All this week, in exclusive extracts from his new book Covid-19, Dr MICHAEL MOSLEY has been explaining how to stay one step ahead of the virus as lockdown eases.
Today, in the last of his unmissable pullouts, he explains why exercise is so important.
Not only will it aid weight loss, a regular fitness routine will bolster your immunity to leave you fighting fit.
Even if you aren’t a high-risk candidate, regular exercise could increase your chances of minimal symptoms and a short illness if you do get the virus, writes Dr Michael Mosley
As the picture of how Covid-19 affects the human body becomes clearer, we are finding that one of the best ways to prepare ourselves to fight off the virus is to be as healthy as possible to begin with.
That means eating a nutritious diet, losing excess weight, sleeping well and keeping fit.
Many people have taken advantage of the extra time in lockdown (and, let’s face it, a desperate urge to get out of the house) to establish great new exercise habits. But others might be finding that the closure of gyms and sports centres and the pause put on most team sports have seriously curtailed their levels of activity.
Perhaps you’ve always been allergic to sport and you’re still fighting shy of incorporating exercise into your life?
Whatever your situation, it is important to know that daily exercise is vitally important for bolstering your immune system and today, in the final part of this week’s series based on my new book Covid-19, I will explain why you need to get more active.
The great news is you don’t need to start training for a marathon or invest in head-to-toe Lycra to reap the benefits.
You can start by simply aiming to stand more. Sitting continually is almost as bad for your health — and your immune system — as smoking.
The first and easiest thing you can do is to stand every 30 minutes. So, set your phone or get an app with an alarm to remind you to move — every half an hour. If you watch a lot of TV, go for a stroll during the advert breaks.
Or keep the control beside the TV, so you have to get up to change channels. Make a point of standing when talking on the phone (you also burn more calories and sound more assertive).
As the picture of how Covid-19 affects the human body becomes clearer, we are finding that one of the best ways to prepare ourselves to fight off the virus is to be as healthy as possible to begin with [File photo]
Next? Get walking. Walking is a cheap, safe way to exercise and researchers at the University of California San Diego School of Medicine in the U.S. found a brisk 20-minutes three times a week is enough to have a positive effect, reducing levels of a natural chemical in the body which drives inflammation. It is also enough to boost levels of a powerful disease-fighting antioxidant known as extracellular superoxide dismutase.
The best time to do it, if you can fit it into your life, is first thing in the morning, before breakfast. That way you not only manage to rev up your metabolism but also get exposed to early-morning light which helps reset your internal clock. This in turn will help you to sleep better at night.
Not only is exercise so good for you, it makes you feel great when you’ve done it — and everyone can start somewhere
If you are heading somewhere — work or school perhaps — that is less than a mile away, why not walk there? And once you’ve got the walking bit mastered, try to add running or cycling to your regime.
Using muscles during exercise has an anti-inflammatory effect and helps immune cells called neutrophils get to an infection site more quickly.
Exercise also encourages the body to manufacture immune cells called macrophages — ‘guard’ cells that patrol the body for signs of attack — so we are better able to control infection. Boosting circulation allows the immune cells to travel through the body more effectively, too.
Among those at higher risk of coronavirus are people who are obese or have raised blood pressure, and making time for more physical activity will certainly help reduce the risk.
Exercise is great for all aspects of your health and key in the quest to maintain a sensible weight, and it is very important to bear in mind right now that these measurable chemical changes could help reduce your risk of acute respiratory distress syndrome (ARDS) — a major cause of death in patients with Covid-19.
Even if you aren’t a high-risk candidate, regular exercise could increase your chances of minimal symptoms and a short illness if you do get the virus.
A new study published in the British Journal of Sports Medicine found that people who exercise five or more days a week spend 46 per cent fewer days laid up with a cold or respiratory virus compared to those who work out only once a week or not at all.
Any exercise that gets your heart rate up seems to be able to turn back the clock of the immune system.
Usefully, in these worrying times, it’s good to know that exercise is also a great stress-buster and it can improve a flat mood by pumping up production of your brain’s feel-good neuro-transmitters and endorphins too.
But what you might not realise, is how important it is to get a decent mix of different types of exercise.
I hate the gym, so I have found ways to make myself do what I need to do to keep myself healthy and happy, to sleep better and also keep my brain in decent condition.
I go for a 30-minute walk or run in nearby fields most mornings. This is partly to get my heart racing, but also so I can get in plenty of early-morning light and get my immune system in to shape.
As well as running, walking and some cycling, I also do strength exercises, such as press-ups and squats.
I make myself do this EVERY DAY because I’ve seen so much research about the health benefits it brings.
I’m concerned that my age (63) and gender put me at increased risk of covid complications and I want to give my immune system the best possible chance of mounting a proper attack in the face of viruses like these.
Not only is exercise so good for you, it makes you feel great when you’ve done it — and everyone can start somewhere.
Get out on two wheels
Consider buying a bike and cycling whenever you can. It’s great exercise and useful because it is vital to make some form of physical activity a non-negotiable part of your day, every single day of the year.
As well as looking after your heart and lungs, you need to look after your muscles, which begin to weaken after the age of 30.
Muscles do look good on the beach but, more importantly, they burn calories even when you are sleeping and they improve your insulin sensitivity.
This in turn reduces your risk of the complications that can result from a bout of Covid-19.
As well as looking after your heart and lungs, you need to look after your muscles, which begin to weaken after the age of 30 [File photo]
Short bursts of exercise are best
Studies show that just a few short bursts of intense physical activity can be powerfully effective. In fact, just a couple of minutes of HIIT (high intensity interval training) a week is enough to give your body a significant boost.
However, HIIT isn’t for everyone. If you are on medication, are injured or have concerns about your heart, you should consult your doctor before starting any exercise regime.
Studies show that just a few short bursts of intense physical activity can be powerfully effective
There is always the risk that you will pull something (earlier this year I tore my Achilles tendon while running) and studies on mice suggest that a sudden increase in exercise intensity and volume can have a transient negative effect on the immune system.
However, if you’re up for it, HIIT offers most of the major benefits of exercise in a short sharp burst, which is over mercifully quickly.
I first came across HIIT a few years ago while making a television documentary for the BBC called The Truth About Exercise.
I was told that a few minutes a week of intense cycling would greatly improve my aerobic fitness and my blood sugar control (which, as we know, is very important if you want to avoid the extreme symptoms of Covid-19). The regimen I was asked to undertake consisted of three 20-second bursts of vigorous exercise on an exercise bike, three times a week.
In just six weeks my insulin sensitivity improved by more than 20 per cent.
Since then, studies have shown that as little as two minutes of HIIT every week will give your body a significant boost — the equivalent to running at a decent pace for 45 minutes three times every week.
Although it is simplest to complete an HIIT session on an exercise bike, you could consider swapping cycling for running up stairs for 20 seconds or putting in short, flat-out sprints while you are jogging.
Start off with a couple of minutes of gentle cycling or jogging to warm up before embarking on the HIIT.
When you feel ready, speed up and work your body as hard as you can for ten or 20 seconds, before slowing down again.
Repeat the sprint after you’ve had a couple of minutes of gentle pedalling/jogging/walking to recover.
Recovery time is important.
6 exercises to build strength
The best way to preserve your muscles is with weight-training or resistance exercises.
I have a simple regime, which I carry out most mornings. I get out of bed, put the radio on and do a series of push-ups, squats, abdominal crunches, the bicep curl and plank — in roughly that order.
There are many other variants to try, but these are the basics. Start with ten press-ups, ten crunches, ten squats and a 20-second plank hold, three times in the first week, building to two sets of ten repeats (and a longer plank hold) by week two, and three sets by week four.
The best way to preserve your muscles is with weight-training or resistance exercises
Push-ups: Lie face down with the palms of your hands under your shoulders and the balls of your feet touching the ground. Keep your body straight. Lower your body till your elbows form a right angle with the floor and then push up. If you find this too hard, do it with your knees on the ground.
Squats: Stand with your feet apart. Bend from the hips, keeping the weight in your heels. Make sure your back is straight. Keep bending until your legs are at right angles to the floor — imagine you are preparing to sit in a chair. Push back up without bending your back. Squats work the biggest muscles in your body. Make this harder by using weights.
Plank: Lie face down on the floor and then raise yourself on to your forearms and toes so that your body forms a straight line from head to toe. Make sure your mid-section doesn’t rise or drop. Squeeze your buttocks and hold the position for as long as possible. Remember, it should never cause pain in the lower back.
Crunches: Lie on your back with your knees bent, your feet flat on the floor and your hands by the sides of your head. Curl up your upper body without lifting your lower back off the floor. Make sure your chin is tucked in towards your chest. When your shoulders and upper back are lifted off the floor, curl back down.
Lunges: Stand with your back straight and your feet shoulder-width apart. Step forward with one leg, bending both knees to right angles and keeping your upper body straight. Pull back to the starting position and repeat, putting the other leg forward.
Triceps dips: Stand with your back to a bench or chair. Place your palms on the seat behind you, bending your knees to right angles, hips straight. Bend your elbows to right angles to lower your body so that your bottom descends halfway to the floor. Push yourself back up using only your arms.
Learn to calm your mind to help heal your body
There’s no doubt these are horribly stressful times and it probably doesn’t help when I say that chronic stress has a direct and damaging effect on the immune system.
The problem is that stress can boost levels of the hormone cortisol, which worsens chronic inflammation throughout the body. It also reduces the number of white blood cell (lymphocytes) your immune system uses to help fight off infection.
Fortunately, all the lifestyle changes I’ve outlined this week from losing weight, adopting a Mediterranean-based diet and boosting your population of ‘good’ gut bacteria, to getting great sleep will help to reduce your stress levels.
But there are other great research-backed steps you can take to reduce stress, and in so doing, lift a little pressure from your embattled immune system.
Don’t dwell on the thoughts, simply notice them and let them drift away, like leaves on a stream. The art of mindfulness is to keep doing this, but for progressively longer periods. If you can manage ten minutes daily you will be doing well. Twenty minutes is better still!
Routine is really important for mental health. If you don’t have structure to your day, it’s very easy to get sucked into spending too much time listening to the news or following the latest developments online, which isn’t healthy.
Each day, my wife Clare and I follow a routine of getting up about 7am, similar to our pre-lockdown routine. We run through a series of strength-building exercises, such as press-ups and squats, and then we ease ourselves into a regular daily mindfulness meditation.
Being at home and worrying about work or health is very stressful. This is why we eat a Mediterranean-style diet (which has been shown in numerous trials to reduce anxiety and depression) and why we also spend about 15 minutes a day practising mindfulness.
Mindfulness isn’t weird or spooky, it is just a question of building awareness and achieving a state of calm. This is what I do: Sit up straight, close your eyes and bring your attention to your breath, focusing on your chest rising and your lungs filling as your breath moves in and out of your body.
No need to slow it down or speed it up. If you notice that your mind has wandered, which it will, return to focus on your breathing.
Don’t dwell on the thoughts, simply notice them and let them drift away, like leaves on a stream.
The art of mindfulness is to keep doing this, but for progressively longer periods. If you can manage ten minutes daily you will be doing well. Twenty minutes is better still!
If I’m particularly stressed, or worrying too much for my brain to switch off at night, I’ll also do a bit of deep breathing.
Breathing exercises have been shown to reduce stress by activating the parasympathetic system (the rest and digest part of your autonomic nervous system) which causes your heart to slow and your blood pressure to drop.
These are my favourite exercises
1. Simple deep breathing: start by inhaling slowly and deeply through the nose — allowing the air to really fill your lungs.
Put a hand on your belly — you should feel it inflate. Hold it for a count of two, then breathe out slowly through your mouth.
The first few times you do this, it will feel unnatural, so you need to practise during the daytime. You will notice that as you do this, your heart rate will slow and you will start to feel more relaxed.
2. ‘4-2-4 breathing’: breathe in deeply through your nose while mentally counting to four. Hold your breath to a count of two, then breathe out through your mouth to a count of four.
3. Alternate-nostril breathing: breathe out through your mouth, then use your right thumb to close the right nostril. Breathe in deeply through your left nostril to a count of four. Really fill your belly. Now switch sides. Block your left nostril with the left thumb and breathe out fully to a count of four. Repeat ten times.
If your stress levels are compounded by a neverending stream of irrational thoughts about whether you or someone you love might catch the virus and end up in hospital, the fear can be very damaging.
It’s good to be risk-aware, and try to ensure your family’s safety, but over-worrying only makes things worse.
This is a classic night-time activity, and can badly interfere with your sleep.
Sometimes it helps to tell yourself that your catastrophic predictions are not real. If they return again and again, you could try giving your negative thoughts a name, like ‘Donald’. So when you have them you can say: ‘That is just Donald sounding off again.’ Doing this sounds crazy, but the science shows it does work.
Another way of approaching your catastrophic or negative thoughts is by imagining what a sympathetic friend would say if you were to share them. What would they say? How would they help to ground you?
It is also important to realise that at night your filters are down, and you are more vulnerable to inner demons, so any thoughts you might have at night will inevitably be less rooted in reality than the negative thoughts you have during the day.
If you get a good night’s sleep, things really will seem better in the morning.
Long road back to normality
One thing that I find hard to accept, emotionally, is that we are just at the start of this crisis.
Death rates in many countries are falling, but rising in others.
New Zealand and Iceland have managed to control the virus by cutting themselves off, but it is hard to see others doing so, long term.
Passengers are seen social distancing and wearing face masks in an airport shuttle bus in Rome, Italy. One thing that I find hard to accept, emotionally, is that we are just at the start of this crisis
Until there is a vaccine we must find ways to live with the virus. One way, for nations which can afford it, is to follow the example of South Korea.
That means social distancing, wearing masks in public, testing and tracking. The last two mean that people who get infected can be detected, isolated and treated before they spread it to others.
Once there are reliable antibody tests we may also see immunity passports. These would be digital documents, probably stored on your phone, which prove you have been infected, and so immune.
People with these passports would be allowed to return to work and a relatively normal daily life. But the documents would be open to fraud and some who test negative might be tempted to become infected just to get one.
In the future we may have to use a ‘lift, suppress, lift’ approach to social distancing.
More children will return to school, universities will reopen and restrictions on social gatherings will be relaxed.
But once there are signs the virus is spreading again, on will go the brakes.
Adapted by Louise Atkinson from Covid-19, What You Need To Know About The Coronavirus And The Race For The Vaccine by Dr Michael Mosley, published by Short Books at £6.99
The uncertainty will be very damaging to the economy.
I would love to see this virus burn out as others have, but I think that is unlikely. Covid-19 is already too well established. Unless we get a vaccine, Covid-19, like the influenza virus, is likely be with us for a long, long time.
It could mutate into a less dangerous form so fewer people die of it, as happened with swine flu in 2009. But I wouldn’t be sure.
So, hugs, handshakes, and large social gatherings are likely to be off the menu for a long time. People are already anxious about going outside and socialising.
What will happen to elderly people, like my mother? How can we keep them safe without them remaining physically isolated?
It will be a long road back to normality.
But if you are an optimist, as I am, you must hope the pandemic brings out the best in us and spurs the world into dealing with new crises more effectively.
Adapted by Louise Atkinson from Covid-19, What You Need To Know About The Coronavirus And The Race For The Vaccine by Dr Michael Mosley, published by Short Books at £6.99.
© 2020 Michael Mosley