key: cord-0945217-47kcwer9
authors: Nyenhuis, Sharmilee M.; Greiwe, Justin; Zeiger, Joanna S.; Nanda, Anil; Cooke, Andrew
title: Exercise and Fitness in the age of social distancing during the COVID-19 Pandemic
date: 2020-04-28
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.04.039
sha: ba1cf536b88961b05bec493a0b01f4e2b9fff77d
doc_id: 945217
cord_uid: 47kcwer9

nan

Just as COVID-19 changed the way healthcare is provided, it has also upended the way consumers 43 approach physical activity. While gyms and workout classes provide a sense of community, support, and 44 personalized instruction, they are also crowded areas with lots of surface area that can transmit 45 infections, and simply wiping sweat off with a towel isn't enough. In deference to these issues, gyms and 46 fitness centers throughout the US have closed during this period to ensure the safety of its patrons.(3) In recent years, the use of home fitness products have increased in popularity due to convenience and 48 safety (e.g. many of the cycling based apps have taken the place of riding outdoors prior to COVID-19 49 rules); and with the current strict social distancing rules enacted due to COVID-19, this trend looks to be 50 the new normal for the foreseeable future.

Patients and their healthcare providers, including allergists and immunologists, must be aware of the 52 various home fitness options available and how these platforms can be implemented. It is important to 53 recognize the difference between home fitness programs that utilize interactive gym equipment (i.e., 54 treadmill, bike, mirror) and fitness apps that provide a variety of exercise options without a requirement 55 for interactive gym equipment.

Home fitness apps requiring gym equipment 57 Some examples of interactive health home fitness apps that require home fitness equipment include: 58 Mirror, Zwift, Tonal, Peloton, iFit, and Nordic Track, each of which has different membership and pricing 59 structures. These interactive platforms utilize real-time personalized health data to encourage users to 60 take a more active interest in their own health; but, just as importantly, they provide a social connection 61 with friends and other users of the platform which can make these types of exercise modalities enticing 62 for those who need social motivation and accountability. Importantly, the data provided by interactive 3 home gym equipment can be combined with the latest wearable tech like Apple watches, Garmin 64 devices, and Fitbits to track activities over time.

The proliferation of companies entering into this space with offerings for various activities that can be 66 accomplished from home include activities that range from cycling to running to Cross-fit to yoga to 67 dance classes. The myriad of home-based activities has a large range of investment from expensive 68 stationary type bikes and treadmills to more affordable options like yoga or body-weight strength 69 sessions. A well-rounded exercise program may combine several of these modalities which will enable 70 the patient to avoid monotony, and work both the cardiovascular and musculoskeletal systems, all of 71 which can be eventually monitored by health care providers.

Home fitness apps that do not require gym equipment 73 Investing in home gym equipment can be expensive, and some athletes eschew indoor exercise because 74 they prefer to exercise outside. For those who still want to exercise indoors without incurring the costs 75 of equipment and monthly/yearly fees, the good news is that there are engaging, on-demand, and 76 livestream workouts available online via YouTube and free mobile apps. These tutorials can provide 77 much-needed guidance for beginners or reinforce technique and form for seasoned gym goers. Many 78 gyms and fitness instructors are offering virtual classes and personal training sessions that can be done 79 in the safety of a person's home. Some fitness apps offer a virtual community and health metric tracking 80 to accompany the more conventional types of exercise that patients can embark on that don't require 81 extra home gym machines, such as walking, running, hiking, and yoga (e.g. Aaptiv, Strava, Peloton, Nike 82 training club, Zombies Run). When discussing optimal fitness routines with patients it is important to 83 give them options that best fit their personal fitness goals, budget, and physical capabilities. 

Walking, bicycling, hiking and jogging allow patients to get some fresh air without coming into close 106 contact with others. It is important to note that due to the aerodynamic effects of movement, additional 107 social distancing precautions should be taken.(4) Larger distances should be kept when walking fast (5 108 meters) or running (10 meters). Additionally, people should avoid walking or running directly behind the 109 leading person and make sure to keep a 1.5 m distance in a staggered or side by side arrangement.

Remind patients that physical activity doesn't have to be a gym-style workout. Everyday activities like 111 walking, gardening, and cleaning can improve fitness and overall health.

Many municipalities encourage wearing masks while outside, even while exercising. Wearing a mask 114 while exercising is going to impede the ease of breathing, thus, finding the best mask for the patient's 115 exercise type is important, as some masks are more breathable than others. Use a mask that can be 116 washed, particularly with allergy season starting. Runny noses will impact the cleanliness of your mask.

If you have asthma, vocal cord dysfunction, and/or dysfunctional breathing (5) 

Recommendations include taking social distancing seriously. Families can exercise together, but make 125 room for others who are sharing the same space by moving over to allow for a six-foot distance. Do not 126 exercise in non-family groups; find a single partner or exercise alone (or with your pet). Remember to be 127 friendly to those around you; this is a difficult time for everyone, and a hand-wave or head nod can help 128 bolster everyone's mood. 

Why Exercise?

Improves quality of life

The American Heart Association recommends 2.5 hours of moderate-intensity aerobic activity a week.

Moderate-intensity aerobic activity is activity that makes your heart beat faster and your breathing heavier, but you can still talk.

Tips for Exercising with Asthma. 

The physical activity 173 guidelines for americans

The $94 billion fitness industry is reinventing itself as Covid-19 spreads 2020 178

Towards aerodynamically equivalent COVID-19 1.5 m 180 social distancing for walking and running

Special Considerations and Perspectives for Exercise

Bronchoconstriction (EIB) in Olympic and Other Elite Athletes. The Journal of Allergy and Clinical 183 Immunology: In Practice. 184 6

Making health habitual: the psychology of 'habit-formation' and 186 general practice