November 12, 2020
Regular physical activity is important for good health. But for many people, the ongoing COVID-19 pandemic has made it challenging to maintain an exercise regime.
Medical experts said long periods of physical inactivity can worsen health and health conditions and can make fighting off a COVID-19 infection more difficult. It can also affect mental health. Many people are experiencing anxiety and depression due to isolation and loss of social support, and exercise can help mitigate these issues.
Dr. Ray Stewart is assistant professor of family, internal, and rural medicine at the College of Community Health Sciences and a sports medicine physician at University Medical Center, which CCHS operates. He talked recently with Dr. Tom Weida, UMC’s chief medical officer, about the physical and mental health benefits of exercise during COVID-19.
TW: You are a sports medicine physician. Tell us about that.
RS: Sports medicine physicians are specialists who take care of active individuals and athletes. You can either be a primary care physician or an orthopedic surgeon to be in that specialty.
TW: How did you get interested in sports medicine?
RS: I was a former athlete in high school and was really part of teams most of my life. When I was training in family medicine, I wanted to continue to be part of a team and sports was a natural draw for me.
TW: What was your sport in high school?
RS: I was a baseball player.
TW: And your position?
RS: First base.
TW: How long has sports medicine been a specialty?
RS: As far as medical specialties go, it’s a relatively new specialty, really being around for the past 30 years or so for formal training. It’s certainly got a lot of emerging developments and science behind it and is becoming a popular fellowship option for primary-care physicians.
TW: What kind of formal training do you need to practice sports medicine?
RS: Most of the time it’s an additional one year of fellowship training outside of your residency, which in my case was family medicine. But other primary-care specialties can also participate in that fellowship.
TW: Is sports medicine care just for athletes?
RS: We take care of athletes primarily, but we also see active individuals. We take care of all levels from little league all the way up to Olympic-level elite athletes and everyone in between. It really runs the gamut, like family medicine does, with taking care of everyone no matter their age or gender.
TW: What is the benefit of a family physician as a team doctor? Why not an orthopedic surgeon?
RS: Interestingly, the concept of a primary care sports medicine doctor actually emerged from the orthopedists. They take care of things that are primarily surgical in nature and they saw the need to have someone with specialization in general medical needs in addition to non-operative orthopedic issues. So, it was really born out of that need. We take care of general medical conditions such as hypertension, diabetes and the like for our athletes as well as their everyday illnesses and injuries.
TW: So, athletes get sick, too.
RS: Exactly. And there’s a lot more to taking care of a team and athletes than just dealing with injuries. Those are certainly the most high-profile things that you would deal with and hear about in the media. But behind the scenes they’re getting sick, they have colds, rashes and other issues, and mental health things that come up that we’re well positioned to take care of.
TW: Speaking of those other things, we’re in the era of COVID-19. How has that changed the practice of sports medicine?
RS: We certainly saw a significant impact from the outset when everything was shut down in March. Obviously, with sports being closed down, it impacted our clinic significantly. We had to refocus our efforts to try to get prepared for when the athletes returned and when the students returned. We really focused on our teaching, and it ended up being a really nice time to revisit our fundamentals and just kind of go back to the basics and to doing what we love to do in anticipation of receiving the students and athletes back in the summer.
TW: Has your practice of sports medicine changed with COVID-19?
RS: Our role has largely remained consistent. Our methods and the protocols we’ve had to deal with revolve around COVID much as everything else does now, or seemingly does. Our role is to take care of the whole athlete and that’s what we’ve done from the outset. We’ve been able to that with the COVID guidelines and work in our testing and other protocols to protect the athletes.
TW: Are you finding that individuals are more or less active than they were before COVID?
RS: Physical activity has always been a challenge for patients in general. And then you throw into the mix something like this, where everything gets shut down, there’s a lot of fear about being in public and going to place to interact and it becomes even more of a challenge. So, we already have a lot of obstacles at the outset and this just adds another big one into the mix. It is a challenge but something we’ve been dealing with for a while.
TW: I seem to see more people walking their dogs these days.
RS: We’re happy to see people outdoors. That was one of the nice things early on in the shutdown, going through our neighborhood and seeing people outside playing with their children and their pets and just enjoying the weather for a change. You didn’t always see that before this happened so there are some good things that have occurred.
TW: How much physical activity do people need to maintain good health?
RS: If you look at the current recommendations, the number is 150 minutes per week, however you would like to divide it out. Obviously, it’s better to space it out over the course of the week but you can do it however you’d like. Most of the time we say 30 minutes a day, five days a week is a good way to go. You also have to remember to incorporate good nutrition. And you have to include flexibility, in terms of stretching, and strength training. You have to incorporate all those things into the regimen you would use.
TW: Does it matter what type of exercise you do?
RS: The physical activity doesn’t matter. It’s what you enjoy doing, what can get you moving and get your heart rate elevated. There are so many activities available at home and at work that you can do. Walking is one of them. Parking farther away at the grocery store and walking in if you are able is a good way to get a few extra minutes in of aerobic exercise. You can take a few minutes at a time to exercise throughout a day and that cumulative effect is helpful over the long run.
TW: With walking, what would be a good number of steps to take? What’s a good target?
RS: There is no absolute number that has a lot of evidence behind it, but most people say 10,000 steps per day is kind of the norm. Some of that depends on the individual, their level of health, their medical conditions and so forth. I would say 10,000 is probably a reasonable number without any hard evidence to suggest that it’s better than any higher number or lower number.
TW: We know that COVID-19 affects people with underlying health issues. Do athletes get sick with COVID?
RS: Absolutely. We’ve had a number of athletes who have become ill with this. Fortunately, it’s a population that is healthy and physically active, so they’ve had less issues as far as severity of illness. The other thing you have to think about is immune system functioning with active individuals. Recent empiric evidence suggests that increased physical activity actually improves your immune functioning, and as a direct result of that you can potentially lower your risk of having illness by having a better functioning immune system. So, just one more reason to be active.
TW: Has the University Medical Center Sports Medicine Clinic been involved in the care of athletes?
RS: Absolutely. We have protocols in place for return to play and return to activity related to post-COVID individuals. That largely revolves around cardiovascular screening to make sure they’re ready to return safely with some of the issues that have arisen there. We also have a graduated return to play and activity protocol that they go through to re-acclimatize to conditioning and to heat and so forth to make sure that they have a safe return.
TW: You mentioned heart. How does COVID-19 impact the heart?
RS: One of the things that we’ve seen a lot in the news media with regard to athletes and sports is some of the issues with heart conditions related to post-COVID patients, particularly myocarditis, which is inflammation of the heart. That’s been around for a long time, after viral illnesses, so not just COVID but any viral illness can really cause that. It’s just received a lot of attention because there’s so much unknown with COVID, so it’s something that we definitely want to be screening for to make sure that we’re not missing anything and to make sure we’re not putting someone back too early, before they’re ready.
TW: Can you say more about inflammation of the heart? How would you describe that?
RS: Probably the best way to describe that is swelling around the heart itself, particularly the lining of the heart, which can cause problems with the different rhythms of the heart that can be potentially dangerous.
TW: We talked about the treatment side. What is the UMC Sports Medicine Clinic doing to try and prevent infection among athletes?
RS: That’s been a big part of our protocol from the outset, trying to deal with masks, social distancing, doing screening going into buildings where athletes will be present, and not only screening the athletes but screening staff and other members of the extended team, if you will, that would be involved with the care or day-to-day maintenance of those athletes. So, we’ve done that to try and prevent transmission. And, of course we’ve had a rigorous testing program that has been in place from the very beginning, which has gotten even more rigorous now that we’re in season with football.
TW: I see when I’m watching football games on television that players aren’t wearing masks. How do you protect them from each other and protect the coaches?
RS: With physical activity sometimes it’s difficult or not feasible to wear a mask because of the need to breathe the way they do because of the activity they’re performing. We encourage them to put their mask on between plays and if they’re on the sidelines and to distance where appropriate. We also know that they are being tested on a daily basis at this level, so it makes it easier to allow them to have a little leeway as opposed to the general public.
TW: Do they have to live in a bubble like the NBA players?
RS: It’s not a true bubble in the sense that they’re not confined to one area. They’re tested so frequently into and out of the facility on a daily basis, and prior to games and after games, that it’s a relative bubble compared to the rest of the population.
TW: Have you noticed an increase of cases since football has started?
RS: To my knowledge, there’s not been any direct surge or increase related to football games or since football has started. We’ve got some more games coming, so we’ll have to see how that plays out. But up to this point, it’s gone really well.
TW: Can the general population start resuming team sports and recreational sports?
RS: We have resumed. Youth sports started back fairly early. Of course, it’s a much lower-risk population right now. High school sports have resumed. We’ve had good success so far. There has been some cancellation of games, but by and large we’ve been able to successfully resume functioning of really all sports. I think we’re at a point where we have to be able to engage again and return to our activities and this is proving that it can be done.
TW: Are there some sports that might seem to be safer than others, as far as not having as much chance to transmit COVID-19?
RS: It’s a lot easier to deal with outdoor sports. There’s certainly less risk there, when you’re in open air. It’s going to be a particular challenge as we get into basketball season, and as temperatures decrease and we move more indoors with things. That’s going to pose a different set of circumstances and challenges to deal with. Certainly, different sports can pose different issues as we move forward.
TW: Are there other safe ways that people can exercise? What about gyms? Are those safe right now?
RS: We’ve had a lot of patients come in from our general patient population that have gone back to their gyms and have done quite well. I think that most of the gyms have done a decent job of social distancing, cleaning equipment, enforcing masks where appropriate. I think, ultimately, it’s an individual decision. If you have a lower risk and it’s something you want to pursue, you feel comfortable at the gym you’re going to, I think it’s a reasonable thing to entertain. If that’s not the case for you, then I think there are other options at home and outdoors that you can pursue.
TW: What are some of the protections that gyms should implement?
RS: Frequent cleaning of their equipment is No. 1. Enforcing mask policies is the other. Also screening people as they come into the gym and making sure they’re not actively symptomatic. Those are some basic things that we’re all doing in different ways. And making sure they encourage clients to be courteous of other people is also important.
TW: In terms of screening, is just doing a temperature check enough?
RS: That’s part of it. I think also important that people say they’re not having symptoms, and so having a checklist of those symptoms that would be common for COVID-19 would be helpful as they come in.
TW: What are some of the common symptoms to look out for, for potential COVID-19?
RS: Certainly, respiratory symptoms are some of the main things, with cough and congestion and runny nose – a lot of the things you would get with typical cold viruses and other upper respiratory illnesses. The loss of taste and smell has been a really big one that has been specific to COVID. But you can also have gastrointestinal symptoms. You can have nausea and diarrhea and other GI-related issues that can be indicative of COVID as well.
TW: What about fatigue?
RS: Fatigue is a huge symptom and one that really affects people the most when they have COVID. They have no energy and a lot of body aches, very reminiscent of flu but on a different level. And as we go into the colder weather season, it’s hard to differentiate between those things (COVID and flu) based on symptoms alone.
TW: What kind of preventive measures might help with the upcoming flu season?
RS: One would expect that the mask mandate that we have would help with some of the (flu) transmission. I think handwashing remains a mainstay of preventing transmission. I think eating healthy, having a balanced diet and being nutritionally sound will keep your immune system functioning. I think regular exercise, as we’ve already talked about, has a positive impact on your immune system. So, being active is very important.
TW: What about flu shots?
RS: The flu vaccine is very important. With the flu vaccine, we’re not actually giving you the flu virus, it’s only part of it to stimulate an immune response. And usually when people feel the way they do after the flu shot it’s because of the immune response they’re getting to the vaccine. So, that means it’s working and doing what it’s supposed to do to stimulate a response to help you develop immunities so that you don’t get the flu.
TW: Going back to exercise, someone who doesn’t exercise, what would you recommend that they start out with?
RS: We’re all dealing with a lot, so I think it’s important to go back to your basics of what you enjoy, so that it can help you in terms of mental health, physical health and just your general wellbeing. I would tell people to find the thing they enjoy the most that has a physical activity related to it and start there. For some people, that’s walking. For some people, that’s cycling. For some people, that’s playing with their kids, playing with their pets. I think that’s where you start because we know that if you find something that’s enjoyable, you’re more likely to sustain that activity and do it over the long haul. And I think that’s where you begin – something easy and reasonable and that would be sustainable for you to do for years.
