PHYSIOLOGY.ORG
Skip main navigation
Close Drawer MenuOpen Drawer Menu
PerspectivesIntegrative Cardiovascular Physiology and Pathophysiology

Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease

Published Online:20 May 2020https://doi.org/10.1152/ajpheart.00268.2020

Abstract

Emerging data indicate a substantial decrease in global physical activity levels during the period of social isolation adopted worldwide to contain the spread of the coronavirus disease 2019 (COVID-19). Confinement-induced decreases in physical activity levels and increases in sedentary behavior may provoke a rapid deterioration of cardiovascular health and premature deaths among populations with increased cardiovascular risk. Even short-term (1–4 wk) inactivity has been linked with detrimental effects in cardiovascular function and structure and increased cardiovascular risk factors. In this unprecedented and critical scenario, home-based physical activity programs arise as a clinically relevant intervention to promote health benefits to cardiac patients. Many studies have demonstrated the feasibility, safety, and efficacy of different models of home-based exercise programs in the primary and secondary prevention of cardiovascular diseases and major cardiovascular events among different populations. This body of knowledge can inform evidence-based policies to be urgently implemented to counteract the impact of increased physical inactivity and sedentary behavior during the COVID-19 outbreak, thereby alleviating the global burden of cardiovascular disease.

REFERENCES

  • 1. Arries EJ, Maposa S. Cardiovascular risk factors among prisoners: an integrative review. J Forensic Nurs 9: 52–64, 2013. doi:10.1097/JFN.0b013e31827a59ef.
    Crossref | PubMed | ISIGoogle Scholar
  • 2. Avila A, Claes J, Goetschalckx K, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based rehabilitation with telemonitoring guidance for patients with coronary artery disease (short-term results of the TRiCH Study): randomized controlled trial. J Med Internet Res 20: e225, 2018. doi:10.2196/jmir.9943.
    Crossref | PubMed | ISIGoogle Scholar
  • 3. Batalik L, Dosbaba F, Hartman M, Batalikova K, Spinar J. Benefits and effectiveness of using a wrist heart rate monitor as a telerehabilitation device in cardiac patients: a randomized controlled trial. Medicine (Baltimore) 99: e19556, 2020. doi:10.1097/MD.0000000000019556.
    Crossref | PubMed | ISIGoogle Scholar
  • 4. Bederman IR, Lai N, Shuster J, Henderson L, Ewart S, Cabrera ME. Chronic hindlimb suspension unloading markedly decreases turnover rates of skeletal and cardiac muscle proteins and adipose tissue triglycerides. J Appl Physiol (1985) 119: 16–26, 2015. doi:10.1152/japplphysiol.00004.2014.
    Link | ISIGoogle Scholar
  • 5. Belavý DL, Gast U, Daumer M, Fomina E, Rawer R, Schießl H, Schneider S, Schubert H, Soaz C, Felsenberg D. Progressive adaptation in physical activity and neuromuscular performance during 520d confinement. PLoS One 8: e60090, 2013. doi:10.1371/journal.pone.0060090.
    Crossref | PubMed | ISIGoogle Scholar
  • 6. Biensø RS, Ringholm S, Kiilerich K, Aachmann-Andersen NJ, Krogh-Madsen R, Guerra B, Plomgaard P, van Hall G, Treebak JT, Saltin B, Lundby C, Calbet JA, Pilegaard H, Wojtaszewski JFP. GLUT4 and glycogen synthase are key players in bed rest-induced insulin resistance. Diabetes 61: 1090–1099, 2012. doi:10.2337/db11-0884.
    Crossref | PubMed | ISIGoogle Scholar
  • 7. Borges JP, Mediano MF, Farinatti P, Coelho MP, Nascimento PM, Lopes GO, Kopiler DA, Tibiriçá E. The effects of unsupervised home-based exercise upon functional capacity after 6 months of discharge from cardiac rehabilitation: a retrospective observational study. J Phys Act Health 13: 1230–1235, 2016. doi:10.1123/jpah.2016-0058.
    Crossref | PubMed | ISIGoogle Scholar
  • 8. Boyle LJ, Credeur DP, Jenkins NT, Padilla J, Leidy HJ, Thyfault JP, Fadel PJ. Impact of reduced daily physical activity on conduit artery flow-mediated dilation and circulating endothelial microparticles. J Appl Physiol (1985) 115: 1519–1525, 2013. doi:10.1152/japplphysiol.00837.2013.
    Link | ISIGoogle Scholar
  • 9. Carter S, Hartman Y, Holder S, Thijssen DH, Hopkins ND. Sedentary behavior and cardiovascular disease risk: mediating mechanisms. Exerc Sport Sci Rev 45: 80–86, 2017. doi:10.1249/JES.0000000000000106.
    Crossref | PubMed | ISIGoogle Scholar
  • 10. Carter SE, Draijer R, Holder SM, Thijssen DHJ, Hopkins ND. The effect of breaking up prolonged sitting on cerebral blood flow. Med Sci Sports Exerc 48: 311, 2016. doi:10.1249/01.mss.0000485937.04381.e7.
    Crossref | ISIGoogle Scholar
  • 11. Demiot C, Dignat-George F, Fortrat JO, Sabatier F, Gharib C, Larina I, Gauquelin-Koch G, Hughson R, Custaud MA. WISE 2005: chronic bed rest impairs microcirculatory endothelium in women. Am J Physiol Heart Circ Physiol 293: H3159–H3164, 2007. doi:10.1152/ajpheart.00591.2007.
    Link | ISIGoogle Scholar
  • 12. Dempsey PC, Sacre JW, Larsen RN, Straznicky NE, Sethi P, Cohen ND, Cerin E, Lambert GW, Owen N, Kingwell BA, Dunstan DW. Interrupting prolonged sitting with brief bouts of light walking or simple resistance activities reduces resting blood pressure and plasma noradrenaline in type 2 diabetes. J Hypertens 34: 2376–2382, 2016. doi:10.1097/HJH.0000000000001101.
    Crossref | PubMed | ISIGoogle Scholar
  • 13. Dohrn IM, Kwak L, Oja P, Sjöström M, Hagströmer M. Replacing sedentary time with physical activity: a 15-year follow-up of mortality in a national cohort. Clin Epidemiol 10: 179–186, 2018. doi:10.2147/CLEP.S151613.
    Crossref | PubMed | ISIGoogle Scholar
  • 14. Duvivier BM, Schaper NC, Hesselink MK, van Kan L, Stienen N, Winkens B, Koster A, Savelberg HH. Breaking sitting with light activities vs structured exercise: a randomised crossover study demonstrating benefits for glycaemic control and insulin sensitivity in type 2 diabetes. Diabetologia 60: 490–498, 2017. doi:10.1007/s00125-016-4161-7.
    Crossref | PubMed | ISIGoogle Scholar
  • 15. English C, Healy GN, Olds T, Parfitt G, Borkoles E, Coates A, Kramer S, Bernhardt J. Reducing sitting time after stroke: A phase ii safety and feasibility randomized controlled trial. Arch Phys Med Rehabil 97: 273–280, 2016. doi:10.1016/j.apmr.2015.10.094.
    Crossref | PubMed | ISIGoogle Scholar
  • 16. Ezeugwu VE, Manns PJ. Sleep duration, sedentary behavior, physical activity, and quality of life after inpatient stroke rehabilitation. J Stroke Cerebrovasc Dis 26: 2004–2012, 2017. doi:10.1016/j.jstrokecerebrovasdis.2017.06.009.
    Crossref | PubMed | ISIGoogle Scholar
  • 17. Ezzati M, Lopez AD. Estimates of global mortality attributable to smoking in 2000. Lancet 362: 847–852, 2003. doi:10.1016/S0140-6736(03)14338-3.
    Crossref | PubMed | ISIGoogle Scholar
  • 18. Farinatti P, Monteiro WD, Oliveira RB. Long term home-based exercise is effective to reduce blood pressure in low income brazilian hypertensive patients: a controlled trial. High Blood Press Cardiovasc Prev 23: 395–404, 2016. doi:10.1007/s40292-016-0169-9.
    Crossref | PubMed | ISIGoogle Scholar
  • 19. Farinatti PT, Oliveira RB, Pinto VL, Monteiro WD, Francischetti E. [Home exercise program: short term effects on physical aptitude and blood pressure in hypertensive individuals]. Arq Bras Cardiol 84: 473–479, 2005. doi:10.1590/S0066-782X2005000600008.
    Crossref | PubMedGoogle Scholar
  • 20. Fitbit, Inc. The Impact of Coronavirus on Global Activity (Online). https://blog.fitbit.com/covid-19-global-activity/ [25 March 2020].
    Google Scholar
  • 21. Franklin NC. Technology to promote and increase physical activity in heart failure. Heart Fail Clin 11: 173–182, 2015. doi:10.1016/j.hfc.2014.08.006.
    Crossref | PubMed | ISIGoogle Scholar
  • 22. Gardner B, Smith L, Lorencatto F, Hamer M, Biddle SJ. How to reduce sitting time? A review of behaviour change strategies used in sedentary behaviour reduction interventions among adults. Health Psychol Rev 10: 89–112, 2016. doi:10.1080/17437199.2015.1082146.
    Crossref | PubMed | ISIGoogle Scholar
  • 23. Gerage AM, Benedetti TRB, Cavalcante BR, Farah BQ, Ritti-Dias RM. Efficacy of a behavior change program on cardiovascular parameters in patients with hypertension: a randomized controlled trial. Einstein (Sao Paulo) 18: eAO5227, 2020. doi:10.31744/einstein_journal/2020AO5227.
    Crossref | PubMedGoogle Scholar
  • 24. Hickey AM, Freedson PS. Utility of consumer physical activity trackers as an intervention tool in cardiovascular disease prevention and treatment. Prog Cardiovasc Dis 58: 613–619, 2016. doi:10.1016/j.pcad.2016.02.006.
    Crossref | PubMed | ISIGoogle Scholar
  • 25. Hirai DM, Musch TI, Poole DC. Exercise training in chronic heart failure: improving skeletal muscle O2 transport and utilization. Am J Physiol Heart Circ Physiol 309: H1419–H1439, 2015. doi:10.1152/ajpheart.00469.2015.
    Link | ISIGoogle Scholar
  • 26. Hua LP, Brown CA, Hains SJ, Godwin M, Parlow JL. Effects of low-intensity exercise conditioning on blood pressure, heart rate, and autonomic modulation of heart rate in men and women with hypertension. Biol Res Nurs 11: 129–143, 2009. doi:10.1177/1099800408324853.
    Crossref | PubMed | ISIGoogle Scholar
  • 27. Karapolat H, Demir E, Bozkaya YT, Eyigor S, Nalbantgil S, Durmaz B, Zoghi M. Comparison of hospital-based versus home-based exercise training in patients with heart failure: effects on functional capacity, quality of life, psychological symptoms, and hemodynamic parameters. Clin Res Cardiol 98: 635–642, 2009. doi:10.1007/s00392-009-0049-6.
    Crossref | PubMed | ISIGoogle Scholar
  • 28. Knudsen SH, Hansen LS, Pedersen M, Dejgaard T, Hansen J, Hall GV, Thomsen C, Solomon TP, Pedersen BK, Krogh-Madsen R. Changes in insulin sensitivity precede changes in body composition during 14 days of step reduction combined with overfeeding in healthy young men. J Appl Physiol (1985) 113: 7–15, 2012. doi:10.1152/japplphysiol.00189.2011.
    Link | ISIGoogle Scholar
  • 29. Krogh-Madsen R, Thyfault JP, Broholm C, Mortensen OH, Olsen RH, Mounier R, Plomgaard P, van Hall G, Booth FW, Pedersen BK. A 2-wk reduction of ambulatory activity attenuates peripheral insulin sensitivity. J Appl Physiol (1985) 108: 1034–1040, 2010. doi:10.1152/japplphysiol.00977.2009.
    Link | ISIGoogle Scholar
  • 30. Ku DN, Giddens DP, Zarins CK, Glagov S. Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis 5: 293–302, 1985. doi:10.1161/01.ATV.5.3.293.
    Crossref | PubMedGoogle Scholar
  • 31. Lans C, Cider Å, Nylander E, Brudin L. Peripheral muscle training with resistance exercise bands in patients with chronic heart failure. Long-term effects on walking distance and quality of life; a pilot study. ESC Heart Fail 5: 241–248, 2018. doi:10.1002/ehf2.12230.
    Crossref | PubMed | ISIGoogle Scholar
  • 32. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 380: 219–229, 2012. doi:10.1016/S0140-6736(12)61031-9.
    Crossref | PubMed | ISIGoogle Scholar
  • 33. Liu H, Xie Q, Xin BM, Liu JL, Liu Y, Li YZ, Wang JP. Inhibition of autophagy recovers cardiac dysfunction and atrophy in response to tail-suspension. Life Sci 121: 1–9, 2015. doi:10.1016/j.lfs.2014.10.023.
    Crossref | PubMed | ISIGoogle Scholar
  • 34. Mainsbridge C, Ahuja K, Williams A, Bird ML, Cooley D, Pedersen SJ. Blood pressure response to interrupting workplace sitting time with non-exercise physical activity: results of a 12-month cohort study. J Occup Environ Med 60: 769–774, 2018. doi:10.1097/JOM.0000000000001377.
    Crossref | PubMed | ISIGoogle Scholar
  • 35. Morris JN, Heady JA, Raffle PAB, Roberts CG, Parks JW. Coronary heart-disease and physical activity of work. Lancet 262: 1053–1057, 1953. doi:10.1016/S0140-6736(53)90665-5.
    Crossref | PubMed | ISIGoogle Scholar
  • 36. Nosova EV, Yen P, Chong KC, Alley HF, Stock EO, Quinn A, Hellmann J, Conte MS, Owens CD, Spite M, Grenon SM. Short-term physical inactivity impairs vascular function. J Surg Res 190: 672–682, 2014. doi:10.1016/j.jss.2014.02.001.
    Crossref | PubMed | ISIGoogle Scholar
  • 37. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, Ludwig DS. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 352: 1138–1145, 2005. doi:10.1056/NEJMsr043743.
    Crossref | PubMed | ISIGoogle Scholar
  • 38. Palombo C, Morizzo C, Baluci M, Lucini D, Ricci S, Biolo G, Tortoli P, Kozakova M. Large artery remodeling and dynamics following simulated microgravity by prolonged head-down tilt bed rest in humans. BioMed Res Int 2015: 1–7, 2015. doi:10.1155/2015/342565.
    Crossref | PubMed | ISIGoogle Scholar
  • 39. Piepoli MF. Exercise training in chronic heart failure: mechanisms and therapies. Neth Heart J 21: 85–90, 2013. doi:10.1007/s12471-012-0367-6.
    Crossref | PubMed | ISIGoogle Scholar
  • 40. Piotrowicz E, Zieliński T, Bodalski R, Rywik T, Dobraszkiewicz-Wasilewska B, Sobieszczańska-Małek M, Stepnowska M, Przybylski A, Browarek A, Szumowski Ł, Piotrowski W, Piotrowicz R. Home-based telemonitored Nordic walking training is well accepted, safe, effective and has high adherence among heart failure patients, including those with cardiovascular implantable electronic devices: a randomised controlled study. Eur J Prev Cardiol 22: 1368–1377, 2015. doi:10.1177/2047487314551537.
    Crossref | PubMed | ISIGoogle Scholar
  • 41. Platts SH, Martin DS, Stenger MB, Perez SA, Ribeiro LC, Summers R, Meck JV. Cardiovascular adaptations to long-duration head-down bed rest. Aviat Space Environ Med 80, Suppl: A29–A36, 2009. doi:10.3357/ASEM.BR03.2009.
    Crossref | PubMedGoogle Scholar
  • 42. Safiyari-Hafizi H, Taunton J, Ignaszewski A, Warburton DE. The health benefits of a 12-week home-based interval training cardiac rehabilitation program in patients with heart failure. Can J Cardiol 32: 561–567, 2016. doi:10.1016/j.cjca.2016.01.031.
    Crossref | PubMed | ISIGoogle Scholar
  • 43. Shanely RA, Nieman DC, Henson DA, Jin F, Knab AM, Sha W. Inflammation and oxidative stress are lower in physically fit and active adults. Scand J Med Sci Sports 23: 215–223, 2013. doi:10.1111/j.1600-0838.2011.01373.x.
    Crossref | PubMed | ISIGoogle Scholar
  • 44. Sonne MP, Højbjerre L, Alibegovic AC, Nielsen LB, Stallknecht B, Vaag AA, Dela F. Endothelial function after 10 days of bed rest in individuals at risk for type 2 diabetes and cardiovascular disease. Exp Physiol 96: 1000–1009, 2011. doi:10.1113/expphysiol.2011.058511.
    Crossref | PubMed | ISIGoogle Scholar
  • 45. Teixeira AL, Padilla J, Vianna LC. Impaired popliteal artery flow-mediated dilation caused by reduced daily physical activity is prevented by increased shear stress. J Appl Physiol (1985) 123: 49–54, 2017. doi:10.1152/japplphysiol.00001.2017.
    Link | ISIGoogle Scholar
  • 46. Thosar SS, Bielko SL, Mather KJ, Johnston JD, Wallace JP. Effect of prolonged sitting and breaks in sitting time on endothelial function. Med Sci Sports Exerc 47: 843–849, 2015. doi:10.1249/MSS.0000000000000479.
    Crossref | PubMed | ISIGoogle Scholar
  • 47. Thosar SS, Bielko SL, Wiggins CC, Wallace JP. Differences in brachial and femoral artery responses to prolonged sitting. Cardiovasc Ultrasound 12: 50, 2014. doi:10.1186/1476-7120-12-50.
    Crossref | PubMed | ISIGoogle Scholar
  • 48. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, Chastin SF, Altenburg TM, Chinapaw MJ; SBRN Terminology Consensus Project Participants. Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act 14: 75, 2017. doi:10.1186/s12966-017-0525-8.
    Crossref | PubMed | ISIGoogle Scholar
  • 49. Varnfield M, Karunanithi M, Lee CK, Honeyman E, Arnold D, Ding H, Smith C, Walters DL. Smartphone-based home care model improved use of cardiac rehabilitation in postmyocardial infarction patients: results from a randomised controlled trial. Heart 100: 1770–1779, 2014. doi:10.1136/heartjnl-2014-305783.
    Crossref | PubMed | ISIGoogle Scholar
  • 50. World Health Organization. Coronavirus Disease (COVID-19) Outbreak Situation (Online). https://www.who.int/emergencies/diseases/novel-coronavirus-2019 [12 May 2020].
    Google Scholar
  • 51. World Health Organization. Statement on the Second Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019-nCoV). https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov) [12 May 2020].
    Google Scholar
Back to Top
Next