Prehabilitation could save lives in a pandemicBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1386 (Published 06 April 2020) Cite this as: BMJ 2020;369:m1386
All rapid responses
Re: Prehabilitation could save lives in a pandemic: Health promotion in the COVID-19 pandemic: Role of global and national health agencies?
In the current unprecedented social distancing and lockdown situation of the populations due to COVID-19 pandemic, Silver aptly highlighted the various possible telemedicine strategies of prehabilitation.1 Any measure which promotes physical and mental health and may prevent occurrence of COVID-19 infection or its progression to complications require attention. However the information the health professionals are trying hard to provide may get lost in the midst of floods of COVID-19 updates and their interpretations and advice. The information and guidelines provided by the global and national health agencies, in contrast, are likely to be well covered by the news and social media and received by the people who are literally house-bound with resultant physical inactivity, lack of work, financial hardship, anxiety, or depression. The global and national health agencies are, as such, expected to provide guidelines useful in the daily activities of the people. For example:
1. Physical activity and exercise: Physical activity and exercise have numerous health benefits. The relevant ones to note in the current COVID-19 pandemic are cardiopulmonary conditioning, immune function improvement, prevention of anxiety and depression, and glucose control.2 Exercise also promotes protection against diseases.3 Various physical activities and exercises may be possible even within the limited space at home. Exercise and dance while watching videos can be done by the family together increasing also the familial bond.
2. Smoking: Active and passive smoking both are well known to increase the risk of respiratory illnesses among children and adult. Smoking cessation is a part of the prehabilitation programme in the presurgical protocol.1
3. Alcohol: Apart from the many other health hazards, alcohol also increases the risk of pneumonia by several possible mechanisms including increased risk of aspiration of microbes and diminished pulmonary defense against infection.4 Such risk may be more so in the presence of upper respiratory tract infection. Confusing with the use of alcohol in the sanitizers, the use of which are regularly emphasized by the global and national health agencies, people may also justify or consider consumption of alcohol, or even methyl alcohol,5 to prevent COVID-19 infection.
4. Water intake: Water is essential for normal functioning of various body systems and organs. Its requirement is increased with physical activity and exercise.6
5. Sleep: Sleep affects various immune parameters, is associated with a reduced infection risk, and can improve infection outcome.7
Studies of the people following various lifestyles and of the patients with severe complications due to COVID-19 infections may also help to identify such and other protective or exacerbating factors.
1. Silver JK. Prehabilitation could save lives in a pandemic. BMJ, 2020; 369: m1386. doi: 10.1136/bmj.m1386.
2. McKinney J, Lithwick DJ, Morrison BN, et al. The health benefits of physical activity and cardiorespiratory fitness. BC Med J 2016; 58: 131–7.
3. Terra R, Gonçalves da Silva SA, Pinto VS, Dutra PML. Effect of exercise on the immune system: response, adaptation and cell signaling. Rev Bras Med Esporte 2012; 18: 208–14. doi: 10.1590/S1517-86922012000300015.
4. Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open 2018; 8: e022344. doi: 10.1136/bmjopen-2018-022344.
5. Gambrell J, Karimi N. Nearly 500 people dead in Iran after drinking methanol to fight off COVID-19. The Associated Press March 27, 2020. https://www.ctvnews.ca/health/nearly-500-people-dead-in-iran-after-drink.... Accessed April 18, 2020.
6. Popkin BM, D’Anci KE, Rosenberg IH. Water, Hydration, and Health. Nutr Rev 2010; 68: 439–58. doi: 10.1111/j.1753-4887.2010.00304.x.
7. Besedovsky L, Lange XT, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev 2019; 99: 1325–80. doi: 10.1152/physrev.00010.2018.
Competing interests: No competing interests