The inmates of the world – citizens of countries whose governments have required them to remain inside their homes for weeks and months on end due to the COVID-19 pandemic – and especially those in solitary confinement should take action to strengthen their immune systems. 

Staying at home while being under pressure from family members and economic worries trigger overeating, especially of sweets, salty snacks and other junk food. And unable to walk outdoors and pursue sports, most are probably getting little exercise. 

But one can exercise at home both aerobically by getting the heart to beat and lungs to breathe faster as cardiovascular conditioning, doing anaerobic exercise through short-exertion, high-intensity movement, or lifting weights to strengthen muscles. Doing this on a regular basis can boost your immune system, increasing you chances of avoiding infections and other disease processes.

Courtesy photo of Prof. Naama Constantini exercising at her Sports Medicine Center.

“Exercise is medicine,” declares Prof. Naama Constantini, one of Israel’s leading sports medicine specialists who directs the Heidi Rothberg Sport Medicine Center of Shaare Zedek Medical Center in Jerusalem and is chairman of the Health Ministry’s National Council for Women’s Health. Since 2016, she has been chairman of the “Exercise is Medicine Center” (EIM) at the Hebrew University, coordinating a steering committee of Israeli activists from the academic and medical worlds, the Israel Defense Forces, non-profit organizations and others. Constantini, who swims three or four times a week and is very fit, is also the mother of seven sports-loving adult children.

But, like most Israelis today, she exercises and works from home – counseling patients over the phone or video connections, as the hospital’s sports medicine center has been temporarily closed due to the national lockdown; patients are not permitted to exercise in a gym at close quarters due to the risk of infection.  

Constantini is a fellow at the American College of Sports Medicine (ACSM), which established EIM in 2007 together with the American Medical Association. This a global health initiative managed by the ACSM to make physical activity assessment and promotion a standard in clinical care, connecting health care with evidence-based physical activity resources for people everywhere and of all abilities and ages. 

EIM encourages doctors and other health care providers to include physical activity when designing treatment plans and to refer patients to evidence-based exercise programs and qualified exercise professionals. All of those involved, including EIM groups in some 50 countries – from Mexico to Singapore – around the world, are committed to the belief that physical activity promotes optimal health and is integral in the prevention and treatment of many medical conditions.

In normal times, EIM Israel organizes courses and lectures for medical students, doctors and nurses and holds a national conference, each year on a different subject relating to exercise. It also works to increase public awareness of the need for regular physical exercise. 

But these are not normal times. The US-based international EIM conference was cancelled. However, the movement has issued a document on “Staying Active During the Coronavirus Pandemic.” Constantini has translated it into Hebrew and planned to do so into Arabic as well for Israel’s Arab citizens. But she noticed that a professor at King Saud University in Saudi Arabia has already produced an Arabic version and asked him for permission to use that text, with adaptations to suit Israeli Arabs. 

“COVID-19 is new, so no specific research has been conducted yet on exercise and boosting the immune system to lower the risk of being infected by the virus,” Constantini told Breaking Israel News in an interview. “In the 1980s, there was much research relating to sports and the immune system and avoiding HIV infection.”

Interestingly enough, studies showed that marathon runners suffered more from respiratory infections, sore throats and other viral infections after participating in long runs. Such sportsmen had six times more infections than those who didn’t run as many as 100 kilometers a week. “Prolonged and intense exercise actually weakened the immune system, reducing the amount of glycogen (a multibranched polysaccharide of glucose that serves as a form of energy storage in the body and is a good source of energy for strenuous activity).

Reduction in glycogen stores and increase in stress hormones as a result of exercise exposes the body to infection. However, Constantini continued, moderate physical exercise five times a week for 30-45 minutes each significantly strengthens the immune system. As a result of regular moderate exercise there is an increase of neutrophils, natural killer cells, cytotoxic cells and other “good” blood cells in the blood 

.. “They are the soldiers of the immune system which migrate from the liver, spleen and other tissues to the bloodstream to fight the “invader” and stay for several hours, so there is a cumulative effect. But if your exercise is excessive, it is too much of a good thing, and harm to the immune system can continue even for weeks after a marathon.” 

Research was conducted on rodents during the polio epidemic in the 1950s; when they were injected with polio and forced to run for long periods of time, they were more likely to die But when they were made to exercise only moderately, they were more likely to survive. “Scientists think that the Coronavirus might act in the same way.”

“With everyone at home, one has to exercise now for health and not for fitness. One can go up and down stairs, jump rope, stretch your limbs with rubber strips, walk in the home or in place, work with weights or even with canned goods like pineapple slices or pickles, use a stationary bicycle, an elliptical machine, a stepper or a treadmill. Older people should also practice and improve their balance. A simple example is standing on one foot on the floor or on a pillow if they are well trained while standing next to something to hold to,” Constantini suggested. 

There are exercise programs on TV, YouTube on the computer and videos, she continued. “Balance and flexibility are very important for the elderly to promote their wellbeing. While they should do moderate aerobic exercise, strength training is even more important for them to improve balance and treat sarcopenia, the thinning of the muscles.” Even people in wheelchairs can use special bikes that move with hand motions. 

It is no less important for children and teens who have been confined at home for long periods, unable to go to school and go out to play. The can jump on small trampolines, dance on rugs, jump up and down and participate in exercise videos. Their activities depend on their parents’ encouragement; if the adults show an example, it improves their relationships as well as their fitness. “Many parents are at home now and have time to be with their kids.” 

As for all kinds of vitamin supplements being pushed in pharmacies and health food stores, Constantini concludes that aside from taking vitamin D drops or pills because they are not in the sun, people who eat balanced diets have no need for such products, which have not been shown to do anything to strengthen their immune systems or protect them from COVID-19.