Exercise/PA and COVID-19 by geographical location

 - Age
- Race
- Ethnicity
- Gender
- Marital status
- Income
- Education
- Employment

Exercise/PA and COVID-19 by demographics

Exercise/PA and circadian rhythm are strongly related to each other, and further investigation into the relationship between exercise/PA, sleep, and COVID-19 could provide important insight into COVID-19 pathophysiology.

Exercise/PA and Circadian Rhythm in relation to COVID-19

Use of alternative methods of assessment during the COVID-19 pandemic is crucial due to the physical restrictions of lockdowns.  Telemedicine allows for remote consultation and injury assessment using electronic methods.  

Exercise/PA and Telemedicine in COVID-19 Pandemic

The COVID-19 pandemic significantly affected individuals' exercise and physical activity (PA) behaviors. Pandemic-related restrictions and lockdowns altered daily routines, impacting the frequency and types of physical activity people engaged in. Furthermore, these sudden lifestyle changes posed unique challenges for various demographic groups, particularly high-risk populations and individuals with comorbidities who rely on regular physical activity for long-term health maintenance.

Effects of the COVID-19 Pandemic on Exercise and Physical Activity

Regular exercise and physical activity (PA) confer physiological benefits that relate to the pathophysiology of COVID-19. These interactions involve multiple systems, including modulations of the immune response, metabolic adaptations such as protection against oxidative stress, and cardiovascular changes. Additionally, PA has implications for the expression of ACE2 in relation to COVID-19.

Exercise/PA benefits and relation to COVID-19 pathophysiology

Exercise and physical activity induce physiological changes on many levels, the effects of which are best understood using a biopsychosocial approach.  The bidirectional relationship between exercise and Covid-19 can be further broken down into different components:
- Exercise/PA and COVID-19 by geographical location
- Exercise/PA and COVID-19 by demographics


University of Michigan - Ann Arbor

- Affected organs and organ systems
- Circadian Physiology in relation to COVID-19
- Exercise/Physical Activity and COVID-19
- Immune response to COVID-19
- Laboratory methods
- Pathogenesis
- Patient comorbidities 
- Symptomology 
- Genetic mechanisms in COVID-19
- The body's response to stress hormones






Focuses of Human physiology studies on COVID-19

Lesser IA, Nienhuis CP.PMID: 32486380 The impact of COVID-19 on physical activity behavior and well-being of canadians. Int. J. Environ. Res. Public Health 2020. doi:10.3390/ijerph17113899.

Impact of COVID-19 restrictions on physical activity behavior and well-being in Canada

Zhang Y, Zhang H, Ma X, Di Q.PMID: 32466163 Mental health problems during the COVID-19 pandemics and the mitigation effects of exercise: A longitudinal study of college students in China. Int. J. Environ. Res. Public Health 2020. doi:10.3390/ijerph17103722.

Mental health problems and the mitigating effects of exercise on college students during COVID-19 in China (Longitudinal Study)

Retrospective epidemiological studies using clinical data and experimental molecular biologies studies have revealed biomarkers of COVID-19.  These elements not only reveal how COVID-19 mechanistically affects the body, but they may also be risk factors for developing severe symptoms and act as targets for pharmacological intervention.  They include:

- A1AT protection
- ACE2 expression and activity
- ADAM17 sheddase activity
- Furin protease activity
- Irregular respiratory function
- Pro-inflammatory cytokine concentration in the plasma
- TMPRSS2 serine protease genetic variation
- Variation in genetic susceptibility to SARS-CoV-2
- Viral interactions with glycosaminoglycans
- Nsp (Non-specific Protein) Activity
- Neuropilin-1 expression


Pathogenesis of COVID-19

Current studies show that many organs that are heavily affected by COVID-19 have a high expression level of ACE2.

- Cardiovascular system
- Central nervous system (CNS)
- Gastrointestinal tract (GI)
- Kidney
- Liver 
- Lungs (Respiratory System)
- Peripheral nervous system (PNS)
- Testis

Organs and Organ Systems Affected by COVID-19

- Animal models
- Cell lines
- Genetically engineered SARS-CoV-2

Laboratory Methods in COVID-19 Research

Infection by SARS-CoV-2, as is with other viral infections, induces a two-phased immune response in the human body, described in the figure below: 
- Innate (rapid, natural, non-specific) 
- Adaptive (slow, acquired, specific)

Those two branches of the immune system cooperate with one another, and can be distinguished based on the cell-types involved (immune response vs white blood cells). However, the adaptive system is further broken down by the type of mechanism:

- Cell-mediated
- Antibody-mediated

Current research around COVID-19 immunity aims at uncovering the interaction between SARS-CoV-2 and the host's immune response, with questions related to pathogenesis, severity, and intervention.

Immune Response to COVID-19 

Presence and severity of symptoms of COVID-19 depend largely on individual characteristics. COVID-19 produces both symptomatic and asymptomatic infection.

Symptomology of COVID-19 

- Pituitary gland: improper functioning of the hypothalamus in association with pituitary gland; changes the metabolism of ADH (regulates the amount of water in the kidneys); abnormal sodium levels
- Thyroid: sick euthyroid syndrome → decrease in size of thyroid gland; changes in TSH levels
- Adrenal gland: increased chance of COVID-19 infection if presented with Cushing’s syndrome (too much cortisol) or Addison’s disease (inadequate aldosterone and cortisol)
- Pancreas: those with diabetes are at higher risk of getting COVID-19
- Bone: low vitamin D and hypocalcemia

Dysfunctions/ diseases in endocrine glands/organs that could lead to greater susceptibility to COVID-19

Exercise/Physical Activity (PA) and Covid-19

COVID-19 comorbidities are high risk conditions that put patients at greater risk for infection and negative outcomes. Some COVID-19 comorbidities have been found to be: 
- Cancer 
- Cardiovascular Disease
- Diabetes
- Digestive Diseases
- HIV
- Hypertension
- Immunological Disease
- Liver Injury
- Obesity
- Renal disease
- Respiratory System Disease

COVID-19 Patient Comorbidities

Circadian biology refers to any biological process that has a rhythmic component dependent on time of day.  Understanding the relation between COVID-19 and circadian rhythm could help improve clinical management in treating COVID-19.

Circadian Physiology in relation to COVID-19

ARTICLES RESEARCHED
- Genetic mechanisms of critical illness in Covid-19
- Epigenetic dysregulation of ACE2 and interferon-regulated genes might suggest increased COVID-19 susceptibility and severity in lupus patients

Genetic mechanisms in COVID-19

Levels of stress may increase in those diagnosed with COVID-19, resulting in an alteration in stress hormone levels and the body's ability to cope with the stress.

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