CME INDIA Presentation by Dr N K Singh, Admin CME INDIA.

Since Lock down most of patients and even regular walkers have stopped doing daily exercises due to panic driven awareness of social distancing. But emerging science tells us the amazing role of exercise to boost immunity and immunosurveillance to kill viruses. This presentation analyses the reality.

Exercise is the billion-dollar drug that never gets prescribed Phil Southerland

Phil Southerland is a global ambassador for diabetes. He serves as the CEO and Co-Founder of Team Novo Nordisk, the world’s first all-diabetes pro cycling team that aims to inspire, educate and empower everyone affected by diabetes, and as President and Founder of the Team Type-1 Foundation.

CME INDIA has few case scenarios:


Today is my 6th day of COVID-19. Before my illness, I used to do gym regularly. Today, just out of curiosity, I did light exercise and found my SPO2 drop from 98 to 93. When will it recover, and can I do my exercise again?


I am also at same stage as you. Difference being I used walk 10,000 steps daily before COVID-19 struck me. I would advise you not to do any kind of exercises (even if they are mild), it’s better to walk so that the thrombotic events can be taken care of. I have isolated at home and the daily step count has been reduced to 2500-3000.


Age 42, a paediatrician, pre-COVID, strong fitness enthusiast. I had severe symptomatic COVID in August. Since then fitness dropped significantly. Now what to do?

Knowing Science of Exercise Motivates your Art to Sustain Exercise

  • If molecular mechanisms get imprinted on our psyche, it acts as a motivational force to do regular exercise.
  • In each cell, muscles store dense packets of glucose, accounting for around 2,000 calories worth of energy throughout the body.
  • This energy just stays there unless you contract the muscle. “When the body is at rest, it has one mechanism for getting glucose out of the bloodstream. That way is insulin,”
  • “What’s so good about exercise is that even if the muscles are insulin resistant at rest, that’s irrelevant with exercise.”
  • Exercise starts its job by placing an energy demand on skeletal muscles. With utilization of glucose and fatty acids, generation of adenosine triphosphate occurs.
  • Both insulin and exercise increase skeletal muscle glucose uptake by translocation of glucose transporter 4 (GLUT4).
  • Exercise however, has no effect on insulin receptor, it modulates post-receptor insulin signaling.
Mechanism of exercise
Medicine Update APICON 2019, NK et al.

Amazing is Contraction-mediated uptake (CMGU)

  • Contraction-mediated uptake (CMGU) occurs when we exercise.
  • A form of non-insulin dependent glucose uptake.
  • What is known is that this pathway isn’t affected by people with type-2 diabetes, making exercise a prime method for improving, or at least controlling the disease.
  • CMGU continues for several hours post exercise. So essentially, muscle contraction allows glucose to enter the cell.

Improve your Insulin sensitivity by up to 48 Hours

  • An acute bout of endurance type exercise improves insulin sensitivity for a period up to 48 hours. The amazing thing about exercise is that it exerts its effects very quickly.
  • There are long-term benefits too of course. But you’ll also get acute, nearly instantaneous benefits as well.

Boon in Cardio-metabolic Prevention and Management

  • It induces antiatherogenic adaptations in vascular function and structure, irrespective of traditional CVD risk factors.
  • It improves cardiac parasympathetic regulation, thereby conferring protection against malignant arrhythmias, and also provides cardio-protection against ischaemia–reperfusion injury.
  • Muscle-derived myokines are responsible for many of the beneficial effects of exercise, particularly by promoting a healthy anti-inflammatory milieu.
  • It is the secret to prevent and control diabetes, fatty liver, stroke and bone diseases.

Corona Blues:

Can regular exercise help in beating COVID19? Lots of research is going on at present – including role of Pranayama. What we know so far:

  • Acute exercise (moderate-to-vigorous intensity, less than 60 min) is now viewed as an important immune system stimulator.
  • Each exercise bout improves the antipathogen activity of tissue macrophages. It parallels with an enhanced recirculation of immunoglobulins, anti-inflammatory cytokines, neutrophils, NK cells, cytotoxic T cells, and immature B cells. If you do daily exercise, these acute changes operate through a summation effect to enhance immune defense activity and metabolic health.
  • There is increasing evidence that the circulation surge in cells of the innate immune system with each exercise bout and the anti-inflammatory and antioxidant effect of exercise training have a summation effect over time in modulating tumorigenesis, atherosclerosis, and other disease processes. ( Journal of Sport and Health Science 8 (2019) 201217) (Stimulates the interchange of innate immune system cells and components between lymphoid tissues and the blood compartment.)
  • Although transient, a summation effect occurs over time, with improved immunosurveillance against pathogens and cancer cells and decreased systemic inflammation.
  • Metabolically, moderate exercise induces small, acute elevations in IL-6 that exert direct anti-inflammatory effects, improving glucose and lipid metabolism over time.

Exercise and COVID

Moving Billions of Lymphocytes: This is the secret

  • How exercise augments host immune defences is multi-faceted, but a key mechanism is the frequent mobilization and redistribution of effector lymphocytes.
  • Importantly, there is a catecholamine-mediated preferential mobilization of those lymphocyte subtypes that are capable of tissue migration, and their phenotypic signatures indicate they are primed and ‘looking for a fight’ (e.g. to recognize and kill virus-infected cells).
  • Literally billions of lymphocytes are mobilized in response, particularly if the exercise is dynamic and taxes the cardiorespiratory system (e.g. running, cycling and rowing).

Do not go for Heavy Exertion, Transient Immune Dysfunction occurs:

  • Taken together, the best evidence supports that high exercise training workloads, competition events, and the associated physiological, metabolic, and psychological stress are linked to immune dysfunction, inflammation, oxidative stress, and muscle damage.
  • NK cell and neutrophil function, various measures of T- and B-cell function, salivary IgA output, skin delayed-type hypersensitivity response, major histocompatibility complex II expression in macrophages, and other biomarkers of immune function are altered for several hours to days during recovery from prolonged and intensive endurance exercise.

Modulate your immunosenescence in Corona Era

(Immunosenescence is defined as immune dysregulation with aging and is related to an increased susceptibility to infections, autoimmune diseases, neoplasias, metabolic diseases, osteoporosis, and neurologic disorders)

  • Enhanced vaccination responses, Lower numbers of exhausted/senescent T cells, Increased T-cell proliferative capacity.
  • Lower circulatory levels of inflammatory cytokines (i.e., decreased “inflamm-aging”).
  • Increased neutrophil phagocytic activity.
  • Lowered inflammatory response to bacterial challenge.
  • Greater NK cell cytotoxic activity.
  • Longer leukocyte telomere lengths.

Keep Moving

  • Physically active individuals also exert better control over their latent viral infections, even during periods of isolation and confinement. These include the ability of our lymphocytes to multiply in response infectious agents and the effector functions of NK-cells and CD8+ T-cells, all of which are essential in the recognition and elimination of cancerous or virally infected cells (Duggal et al., 2019).
  • Viral reactivation is a hallmark of compromised immunity, which, in this context, we deem to be due to the stressors associated with isolation and inactivity. Indeed, periods of isolation and confinement elevate glucocorticoids (e.g. cortisol) that can inhibit many critical functions of our immune system.

Immune surveillance is the answer

  • Exercise facilitates immune surveillance by increasing immune cell ‘patrolling’ in these vulnerable areas (e.g. the upper respiratory tract and the lungs) to prevent viruses and other pathogens from gaining a foothold.
  • This process is also vital to minimize the impact of the virus and to expedite viral resolution should our immune barriers be breached and we become infected. Exercise also releases various cytokines from the skeletal muscle.

The recent surge in home-based exercise platforms

  • Online instructor-led classes and ‘exergaming.’
  • Specialized technology and equipment is not required; keeping active indoors or outdoors through brisk walking, stair climbing, yard/house work and/ or playing active games with the family can be just as effective.
  • What is important is that we avoid prolonged periods (> 60-min) of time sitting and try to implement even a few minutes of activity at regular intervals throughout the day, all of which count toward achieving these weekly goals.
  • Exceeding recommended physical activity levels during this time is not recommended as there is some evidence that excessive exercise (e.g. those activities performed by highly athletic individuals) might impair immunity and increase infection risk (Simpson et al., 2020)

CME INDIA Learning Points:

  • There is increasing evidence that the circulation surge in cells of the innate immune system with each exercise bout and the anti-inflammatory and antioxidant effect of exercise training have a summation effect over time in modulating tumorigenesis, atherosclerosis, and other disease processes.
  • Regular physical activity exerts a multitude of beneficial health effects but, perhaps more importantly during this pandemic, is its ability to both enhance immune defense and mitigate the deleterious effects of stress on immunity (Duggal et al., 2019; Simpson et al., 2015).
  • Implementations of social distancing has resulted in the mass closure of gyms and parks where exercise and training regimens would normally be undertaken, but it is essential that physical activity be encouraged during this viral outbreak.
  • The available scientific evidence from other viral infections would indicate that physically active people will have less severe symptoms, shorter recovery times, and may be less likely to infect others they come into contact with.
  • Exercise is also likely to be most beneficial for those who are asymptomatic or experiencing only mild symptoms. Exercise training has been shown to improve immune responses to both the influenza and pneumococcal vaccines in older adults (Duggal et al., 2019), a particularly vulnerable population during this COVID-19 outbreak.
  • Exercise might not prevent us from developing COVID-19, but it is our perspective that physical activity will help maintain and counteract the negative effects of isolation and confinement stress on immune competency and should, therefore, be strongly promoted during this worldwide mitigation strategy
  • During COVID infection period: Avoid physical exertion as rule of thumb.

CME INDIA Tail Piece:

1. Dr. Ken Powell: “Some activity is better than none, and more is better than less”

Yoga and COVID

2. Numerous studies have confirmed that dog owners are more physically active than those without dogs, but also that not all pet dogs are walked regularly – Int J BehavNutr Phys Act. 2014 Aug 20;11:83. doi: 10.1186/1479-5868-11-83.

Running with dog

3. Which exercise?

Which exercise?

4. Scientific recommendations about exercise:

Scientific recommendations regarding exercise.
Medicine Update API,2019 NK et al.

So, what you think about starting and sustaining exercise?


1.Nieman DC, Wentz LM. The compelling link between physical activity and the body’s defense system. J Sport Health Sci. 2019;8(3):201–17. 

2.Simpson RJ, Katsanis E. The immunological case for staying active during the COVID-19 pandemic. Brain Behav Immunity. 2020.

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