The arrival of the Novel Coronavirus quickly became a pandemic. Shortages of medical resources like personal protective equipment (PPE) for healthcare personnel and ventilators for hospitalized patients took an unprecedented toll on lives.

Now, as I write this in early June, the U.S. is gradually reopening after months of lockdown. I look back from this vantage point and find myself wondering, “Could any of those deaths have been avoided?”

How COVID-19 can become lethal

Thankfully, the majority of those who tested positive or were hospitalized have survived. For those who did not, it was primarily due to a known vulnerability or severe complications. In particular, a condition called Acute Respiratory Distress Syndrome, or ARDS, turns COVID-19 into a killer. ARDS comes on rapidly, resulting from illnesses like COVID-19, blood infection, severe pneumonia, etc.

In ARDS, normal lung mechanisms that oxygenate circulating blood are damaged. In healthy lungs, a thin protective membrane keeps the smallest blood vessels from leaking fluid into the very small air sacs that oxygenate blood. If the membrane is compromised by severe disease, fluid seeps into the air sacs and destroys their ability to function. As the heart pumps the now-depleted blood out to the rest of the body, the lack of oxygen causes cell death in tissues. It’s like suffocating every body part. This is why ventilators are used to try to raise a patient’s oxygen levels. The statistics are grim: the U.S. Centers for Disease Control estimated that 20-42% of hospitalized COVID-19 patients developed ARDS. While the exact mortality rate for those placed on ventilators is still not known, estimates ranged from 25-70%. Among the those over 80, the rate was 80%. Again, I ask myself if any of these were preventable.

A new study suggests aerobic exercise may save lives

A new study out of the University of Virginia offers one answer. Newsweek’s report was titled, STUDY SUGGESTS REGULAR EXERCISE CAN PREVENT CORONAVIRUS PATIENTS FROM DEVELOPING SEVERE COMPLICATIONS.^[i]

The study is co-authored by two researchers at the U. of Virginia School of Medicine, Zhen Yan and Hannah R. Spaulding.^[ii] Their paper concerns a powerful antioxidant called extracellular superoxide dismutase (EcSOD) that is produced in the body and has the ability to neutralize free radicals. We’ve all heard that free radicals cause damage, but exactly how does this happen? Well, it’s a little like rust that corrodes metal through a process called oxidation. Free radicals also call oxidation in the body; they are unstable atoms or molecules that “steal” electrons from parts of cells: DNA, necessary proteins, or even the membranes that hold the cell together. Just as a car body can rust, the human body can “rust” into a state of accelerated aging or disease. However, when free radicals are neutralized by substances that cancel out oxidation, i.e. antioxidants, body tissues remain in good working order.

Through their research, Yan and Spaulding established the following observations:

• EcSOD has a unique binding capacity to cell surface and its immediate environment
• When its activity is enhanced, it appears to prevent oxidative stress and damage (“rusting”) that occur in a variety of disease processes
• Endurance exercise appears to promote EcSOD expression in skeletal muscle, the largest organ in our body, leading to elevated levels of EcSOD in other peripheral organs.^[iii] In other words, pushing your body’s arms and legs into sustained aerobic exercise helps produce and distribute this powerful, natural antioxidant with its protective properties.

With regard to COVID, it boils down to this: As ARDS progresses, a cascade of events leads to a sort of immune system backfire, in which an excess of harmful free radicals and inflammatory factors rapidly accumulate and increase injury to lung tissues. Experiments with mice have demonstrated that the ones who are induced into an acute lack of EcSOD have a dramatic increase in mortality rates, whereas mice exposed to exercise training/therapeutic exercise to enhance EcSOD expression in skeletal muscle have much less lung damage and better survival rates.

The authors write, “These findings strongly support that enhanced EcSOD expression from skeletal muscle or other tissues/organ, which can be redistributed to the lung tissue, could be a viable preventative/therapeutic measure in reducing the risk and severity of …ARDS.”^[iv] Specifically, they suggest considering regular exercise (weight-bearing to increase muscle mass, sustained aerobics to generate and distribute EcSOD) as preventive measures against severe ARDS due to COVID-19, and even EcSOD gene/protein therapy as a potentially effective treatment for those suffering active ARDS.

An answer to my question… and more

So, did I get my question answered? Indirectly, I did. If the Yan study is on the mark, some deaths due to COVID-induced ARDS may indeed be prevented by committing to regular aerobic exercise, and nature’s own antioxidant. It remains to be seen if a significant number of recoveries can be tracked and linked with regular aerobic workouts. With the gradual reopening of gyms, and the summer season at hand, it’s time to figure out a safe way to get back into a workout routine you may have neglected during the period of home sheltering. And if you don’t feel safe to head out to exercise, Yan notes that 30 minutes of daily moderate exercise can be done at home, offering the same health benefits as one might expect at a health club or workout class.^[v]

In addition to the potential survival advantage that working out may offer by reducing the severity of ARDS, there are so many other reasons why exercise should be a lifelong habit. I have previously written about the ability of exercise to maintain heart health and cellular longevity. I also wrote an earlier blog about the way in which intense exercise may offer a protective anti-inflammatory function against cancer. In line with my own specialty, I was particularly interested in a new international clinical study being launched out of Australia, and which will include research teams in the U.S., Canada, Ireland and the UK. Entitled “Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol”, it is designed to enroll 866 patients with advanced prostate cancer.^[vi] It builds on previous evidence that exercise has a direct impact on cancer progression as well as helping patients tolerate therapies and reduce the side effects of chemotherapy, etc. Its underlying theory is that exercise itself will act like a drug, altering gene expression and other biochemistry for favorable results. The goal is to extend overall survival.

Similarly, another Australian study is recruiting patients with low-grade prostate cancer who are on Active Surveillance to determine if exercise can delay the transition to definitive treatment.^[vii] The study is designed for 168 participants randomly assigned to either an exercise group or usual care group. The authors propose that exercise has the therapeutic potential to safely extend time on AS.

Both of these trials are valuable because they are controlled and randomized, which elevates the level of authoritative research into the relationship between exercise and its capacity to protect and boost physical, mental, emotional and psychological wellness. The more we unlock the body’s secrets, the more we realize that while we didn’t control which genes we were born with, or a viral pandemic, we can control the choices we make to live as long and healthy a life as possible.

Let’s go beyond survive, let’s thrive.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Impelli, Matthew. “Study Suggests Regular Exercise Can Prevent Coronavirus Patients From Developing Severe Complications.” Newsweek, April 17, 2020. https://www.newsweek.com/study-suggests-regular-exercise-can-prevent-coronavirus-patients-developing-severe-complications-1498672
[ii] Yan Z, Spaulding HR. Extracellular superoxide dismutase, a molecular transducer of health benefits of exercise. Redox Biol. 2020 May; 32: 101508.
[iii] Ibid.
[iv] Ibid.
[v] Impelli, Ibid.
[vi] Newton RU, Kenfield SA, Hart NH, Chan JM et al. Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol. BMJ Open. 2018 May 14;8(5):e022899.
[vii] Galvão DA, Hayne D, Frydenberg M, Chambers SK et al. Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial. BMJ Open. 2018 Apr 20;8(4):e022331.