al., Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: A study in 48 440 adult patients, Br. J. Sports Med,
doi:10.1136/bjsports-2021-104080Sanchis-Gomar, Lavie, Mehra, Henry, Lippi, Obesity and Outcomes in COVID-19: When an Epidemic and Pandemic Collide, Mayo Clin. Proc,
doi:10.1016/j.mayocp.2020.05.006Skopich, Swim Season Opens in December, The Moscow Times
Stefan, Birkenfeld, Schulze, Ludwig, Obesity and impaired metabolic health in patients with COVID-19, Nat. Rev. Endocrinol,
doi:10.1038/s41574-020-0364-6Thomaz, Da Silva, Da Costa, Validity of self-reported height, weight and body mass index in the adult population of Brasilia, Brazil, Rev. Bras. Epidemiol,
doi:10.1590/S1415-790X2013000100015Wang, Baker, Quan, Shen, Fekete et al., A Preventive Role of Exercise Across the Coronavirus 2 (SARS-CoV-2) Pandemic, Front. Physiol,
doi:10.3389/fphys.2020.572718Warburton, Nicol, Bredin, Health benefits of physical activity: The evidence, Can. Med. Assoc. J,
doi:10.1503/cmaj.051351Weir, Jan, BMI Classification Percentile and Cut off Points
Zbinden-Foncea, Francaux, Deldicque, Hawley, Does High Cardiorespiratory Fitness Confer Some Protection Against Proinflammatory Responses After Infection by SARS-CoV-2?, Obesity,
doi:10.1002/oby.22849Zenner, De Decker, Clement, Blood-pressure response to swimming in ice-cold water, Lancet
{ 'indexed': {'date-parts': [[2022, 4, 1]], 'date-time': '2022-04-01T17:55:48Z', 'timestamp': 1648835748906},
'reference-count': 52,
'publisher': 'MDPI AG',
'issue': '13',
'license': [ { 'start': { 'date-parts': [[2021, 7, 4]],
'date-time': '2021-07-04T00:00:00Z',
'timestamp': 1625356800000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'https://creativecommons.org/licenses/by/4.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'short-container-title': ['IJERPH'],
'abstract': '<jats:p>The objective of this study was to investigate the incidence and course of COVID-19 '
'and the risk of an upper respiratory tract infection in a group of people with physically '
'active lifestyles. Data were collected anonymously using an online survey platform during '
'December 2020. The age of participants ranged from 18 to 65 years. Out of 2343 participants, '
'11.5% overcame COVID-19 infection. Relative to the control group (CTRL), physically active, '
'cold-water swimmers (PACW) did not exhibit a lower risk of incidence for COVID-19 (RR 1.074, '
'CI 95% (0.710–1.625). However, PACW had a higher chance of having an asymptomatic course of '
'COVID-19 (RR 2.321, CI 95% (0.836–6.442); p < 0.05) and a higher chance of only having an '
'acute respiratory infection once or less per year than CTRL (RR 1.923, CI 95% (1.1641–2.253); '
'p < 0.01). Furthermore, PACW exhibited a lower incidence of acute respiratory infection '
'occurring more than twice per year (RR 0.258, CI 95% (0.138–0.483); p < 0.01). Cold-water '
'swimming and physical activity may not lessen the risk of COVID-19 in recreational athletes. '
'However, a physically active lifestyle might have a positive effect on the rate of incidence '
'of acute respiratory infection and on the severity of COVID-19 symptoms.</jats:p>',
'DOI': '10.3390/ijerph18137158',
'type': 'journal-article',
'created': {'date-parts': [[2021, 7, 5]], 'date-time': '2021-07-05T02:34:36Z', 'timestamp': 1625452476000},
'page': '7158',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': [ 'A Possible Preventive Role of Physically Active Lifestyle during the SARS-CoV-2 Pandemic; '
'Might Regular Cold-Water Swimming and Exercise Reduce the Symptom Severity of COVID-19?'],
'prefix': '10.3390',
'volume': '18',
'author': [ { 'ORCID': 'http://orcid.org/0000-0001-9525-4983',
'authenticated-orcid': False,
'given': 'Viktor',
'family': 'Bielik',
'sequence': 'first',
'affiliation': []},
{'given': 'Marian', 'family': 'Grendar', 'sequence': 'additional', 'affiliation': []},
{'given': 'Martin', 'family': 'Kolisek', 'sequence': 'additional', 'affiliation': []}],
'member': '1968',
'published-online': {'date-parts': [[2021, 7, 4]]},
'reference': [ {'key': 'ref1', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/ijerph17238984'},
{'key': 'ref2'},
{'key': 'ref3', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0140-6736(80)90605-4'},
{ 'key': 'ref4',
'first-page': '887',
'article-title': 'Gender-related effect of cold water swimming on the seasonal changes in '
'lipid profile, ApoB/ApoA-I ratio, and homocysteine concentration in '
'cold water swimmers',
'volume': '68',
'author': 'Checinska-Maciejewska',
'year': '2017',
'journal-title': 'J. Physiol. Pharmacol.'},
{'key': 'ref5', 'doi-asserted-by': 'publisher', 'DOI': '10.1123/japa.2015-0222'},
{ 'key': 'ref6',
'doi-asserted-by': 'crossref',
'first-page': '77',
'DOI': '10.1016/bs.afnr.2015.06.001',
'article-title': 'Physical Activity and Health: “What is Old is New Again”',
'volume': '75',
'author': 'Hills',
'year': '2015',
'journal-title': 'Adv. Food Nutr. Res.'},
{'key': 'ref7', 'doi-asserted-by': 'publisher', 'DOI': '10.1503/cmaj.051351'},
{'key': 'ref8', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fnut.2020.597600'},
{'key': 'ref9', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bjsports-2021-104080'},
{'key': 'ref10', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s12979-020-00204-x'},
{'key': 'ref11', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.bbi.2020.05.059'},
{'key': 'ref12', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41574-020-0364-6'},
{'key': 'ref13', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jaip.2020.04.039'},
{'key': 'ref14', 'doi-asserted-by': 'publisher', 'DOI': '10.1155/2020/3292916'},
{'key': 'ref15', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/sms.13710'},
{'key': 'ref16', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/ijerph17176265'},
{'key': 'ref17', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/qjmed/92.4.193'},
{'key': 'ref18'},
{ 'key': 'ref19',
'unstructured': 'Ministry of Interior of the Slovak '
'Republichttps://www.minv.sk/?tlacove-spravy-4&sprava=koronavirus-mame-cestovny-semafor'},
{ 'key': 'ref20',
'unstructured': 'Ministry of Interior of the Slovak '
'Republichttps://www.minv.sk/?tlacove-spravy&sprava=od-1-oktobra-plati-na-slovensku-nudzovy-stav'},
{ 'key': 'ref21',
'doi-asserted-by': 'publisher',
'DOI': '10.1249/01.MSS.0000078924.61453.FB'},
{'key': 'ref22', 'doi-asserted-by': 'publisher', 'DOI': '10.1590/S1415-790X2013000100015'},
{ 'key': 'ref23',
'unstructured': 'R: A Language and Environment for Statistical '
'Computinghttp://www.r-project.org/index.html'},
{ 'key': 'ref24',
'unstructured': 'Beeswarm: The Bee Swarm Plot, an Alternative to '
'Stripcharthttps://cran.r-project.org/package=beeswarm'},
{ 'key': 'ref25',
'unstructured': 'Fast Unified Random Forests for Survival, Regression, and Classification '
'(RF-SRC)https://cran.r-project.org/web/packages/randomForestSRC/randomForestSRC.pdf'},
{ 'key': 'ref26',
'unstructured': 'ggRandomForests: Visually Exploring Random '
'Forestshttps://cran.r-project.org/package=ggRandomForests'},
{'key': 'ref27', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.mayocp.2020.10.003'},
{ 'key': 'ref28',
'series-title': 'StatPearls',
'article-title': 'BMI Classification Percentile and Cut off Points',
'author': 'Weir',
'year': '2021'},
{'key': 'ref29', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.mayocp.2020.06.046'},
{'key': 'ref30', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.mayocp.2020.05.006'},
{'key': 'ref31', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmjopen-2020-040402'},
{'key': 'ref32', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/oby.22849'},
{'key': 'ref33', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/oby.22949'},
{'key': 'ref34', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fimmu.2021.587146'},
{'key': 'ref35', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jmb.2016.10.028'},
{ 'key': 'ref36',
'doi-asserted-by': 'crossref',
'first-page': '2822',
'DOI': '10.1016/j.bbamcr.2014.12.040',
'article-title': 'Mitochondrial dynamics and viral infections: A close nexus',
'volume': '1853',
'author': 'Khan',
'year': '2015',
'journal-title': 'Biochim. Biophys. Acta Mol. Cell Res.'},
{'key': 'ref37', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fphys.2020.00091'},
{'key': 'ref38', 'doi-asserted-by': 'publisher', 'DOI': '10.1126/scitranslmed.aao6298'},
{'key': 'ref39', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/nyas.13345'},
{'key': 'ref40', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.mce.2020.110917'},
{'key': 'ref41', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/apha.12686'},
{'key': 'ref42', 'doi-asserted-by': 'publisher', 'DOI': '10.1155/2010/520258'},
{'key': 'ref43', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fendo.2020.571659'},
{'key': 'ref44', 'doi-asserted-by': 'publisher', 'DOI': '10.14814/phy2.14489'},
{'key': 'ref45', 'doi-asserted-by': 'publisher', 'DOI': '10.1210/endocr/bqaa051'},
{'key': 'ref46', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s13105-020-00771-z'},
{'key': 'ref47', 'doi-asserted-by': 'publisher', 'DOI': '10.1159/000507294'},
{'key': 'ref48', 'doi-asserted-by': 'publisher', 'DOI': '10.1123/ijspp.8.3.243'},
{'key': 'ref49', 'doi-asserted-by': 'publisher', 'DOI': '10.1123/ijspp.8.3.227'},
{'key': 'ref50', 'doi-asserted-by': 'publisher', 'DOI': '10.1249/JSR.0000000000000653'},
{'key': 'ref51', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/eci.13490'},
{'key': 'ref52', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fphys.2020.572718'}],
'container-title': ['International Journal of Environmental Research and Public Health'],
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://www.mdpi.com/1660-4601/18/13/7158/pdf',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2021, 7, 5]],
'date-time': '2021-07-05T03:07:34Z',
'timestamp': 1625454454000},
'score': 1,
'resource': {'primary': {'URL': 'https://www.mdpi.com/1660-4601/18/13/7158'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021, 7, 4]]},
'references-count': 52,
'journal-issue': {'issue': '13', 'published-online': {'date-parts': [[2021, 7]]}},
'alternative-id': ['ijerph18137158'],
'URL': 'http://dx.doi.org/10.3390/ijerph18137158',
'relation': {},
'ISSN': ['1660-4601'],
'issn-type': [{'value': '1660-4601', 'type': 'electronic'}],
'subject': ['Health, Toxicology and Mutagenesis', 'Public Health, Environmental and Occupational Health'],
'published': {'date-parts': [[2021, 7, 4]]}}
