The case for promoting physical activity amidst the COVID-19 pandemic. An update.

This manuscript provides further data that support the previously published perspective.

The coronavirus disease-2019 (COVID-19) pandemic has reportedly resulted in 2.7 million deaths worldwide. The aforementioned manuscript provided an informed perspective on the factors that increase morbidity and mortality due to COVID-19. This perspective presented data to propose that people of older age are not of increased risk of death due to COVID-19 if they are generally fit and healthy. It also presented evidence showing that very fit individuals, such as elite athletes, do not experience any serious long-term adverse outcomes, such as a decline in lung capacity, nervous system function and mental or physical performance.

Further data accumulated during the three months following publication of this perspective that strongly support these hypotheses. The number of healthy supercentenarians that have recovered from COVID-19 infections keeps increasing. The oldest survivor of COVID-19, who is currently the second oldest living person in the world, survived the infection just a few days before her 117th birthday. As previously discussed, these older survivors do not phenotypically manifest signs of metabolic syndrome, as their BMI appears to be within the normal range. Additionally, more elite athletes have successfully recovered from COVID-19 infections and have continued to excel in their sport.

An early meta-analysis described an increased risk of mortality for overweight (BMI > 25.0 kg m−2) people with COVID-19. It was thus proposed that obesity and its associated comorbidities, such as diabetes, hypertension and cardiovascular disease may be better predictors of adverse outcomes for COVID-19 infections, than the ageing-associated immunosenescence. Indeed, the latest data (March 2021) from the Centers for Disease Control and Prevention (CDC) identify that nearly 80% of the hospitalised patients with COVID-19 in the US are overweight (28.3%) or obese (50.8%). An analysis of the COVID-19 mortality data by the World Obesity Federation, also published in March 2021, demonstrated a “dramatic correlation” between death and obesity rates, confirming the hypothesis presented previously that obesity is the driver of the global death toll due to COVID-19.

The possible mechanism for obesity mediating adverse outcomes in people with COVID-19 was previously described. Briefly, a chronic state of low-grade systemic inflammation that characterises obesity, an increased abundance of ACE2 receptors in the adipose tissue, and the development of insulin resistance due to visceral adipose tissue inflammation, may mediate adverse outcomes.

The COVID-19 pandemic has presented a unique opportunity to raise awareness on the importance of leading a healthy lifestyle to reduce morbidity and mortality and to increase lifespan and improve quality of life. In addition to the data on increased morbidity and mortality in overweight people, it appears that the greatly sought solution – vaccination – may not work as effectively in this population, that needs it the most. A recent study, currently under review, demonstrated reduced immunogenicity in obese people with COVID-19, with the vaccine stimulating production of half the amount of antibodies in these people. Moreover, the increasing obesity prevalence also poses an opportunity for the emergence of more potent communicable agents, as it has been demonstrated that the chance of more virulent strains is increased in obese populations due to prolonged viral shedding that may increase the overall mortality rate. Considering the rising prevalence of overweight and obesity, with nearly one-third of the global population being overweight, the population will remain at large prone to all the chronic and other communicable risk factors if emphasis is not placed on treating the underlying cause for most of the global morbidity and mortality.

It is the author’s recommendation that health authorities and governments implement strong initiatives to promote physical activity and to educate the population on leading a healthier lifestyle. In addition to facilitating a favourable body composition, physical activity also mediates a healthier fat distribution that lowers the risk of adverse cardiometabolic outcomes even in people with same total body fat, but different distribution.

Lifestyle modifications often encounter barriers to implementation. As the saying goes, “one can only lead a horse to water, they cannot make it drink”. However, given the accumulating evidence on obesity driving adverse outcomes for both chronic and communicable diseases, it is time to invest on educating the public on the paramount importance of adopting a healthy lifestyle.

Funding

None.