Covid-19: Leading Cardiologist’s advice on exercise

Leading Cardiologist Professor Sharma explains how to exercise safely during the pandemic and how marathon runners can cope with the break in training.

London Cardiologist, Professor Sanjay Sharma (Professor of Sports Cardiology and Inherited Cardiac Diseases at St George’s University) has worked alongside the charity, Cardiac Risk for the Young (CRY) for the past two decades as the charity’s Consultant Cardiologist. He is also the appointed Cardiologist for the Virgin Money London Marathon (currently postponed to 4th October 2020) and regularly oversees the assessment of the heart health of professional footballers and elite athletes across all sports.

Since the full effects of the UK’s lockdown, Professor Sharma has been asked numerous questions about how, where and when to exercise safely during this pandemic, as well as addressing specific concerns from professional players and young people living with pre-existing heart conditions. A comprehensive review of all these issues can be found here on the CRY website but Professor Sharma has also provided an overview of the key queries that have arisen from the current crisis, as he aims to reassure athletes and the general public of the’ dos and don’ts’ of how to exercise in isolation – and at a safe distance.

Is it still ‘safe’ to exercise during the pandemic?

Yes, absolutely. There is evidence that moderate exercise performed for 20-30 minutes 3-4 times per week strengthens the immune system and reduces the risk of viral infection. Scientific studies have also shown that regular moderate exercise prior to developing a potentially serious viral infection such as flu protects people from dying from it. There is also evidence that people who continued to remain active during the 1998 Hong Kong flu were more likely to survive compared to people who did not perform any exercise.

The current pandemic means that exercising in gyms and other communal exercising areas or performing team sports is no longer possible. The Government currently permits one outdoor – and individual sporting activity per day, unless with members of your own household – such as walking briskly, jogging or cycling. When outdoors, always anticipate and avoid a less than two-metre distance from other individuals.

I am a competitive athlete – how do I keep fit for when the competitive season starts again?

Individuals competing at club level and professional athletes need to maintain fitness to return to competition in the foreseeable future. Many elite athletes will have been provided with a remotely supervised training schedule and others may have developed their own exercise programme. In my experience, they are also likely to have static exercise machines at home to allow them to keep fit. In cases, clubs may provide wearable GPS devices to monitor physical activity remotely. In the current situation, the exercise programmes recommended may not fully reflect your sport, particularly team sports such as football or rugby. The key is to remain as fit as possible for when the season resumes. Full match fitness is unlikely with most team sports and it is anticipated that a mini pre-season training will be organised by most clubs before formal competition recommences.

I was due to run a marathon soon, but this has been postponed for 6 months. Shall I continue training as usual?

Most people who were planning to run a marathon or half marathon in the next few weeks will have trained for several months and will be reaching peak performance. It is highly unlikely that any marathon events will take place in Europe for at least 5 months and indeed, the uncertainty around the duration of this pandemic is so uncertain you should pace yourself and prevent the risk of overtraining and reducing your immunity (see below).

Train as if the event is 4 months away and take at least 3 rest days per week. Try not to attempt a personal best this year and focus on running for a good cause and in celebration of the end of the pandemic. Hospitals are likely to be depleted for several months and medical directors would be keen to keep the number of transfers to hospital to a minimum.

I have heard that if I exercise too much, I will increase my chances of getting the infection. Is this true?

Not necessarily. Although athletes are accustomed to exercising much more intensively than the general population, it is recognised that intensive exercise can cause stress on the body and cause it to become run down and more prone to infections. That said, there is currently no evidence that athletes are especially susceptible to COVID-19 infection. The pragmatic position, however, is that an athlete should not try to exceed their usual training programme during this period of uncertainty.

Will any vitamin supplements protect me from the infection?

The first thing is to eat well and sleep well. Fresh fruit and vegetables are obviously advised but may require queueing or frequent trips to supermarkets. If possible, try to stock your freezer up with berries etc. Vitamin C (500 mg daily), D (4000 iu/daily and omega oil supplements (1000 mg daily) have shown benefit in improving the immune system that helps fight infection. Elite sportspeople should continue with supplements provided by the club nutritionist and seek advice on any recommended additional nutritional needs.

I heard that the COVID-19 virus could affect the heart

A proportion of people will be bedridden for a few days (14%), with a small percentage requiring hospital admission (5%). There is evidence that around 7% of people who need admission to hospital shows signs that the heart muscle is also inflamed. This condition is known as myocarditis. Whilst it’s unlikely you’ll develop myocarditis if you are suffering mildly from the infection and adopting self-care at home, symptoms to be aware of include chest pain that may be made worse by breathing in deep, increasing breathlessness and palpitation (racing heart). In such cases, you should contact your doctor or emergency services immediately. Do not exercise if you experience any of these symptoms until you have consulted your doctor.

Is there a test I can have, to check if my heart is affected by the virus?

Yes. Individuals with myocarditis can be diagnosed by measuring a protein termed cardiac troponin in the blood. This protein is released by damaged heart muscle and is found in high levels in people with myocarditis. If the cardiac troponin level in blood is increased, your doctor will ideally arrange an electrical tracing of the heart (ECG) and a heart scan and an appointment (currently via video) with a cardiologist.

What will happen if I have myocarditis?

Myocarditis can be serious in some people especially if they continue to exercise. Exercising with myocarditis can cause the heart to become damaged permanently and may even cause sudden death. The first thing is to rest the heart by stopping exercise completely for at least 3 months. Depending on the results of the heart scan the cardiologist may also prescribe medications to help the heart if it appears to have been weakened by the infection. You will have another assessment after 3 months to determine if your heart is strong enough to go back to play sport and some athletes may need to rest for another 3 months.

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