Today, we see the importance of keeping you moving well and free from pain, so you can exercise for a strong immune system.

Here at Lift, COVID-19 has changed the way we think about our role in the overall healthcare system.

Our goal, as always, is to serve you in your drive to heal and thrive. We recognize the role we play as advocates for health. We value the trust you put in us as guardians of your ability to move well, be active, and reach your goals.

But let’s pause for a moment, and think big picture about your life, your bucket list, and dreams.

Try to picture yourself achieving a goal that’s important to you:

• Something you’ll need to be fit and moving well for.
• It’s a goal you can not and will not fail to achieve.
• It could be later this year or 20 years down the road, with some milestones in between.
• Think about how you need to be doing physically in order to achieve your goal. Moving well. Pain-free. Strong. Fit. Healthy. Nourished. Rested. Happy.

On the way to your goal, you’ll need a solid base of overall health. You’ll use this to beat a few obstacles, including COVID-19.

Back to thinking about the present day, there’s a chance that by washing your hands, physically distancing, and practicing a range of risk reduction behaviors you may be a recipient of a vaccine rather than the disease itself. But there’s also a good chance you may be exposed to the virus, and need to fight it off the old-fashioned way.

Let’s talk about how to prepare yourself to win the fight against COVID-19.

Is your body ready to win this fight, in the event that you are exposed to coronavirus? In this 5-part article we will present:

1. Why are exercise and the immune system important right now?
2. What are the researchers and physicians who specialize in this field saying?
3. How can I exercise to boost my immune system function?
4. Do you have a base of pain-free movement, and existing moderate-intensity exercise habits?
5. What about other types of exercise?

Remember, you are an individual but you are not alone.

Your friends and family are negotiating this time as well. Your first responsibility is to care for yourself, and then you can be a role model or supporter for others. As you move along this journey you can become an advocate and share your learning with people close to you, gently encouraging people you care about to find their own path. Keep an eye out for people around you who need help.

A word about readiness. Are you ready to start exercising?

If for any reason you feel like you don’t even want to exercise right now, we have good news.

• In sections 3 and 4 we’ll outline some ideas to help make this achievable.
• Keeping your focus on starting small is ok and can have profound benefits.
• If you’re just feeling overwhelmed with everything right now, these same exercise guidelines will help your stress levels too.
• Read on, and again, feel free to reach out to us through comments, contact form, phone or appointments.

Ok we’re ready to get started. [insert virtual fist-bump here].

Part 1: Why are exercise and the immune system important right now?

Let’s start by stating the obvious.

Your immune system fights viruses and infections. This is important at the best of times. It is very important in 2020 due to coronavirus.

Why exercise matters now more than ever:

For years, researchers have studied the link between exercise and health. Everything from physical function and mobility to chronic disease prevention and mental health seems to benefit from a magic formula for exercise. But did you know that exercise is a powerful immune system stimulant? That’s right. Your body’s ability to react to infection is enhanced by exercise. Bigtime. Let’s explore why this is important, perhaps now more than ever.

The bad news – challenges we face regarding exercise, COVID-19 and the immune system

1. In Canada, only 17% of adults meet exercise recommendations of minimum 150 minutes moderate-intensity physical activity per week
2. COVID-19 is a novel virus so none of us have antibodies to help block its entry to our body
3. Risk factors for more severe cases of COVID-19 are 1) obesity, 2) pre-existing medical conditions, and 3) old age
4. Finding the right way to exercise can be hard. You may have barriers, or challenges due to your lifestyle, energy level, physical ability, injury, pain level, chronic conditions or movement limitations
5. There is a lack of public knowledge around how to exercise for optimal immune function

The good news – exciting facts about exercise, COVID-19 and your immune system!

1. Regular exercise will enhance your immune system response in the event that you are infected with coronavirus (or any other illness)
2. Meeting exercise guidelines will enhance your immune system response to other illnesses ranging from the flu to cancer
3. This is a significant time of change in our lives and lifestyle – while we’re picking up the pieces let’s rebuild our lives with health and exercise as a priority
4. Good exercise habits for the long term will decrease your likelihood of obesity and chronic medical conditions
5. Smart exercise choices will help you improve stress management, fatigue, and sleep quality.
6. Barriers and challenges to exercising can be overcome – we’re here to help and if we can’t help you we will know someone who can.
7. Meeting your exercise recommendations can be versatile, fun, and does not have to be unpleasantly strenuous (in fact, it shouldn’t be).

Right! So 5 parts bad news and 7 parts good news. [virtual fist-bump #2]

Part 2: What are the researchers and physicians who specialize in exercise immunology saying?

Please note, we are a team of physio, chiro, massage therapists who work closely with strength coaches, doctors, and a wide range of population who care deeply about their physical wellbeing. But we are not career researchers specializing in the link between immune health and exercise. Fortunately, those researchers exist and we have been able to reach them, and read up on what they’re saying right now about exercise in relation to COVID-19 and immune system function. They seem to agree about all the key points, but each has different angles to highlight… we found this highly motivating and enlightening, and hope you will too. Let’s hear what they have to say. (Note: if you’d like links to the original articles please read through the references at the bottom of this page).

Dr. David C. Nieman, author of Coronavirus disease-2019: a tocsin to our aging, unfit, corpulent, and immunodeficient society; and The compelling link between physical activity and the body’s defense system.

• the 2 most promising strategies to reduce the risk for COVID-19 at both the community and individual level are (1) mitigation activities and (2) the adoption of lifestyle practices consistent with good immune health.
• The world’s population is becoming older, more obese, and more physically inactive, increasing the likelihood of pandemics such as coronavirus disease-2019.
• Aging, obesity, and physical inactivity adversely impact immune function and host defense.
• Regular moderate-intensity physical activity improves immunosurveillance against pathogens and reduces morbidity and mortality from respiratory illnesses. (that’s a fancy way of saying it primes our immune system to recognize threats and reduces the severity of illness and likelihood of death)
• Coronavirus disease-2019 is a wake-up call, a tocsin, to the world to focus on primary prevention countermeasures. (that’s a fancy way of saying exercise people, exercise!)
• Specifically, 150-300 minutes of moderate physical activity has strong evidence to support the likelihood that these habits will help you to beat coronavirus and other illnesses in the future

Dr. Jeffrey A. Woods, interviewed in “Should, and how can, exercise be done in a coronavirus outbreak?”

• It is safe to exercise during the coronavirus outbreak. One should not limit the multitude of health benefits that exercise provides us on a daily basis just because there is a new virus in our environment. However, there may be some additional precautions to reduce your risk of infection.
• Even a single exercise bout can be beneficial, but regular exercise provides a much bigger benefit. Molecular and cellular events take place within seconds to minutes following the beginning of an exercise bout or period of physical activity. This is why there is so much work right now examining sitting time and how often physical activity should be interspersed with inactivity to promote health.
• It is safe for sedentary individuals to exercise or to start an exercise program. Physician consultation and approval may be needed for people with disease, comorbidity, orthopedic problems, or advanced age. If you are sedentary, it may be a good idea not to overdo it. Research suggests that unaccustomed strenuous or prolonged exercise might reduce the function of your immune system defenses. As such, avoiding long and stressful exercise sessions that you are unaccustomed to might be a good idea.
• Typically, one can exercise moderately with mild upper respiratory tract symptoms (e.g., runny nose, sinus congestion, mild sore throat). However, I would recommend against exercising if you are experiencing any of these symptoms: severe sore throat, body aches, shortness of breath, general fatigue, chest cough, or fever. You should also seek medical care if you are experiencing those symptoms.
• Even a single exercise bout can be beneficial, but regular exercise provides a much bigger benefit. Molecular and cellular events take place within seconds to minutes following the beginning of an exercise bout or period of physical activity. This is why there is so much work right now examining sitting time and how often physical activity should be interspersed with inactivity to promote health.
• Strength exercise, yoga, and tai-chi may have benefits to the immune system as well but research here is emerging.

Dr. Jordan Metzl in a British Journal of Sports Medicine Podcast: Exercise Prescription During a Pandemic

• Exercise is especially imperative now
• Think about how to incorporate movement and exercise in your new routines
• Explore opportunities to follow online fitness routines during times you need to be at home
• Understand that you are physically distancing but you don’t have to be socially distancing – build the spirit of social connection into your physical conditioning during the new normal
• Exercise can benefit your stress levels in this difficult time
• Exercise intensity can be dialed down a bit to keep you feeling energized
• It’s important to create inclusive opportunities for people who have been sedentary
• Professionals can share and model activities that demonstrate appropriate exercise during this time

Dr. Richard J. Simpson, author of a great blog post from the American College of Sports Medicine, Exercise, Immunity and the COVID-19 Pandemic:

• Each bout of exercise, particularly whole-body dynamic cardiorespiratory exercise, instantaneously mobilizes billions of immune cells, especially those cell types that are capable of carrying out functions such as the seeking and destroying of virus-infected cells.
• “These immune cells that are mobilized with exercise are primed and looking for a fight.”
• Not only can exercise have a positive direct effect on the cells and molecules of the immune system, but it is also known to counter the negative effects of isolation and confinement stress on various aspects of immunity.

Dr. Liz Joy author of Staying Active during COVID-19, also from the American College of Sports Medicine:

• Those at greatest risk for severe complications of COVID-19 are the elderly (defined as age 65 and older), and others with chronic diseases or compromised immune function. Those individuals should avoid gyms altogether, and exercise at home or in their neighborhood.
• Compared to being sedentary, moderate-intensity physical activity is associated with better immune function. Likewise, regular physical activity is associated with lower levels of anxiety and perceived stress (which many of us are feeling in the wake of the COVID-19 pandemic).

Part 3: How can I exercise to boost my immune system function?

The quick answer is, consistently get 150-300 minutes of moderate-intensity exercise per week. Good news – moderate intensity has a bit of a range to work within so this is actually way easier than it sounds. We’ll show you how to adjust your exercise to how you feel each day.

What does it mean to get 150-300 minutes of moderate-intensity exercise per week?

The answer depends a bit on you and your personality. Do you like things simple? Or are you fascinated by technical details, numbers, and accuracy?

The simple answer

Get moving in a way that is active, fun, and a bit of work. But not extremely strenuous. You won’t feel out of breath and should be able to talk at this level of exertion. Depending on the person this could range from a brisk walk or dancing in the house, to cycling, jogging or a mix of strength exercises like squats and push-ups with heart rate boosters like jumping jacks or hops. You can modify your intensity or activity based on how you feel that day – if you’re super stressed, fatigued or borderline getting sick, keep it lighter; if you feel great and have been getting lots of sleep and good food, you may be able to push yourself slightly, but not too hard.

The technical answer

Moderate exercise means anything that raises your heart rate into the range of 50-80% of maximal heart rate (depending what you read, you’ll find slightly different numbers). Here’s a handy chart to help you learn what your heart rate ranges should be at to qualify. What’s interesting about these 3 zones of cardiovascular exercise is, if you come to understand them in more detail, each zone has specific training benefits. Extending on what we said above – if you’re extremely stressed, fatigued, haven’t been sleeping well, or if you’ve over-trained or been subject to excessive stress, the first level is probably great for you today. Think of it as active recovery. If you’re well rested and grooving a pretty good routine with consistent sleep, nutrition and well-managed stress then you’ll probably do well in Zone 3. If you’re a bit of a mix, then Zone 2 may be the right place for you today.

The bottom line for boosting your immune system with exercise

Top recommendation: create a daily or weekly routine that meets your 150 minutes goal, with exercise bouts lasting 10 minutes or longer. This could be 2-3 10 minutes periods, or 3 50 minute periods throughout the week. What fits your lifestyle, is achievable, and feels the best to your body?

Part 4: Do you have a base of pain-free movement, and existing moderate-intensity exercise habits?

Step 1: Recognize your barriers

Do any of these seem applicable to your situation? a) Your body is telling you something… Pain, mobility, and stiffness with preferred methods of moderate-intensity exercise b) You are under too much pressure to fit this into your routine… Social influences (relationships, kids, work, friends) and time constraints are making this so stressful you prefer to avoid it c) Your exercise preferences have been undermined by COVID-19… businesses, sports, recreation opportunities that you normally enjoy are not available to you currently d) You haven’t found exercise methods you really like… Knowledge of the range of exercises available and problem-solving may be holding you and your immune system back

Step 2: Problem solve solutions and engage with supporters

If you have barriers to participating in this type of exercise such as pain and mobility limitations, book a session with one of our physiotherapists at Lift and we will help you overcome your limitations and find appropriate exercise solutions during this time. Start with foundational stuff. Build routines. When can you exercise? Do you need to work out routines or changes with people around you to make this possible? Once you have a routine, get it in your schedule. Develop versatile ways to meet your exercise needs when something bumps your schedule. Explore new ways of exercising and start building habits for how to stay active that take advantage of what is available to you during times when businesses are open; outdoor spaces are available; AND inside your own home. Be versatile and be prepared to switch modes in the event that COVID-19 spikes in your region. Check-in with physiotherapists, strength coaches, and other advocates to establish more ideas that can work for you.

Step 3: Introduce change

After brainstorming ideas and engaging with the people who can help you plan what’s best for your situation, start introducing change. If you have been sedentary, start with lower intensity activities and focus on your routines as being what’s most important. If you have good routines, now is a great time to focus on versatility and optimizing your daily response to how you’re feeling. (Side-note, if you’ve never heard of HRV Monitoring this is an exceptional tool to help correlate daily physical measures with your exercise plans). If you’re really fit but prone to over-doing things… Try to reel that in during this time. Keep your energy levels steady and understand that submaximal efforts build you up. World champion weightlifters, sprinters, runners, and athletes do a lot of work at submaximal efforts through the week and through each year.

Part 5: What about other types of exercise?

Yes! But…

The bottom line is, we want your heart rate in these moderate-intensity zones above for 150-300 minutes. This is your priority. Your foundation. Other forms of exercise such as strength training and high-intensity training can build on this foundation. Conversely, lower intensity exercises such as very slow-paced yoga may not elevate your heart rate to get you into this zone. You may have noticed the experts in Part 2 commented about other forms of exercise. From a very strict research point of view, understand that most research on the link between immune system and exercise has focused on classic research designs such as treadmill walking or running, cycling etc. to explore the relationship of heart rate, immune function and a wide range of health markers in very controlled circumstances that are easy to study. This helps them to tie study results to treatment methods and control or eliminate variables that may confound the results. So research most strongly supports these specific modes of getting your heart rate up. However, these same researchers seem to be advocating a more inclusive message – get active in whatever way suits you best. The belief is, elevating your heart rate into these key ranges is what’s most important. So you can play with all different types of movement ranging from playing tag with your 3-year-old niece, to fast-paced yoga, brisk walks, or strength training. If you want to carefully monitor your minutes and zones, there are great apps for that. Polar offers tools starting from as low as $80 that can enable you to track your heart rate during exercise and get immediate feedback about what zone you are training in. But without technology, you can also learn to correlate how you feel with your heart rate.

So strength training, resistance exercise, and yoga could be ok?

Yes, and resistance exercise (strength training) are important parts of your overall physical health. When designed carefully they can even contribute to your moderate cardiovascular exercise totals. For the purpose of boosting your immune health, in this article, we’re keeping the emphasis on getting your 150-300 minutes as a fundamental baseline for your health and wellness. If you don’t currently get 30-50 minutes a day of exercise, movement breaks, resistance exercise, and even yoga can be designed to get your heart rate into these target zones.

A sampling of quality 10-minute programs to get started today:

• 10-minute strength training (for example try our very own movementchampions.ca featuring good quality full body programming)
  • This is a level 1-3 program, we recommend everyone start on Level 1 regardless of experience to pick up on cues, and progress as able.
• 10-minute cardio (try this one from Madfit on YouTube)
  • Note this instructor is FIT! Remember your target heart rate – if you can stay in your target zone doing two good repetitions while she does six, that’s OK! Concentrate on good technique and full movements, and stay in your HR zone; be consistent and as your cardio improves over time you’ll be able to do more repetitions
• 10-minute yoga (try this one from Yoga with Kassandra on YouTube)
  • Yoga and cardio in one… this is a moderate intensity program, if you’d like lower intensity or find your heart rate is higher than the training zone you’re targeting, try a different 10-minute yoga program (look up Yoga by Adriene and Sara Beth Yoga on YouTube)

Lots of energy? Build your body up

If you’re hitting your marks for 150-300 minutes of exercise and have the energy to spare, now is the right time to add in 2-3 60-minute strength training sessions per week. At Lift Clinic we have close relationships with some of Vancouver’s best strength coaches and during an appointment, we’d be happy to provide you with a specific recommendation.

• Work with a local professional to develop a program specific to you
• Support a local gym for coached sessions in-person (ask them about their new safety protocols) or virtually
• If you have pain or significant movement limitations that cause discomfort with exercise, your best step is to book a session with one of our physiotherapists. We can help you to better understand how strength programming can compliment your rehabilitation and movement goals as part of your program.
• If you don’t have pain or movement limitations feel free to reach out to us through our contact form at the bottom of this page with some details about your situation and we can advise you on your best path forward.

If you found this helpful, please pass it on!

Thanks for reading to the bottom. We’re passionate about this subject and really hope it helps you, your family and friends. Please share this resource, and let us know what you think through the comments below!

Reference articles and further reading

• Canadian Exercise Guidelines for Adults Age 18-64. (n.d.). CSEP | SCPE. Retrieved June 23, 2020, from https://csepguidelines.ca
• Exercise, immunity and the covid-19 pandemic. (n.d.). Retrieved June 23, 2020, from https://www.acsm.org/blog-detail/acsm-blog/2020/03/30/exercise-immunity-covid-19-pandemic
• Exercise prescription during a pandemic: Keeping active with Dr. Jordan Metzl. Episode #431. (n.d.). Retrieved June 23, 2020, from https://soundcloud.com/bmjpodcasts/exercise-prescription-during-a-pandemic-keeping-active-with-dr-jordan-metzl-episode-431
• Government of Canada, S. C. (2019, April 17). The Daily—Tracking physical activity levels of Canadians, 2016 and 2017. https://www150.statcan.gc.ca/n1/daily-quotidien/190417/dq190417g-eng.htm
• Nieman, D. C. (2020). Coronavirus disease-2019: A tocsin to our aging, unfit, corpulent, and immunodeficient society. Journal of Sport and Health Science. https://doi.org/10.1016/j.jshs.2020.05.001
• Nieman, D. C., & Wentz, L. M. (2019). The compelling link between physical activity and the body’s defense system. Journal of Sport and Health Science, 8(3), 201–217. https://doi.org/10.1016/j.jshs.2018.09.009
• Polar heart rate zones. (n.d.). Retrieved June 23, 2020, from https://support.polar.com/e_manuals/Team_Pro/Polar_Team_Pro_user_manual_English/Content/Polar_Heart_Rate_Zones.htm
• Zhu, W. (2020). Should, and how can, exercise be done during a coronavirus outbreak? An interview with Dr. Jeffrey A. Woods. Journal of Sport and Health Science, 9(2), 105–107. https://doi.org/10.1016/j.jshs.2020.01.005