Isolating yourself physically in order to avoid COVID-19 is necessary from an epidemiological standpoint, but for your overall health, it can be detrimental. As we have isolated ourselves at home, avoiding workplaces, gyms and even grocery stores, both the amount and variety of movement we engage in on a daily basis has, for most, decreased significantly.
The small muscles close to your spine, from your low back to your neck, weaken quickly when we spend a lot of time sitting with a backrest. When these muscles don’t stabilize the bones of your spine properly, then fatigue, pain and gradual degenerative changes follow. When bigger muscles remain underutilized, they shrink and weaken, too. But did you know that this not only leads to weakness, but also to problems regulating blood sugar, difficulties with balance, body composition and an increased risk for everything from dementia, cardiovascular disease and cancer?
Unfortunately, the individuals most vulnerable to a severe COVID-19 infection, the elderly and those with pre-existing conditions, also tend to be the ones suffering the most from this increased inactivity. In individuals with some beginning balance problems, loss of muscle and bone mass or general deconditioning, the “new normal” may be the last straw, predisposing them to a detrimental loss of function.
Others, while not at risk of potentially dangerous falls or loss of independent function, may be bothered by a loss of strength, unwelcome weight gain and increased aches and pains, or a worsening of already existing musculoskeletal complaints. Even our children are moving less than before, and certainly less than what is ideal.
Is there anything we can do to prevent these quarantine side effects, or should we count the loss of physical fitness as yet another COVID-related loss in a world that’s changed so much?
The answer, of course, is a resounding no. In March I wrote this post outlining the potential dangers of inactivity, offering a simple but reasonably comprehensive program to help readers prevent the deleterious effects of inactivity.
So how are we doing, almost a year into our new reality?
To their credit, most of my previously active patients have found some alternative way of staying active. However, now more than ever, variety is being sacrificed and our bodies suffer the consequences. The reason this matters is that physical activity, even as we point to it with a sweeping gesture and give it all one name, ‘exercise,’ is surprisingly specific in its effects. An online yoga class may offer an excuse to stand up and fold your body into a position different from sitting, which is great—we certainly need that variety—but it does nothing for your heart and surprisingly little for your other muscles. Perhaps you’ve bought a rowing machine or stationary bike? Good for you! Used correctly, these will offer benefits both to your cardiovascular system and even affect certain hormone levels in a beneficial way. But they will not allow you to move in a varied way, work on your balance and coordination, and strengthen your body uniformly, nor increase your stability.
A good place to start is a test for musculoskeletal risk factors to find out whether you have some specific areas of weakness to be aware of.
So what’s the solution?
It’s tempting to first reflect on what type of movement we enjoy and go for that, but this is bound to lead to an approach to exercise that offers benefits in some areas, while leaving you lacking in others. Having good enough balance to plod through the snow is no good if you’re not strong enough to do so. You may have the stamina to pedal fast on a stationary bike, but suffer from spinal pain due to weakness in crucial muscles. A better approach is to first reflect on our goals and challenges, and then reverse-engineer from there. Here’s how that works:
Let’s say you’re a 55-year old sedentary worker with some neck and low back pain. You used to enjoy a Zumba class once a week and go for walks. Now Zumba is no longer available, and when you’re done with work, which you perform seated by a computer all day, it is dark and uninviting outside, and you’ve been finding it hard to fit in some health-promoting activity in your day. To come up with the best overall solution for you, take a moment to reflect on your goals, challenges and resources, working like this:
Prevent weight-gain, achieve reasonable cardiovascular fitness (which also helps protect against serious COVID-19 complications), eliminate the neck and low back pain, maintain enough strength to be functional and comfortable with everyday activities. The good old “looking good naked,” increasing your energy levels, better sleep, decreased stress levels and improved mood are all laudable goals as well!
Pain in the neck and low back, need to work on the computer during the day, preferred physical activity no longer available, feel unsure about how to go about strengthening.
Financially able to purchase equipment, classes etc, motivation to feel better, able to structure the day more freely than at the office, and access to physical therapists, online classes, etc.
Now you have a more clear picture of your needs, and will be better able to choose activities that will help you meet your goals!
If laying it out like this doesn’t shed enough light on how to proceed, don’t overlook the benefits of discussing your situation and goals with your physical therapist and getting some solid professional advice.
Now let’s problem-solve! Your pain probably has a lot to do with the long hours spent sitting in the same position. This weakens the stabilizing musculature of your spine and leaves the spine unprotected. Your body’s tissues don’t like being held still, in the same end-range position, and this contributes to your discomfort through decreased oxygenation of muscles and overloading of ligaments. Your heart needs for you to be a bit out of breath (often referred to as “cardio” or cardiovascular exercise) on a regular basis, and your muscles and bones need strain, or resistance training in order to not atrophy and be replaced by fat tissue. Putting all this together, the plan might look like this:
Throughout the day:
Vary your position often. Alternate between sitting upright and leaning against the back rest, and between sitting and standing while you work. Take breaks to vary your position. You want to reverse the position you spend most of your time in: stretch hip flexors, straighten your spine, bend it backwards, raise your arms, rotate your trunk. You’ll find the most essential stretches here. Simple!
Work on your stability. When the stabilizing muscles don’t properly stabilize the small bones of your spine, fatigue, pain and gradual degenerative changes follow. Start here with a safe and effective, exercise for spinal stability. Simply sitting upright has also been shown to activate the spinal stabilization muscles throughout your spine, including your neck.
Three times a week:
Get your heart pumping. Go for a brisk walk, or for a run, jump rope, use machines (stationary bikes, rowing machines etc) or perform resistance training with enough weight and without breaks to leave you breathing heavily. A series of jumps is another great way to get some higher-intensity cardiovascular exercise. If you’d like to avoid the impact, whether to spare yourself or your neighbors, you can perform a brief HIIT (high-intensity interval training) body-weight training session that gives you cardiovascular exercise and strength training all in one!
Three times a week:
Make your muscles work. There's no need to purchase expensive, bulky equipment. Simple exercise bands offer the same resistance as weights do, and a lot of resistance training can be performed without any equipment at all. Squats, push-ups etc (see my pandemic training program for simple ideas) work very well, and should you want to add resistance you can get far with milk jugs, bags weighted down by books etc. Again, using your body weight is quite sufficient for basic strength.
A common mistake people make when considering strength training is picturing yourself holding a dumbbell in your hand, moving the arm to strengthen it. The lower body muscles are actually much more important, both functionally and for your overall health, so think more about squats, stepping up and down etc. Upper body muscles are also important, but knowing how to prioritize is step number one. And remember, stabilizing exercise was listed above overall strengthening! This is important in order to avoid injury and pain, both acute and long-term.
Remember, you don’t need to perform all your exercises at once. Body weight exercises are a great way to break up the physical monotony of sedentary work!
Balance and coordination. There are obvious reasons why balance and coordination are important, and safety is of course the number one reason. But poor coordination of movement also contributes to poor quality of movement, and thus to degenerative changes and injuries. Balancing on one leg is a simple way to start, and it can be progressed through adding a soft surface to stand on, closing your eyes, moving your arms or the opposite leg, etc. Tuning in to your body and the sensations in it while you perform your exercises is a simple way to gradually improve your sense of position. Get used to looking up instead of at the floor when you walk and exercise - we tend to compensate for loss of proprioception through our visual sense without even realizing it! Compare what you see in the mirror when you move with how it feels with your eyes closed. And as an example of the fact that your body is a system where one part depends on its integration into the whole, the stabilizing exercises for your spine are also very important for your ability to balance!
Now that you have a game plan it may be tempting to make a bold move and start doing it all at once. But big, dramatic changes tend to lead to a disappointing cycle of boom and bust. Consider, instead, starting small and building on previous successes through incremental additions. For the first week, commit to postural changes, using a reminder on your phone, or a free app such as Insight Timer. Set reminders to reverse and change your position at least every 50 minutes. Once this habits starts to feel familiar, add a 5-10 minute session of the stabilizing exercise. You can add a habit of performing simple balancing exercises (eg every time you visit the bathroom). Create an association with washing your hands (after all, we’re doing that more than ever these days) and balancing on one leg. Later, challenge yourself a bit more. Start adding cardiovascular exercise to your routine, and if you are short on time, remember that the 12 minute HIIT program offers both cardiovascular training and strengthening!
So, now that you are committed to a well-rounded exercises program, how will you benefit? Well, how about staying alive, for one? In a 2004 study being fit or active was associated with a greater than 50% reduction in risk of death from any cause and from cardiovascular disease. You will see a decreased risk of cancer, heart disease, pulmonary disease, hypertension, intermittent claudication, metabolic disorders such as diabetes, muscle, bone and joint diseases (rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, osteoporosis), osteoporosis, dementia, depression, anxiety, obesity, elevated LDL levels, frailty, and of course severe Covid-19-related illness. Your immune system benefits greatly form exercise, and the effects of exercise on our psychological well-being are so powerful that it’s been proposed that exercise may be considered as a psychoactive drug. So if you’ve been feeling a bit bummed out about the losses we’ve endured over the past year, you might want to try to add more, and varied, exercise to the mix. Your mood will improve, and over time, so will your physical health, energy and productivity.
Start where you are!
Does all this seem like a bit too much? Does just reading the list make you feel tired? If so, consider an important rule (that I've made up :-): Start where you are! Give yourself some time to create good habits, starting with regular postural changes. When you're ready, add some simple stabilizing exercises, and before you know if, you'll feel ready to add the rest.
While it’s hard to make up for the loss of social interaction, limits on travel, eating out and visiting movie theaters and museums, we can choose to make the best of the situation and, when it’s safe to do so, emerge from our long quarantine in even better physical shape than before.