key: cord-256665-p9vbeffv authors: Kenyon, Chris title: The Forrest Gump approach to preventing severe COVID-19 – reverse the predisposing pro-inflammatory state with exercise date: 2020-05-06 journal: Microbes Infect DOI: 10.1016/j.micinf.2020.05.003 sha: doc_id: 256665 cord_uid: p9vbeffv nan The Forrest Gump approach to preventing severe COVID-19 -reverse the predisposing 1 pro-inflammatory state with exercise 2 chronic diseases predispose to severe disease is that they are associated with a pro-33 inflammatory state and an imbalance between the pro-inflammatory angiotensin converting Exercise has also consistently been shown to be an effective way to reduce blood pressure in 70 hypertensives [15] . A healthy, tailored diet can also play an important complementary role. 71 As an example, randomized controlled trials have shown that certain diets can lead to 72 remission of diabetes in up to 50% of participants [16, 17] . 73 74 If this theory is correct, then regular exercise and a healthy diet would not reduce one's risk 76 of getting infected with SARS-CoV-2, but they would reduce one's risk of getting severe 77 disease. We must acknowledge that randomized clinical trials in high risk populations would 78 need to be conducted before we can conclude that exercise and diet would have this 79 protective effect. Unfortunately, no such trials are currently registered on 80 www.clinicaltrials.gov. As an alternative, the protective-effect-of-exercise/diet could be 81 tested in animal models of severe COVID-19 [18] . 82 83 In the absence of these studies it is worth recalling the good evidence for a broad array of 84 other health benefits from exercise. One study for example found that every hour of running 85 prolongs one's life by 7 hours [14] . If exercise protects against severe COVID-19 too, then 86 this would be the cherry on the cake. The advice "run, Forrest, run!" saved the handicapped 87 Forrest Gump from nasty bullies, cured his physical disability and paved the way for a new 88 healthy lifestyle. In this time of widespread COVID-19-induced anxiety and sense-of-89 helplessness, advising people to exercise regularly will likewise accomplish more than 90 preventing severe COVID-19. At a macro level, a number of authors have concluded that the 91 current COVID-19 pandemic was ultimately caused by excessive human consumption that 92 has resulted in extensive habitat destruction and spillover of SARS-CoV-2 into humans [19-93 21]. This is mirrored at a micro level by an imbalance between excessive consumption, large 94 ecological footprints and insufficient exercise [20, 22] . This imbalance extends to the marked 95 contemporary inequalities in wealth and opportunities between individuals and populations 96 [22, 23] . These insights suggest that dealing with the current pandemic and preventing future 97 pandemics and other health disasters will ultimately require rebalancing each of these levels 98 [20, 21, 23] . Each of us could start this process by donning our running shoes more regularly. 99 Universal screening for SARS-CoV-2 in 107 women admitted for delivery 110 Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized 111 with COVID-19 in the New York City area Case-fatality rate and characteristics of patients 114 dying in relation to COVID-19 in Italy Characteristics of and important lessons from the coronavirus 117 disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the 118 Chinese Center for Disease Control and Prevention Cardiovascular disease, drug therapy, and 120 mortality in COVID-19 Asthma and COVID-19: is asthma a risk factor for severe outcomes? 123 Allergy Hyperinflammation and 125 derangement of Renin-Angiotensin-Aldosterone System in COVID-19: a novel hypothesis for 126 clinically suspected hypercoagulopathy and microvascular immunothrombosis A hypothesis for pathobiology and treatment of COVID-19: the 129 centrality of ACE1/ACE2 imbalance Elevated 132 serum levels of angiotensin-converting enzyme in patients with diabetic retinopathy Inflammageing: chronic inflammation in ageing, cardiovascular 135 disease, and frailty Imbalanced 137 host response to SARS-CoV-2 drives development of COVID-19 -7) participates in enhanced skeletal muscle insulin sensitivity after a bout 141 of exercise 144 Two protocols of aerobic exercise modulate the counter-regulatory axis of the renin-145 angiotensin system Running as a key 148 lifestyle medicine for longevity Influence of physical activity on hypertension and cardiac 150 structure and function What 152 interventions should we add to weight reducing diets in adults with obesity? A systematic 153 review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy 154 or combinations of these interventions Simulation of the clinical 160 and pathological manifestations of Coronavirus Disease 2019 (COVID-19) in golden Syrian 161 hamster model: implications for disease pathogenesis and transmissibility Preventing bat-born viral outbreaks in future using 164 ecological interventions Human health on an ailing planet -167 historical perspectives on our future Impacts of 170 biodiversity on the emergence and transmission of infectious diseases Income inequality and health: a causal review Why inequality could spread COVID-19