As the global covid-19 pandemic continues to evolve, countries have taken actions to prevent the spread of the virus [1]. International travels restrictions, lockdown measures, physical distancing and good hygiene practices are few examples of measures implemented to help reduce transmission and enable health systems to cope. The epidemiological characteristics of covid-19 outbreak suggest certain populations that are at a higher risk of fatality [2]. The probability of dying (number of deaths/number of cases) if infected by the virus (%) is highly dependent on age, with the highest death rate reported for older people (over 20% death rate for those 80 years of age and over). Furthermore, people with pre-existing medical conditions (such as cardiovascular, diabetes, and chronic respiratory disease) have higher rate of fatality if infected by covid-19 [3].

Consequently, further restrictions such as varying levels of “lockdown” were imposed on aged care facilities to protect older, highly vulnerable populations. Limited visits, reduced social gatherings, and termination of group physical activities are only a few measures that are currently being practised by many aged care facilities. Given the uncertainty around the duration it will take to control the spread, these restrictions may be in place for at least several months.

The implications of social distancing and sedentary behaviour can have severe health implications on older people, especially those in residential care facilities, who are already socially isolated and physically inactive [4, 5]. Social isolation and physical inactivity are predictors for mortality in older age [6, 7]. Muscle wasting and cardiopulmonary deconditioning can occur rapidly during reduction in physical activity and prolonged immobility (e.g., bedrest). Consequently, these restrictions may have far reaching impact on older people wellbeing both mentally and physically.

Physical activity offers many health benefits including enhancing our immune system’s ability to regulate itself which can further reduce the risk of contracting diseases [8]. The importance of maintaining regular physical activity even during the current crisis has been discussed [9]; and practical protective recommendations have been proposed that include personal hygiene and regular sanitary cleaning practice. Exercising outdoor has been recommended as a safe alternative to any indoor physical activities. It is also known for its beneficial effect on mental and physical wellbeing [10]. While governments attempt to protect this vulnerable group, it is equally important to ensure ongoing engagement in physical and social activities despite the current pandemic. 

Online resources (exercise videos) can be very useful at present. Use remote platforms to ‘steam live’ exercise classes (e.g., Facebook, video conferencing and others) via available technology (mobile phone, tablets).

Avoid prolonged sedentary behaviour (e.g., sitting) by taking frequent standing or walking breaks as well as practice daily life mobility specific activities/tasks (sit to stand, stairs, transfer movements). 

In any small group activity, appropriate physical distance between people should be kept between 2 meters and the presence of a qualified staff might be required. 

There is a need to consider different approaches to sustaining social interactions and physical activity for older people at this time, that meet the required constraints to address covid-19, rather than stopping all forms of activity.

Pazit Levinger, Associate Professor, National Ageing Research Institute, Melbourne Australia

Keith D Hill, Professor and Director, Rehabilitation, Ageing and Independent Living (RAIL) research centre, Monash University, Melbourne, Australia

Competing Interest: None declared

 References:

1. WHO: Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) In.; 2020.
2. Vital Surveillances: The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020. In. Edited by Weekly CC, vol. 2. China; 2020: 113-122.
3. COVID-19 Coronavirus Outbreak https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/
4. Sackley CM, Levin S, Cardoso K, Hoppitt TJ: Observations of activity levels and social interaction in a residential care setting. Int J Ther Rehabil 2006, 13:370-373.
5. Parry S, Chow M, Batchelor F, Fary RE: Physical activity and sedentary behaviour in a residential aged care facility. Australas J Ageing 2019, 38(1):E12-E18.
6. Steptoe A, Shankar A, Demakakos P, Wardle J: Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A 2013, 110(15):5797-5801.
7. de Rezende LFM, Rey-Lopez JP, Matsudo VKR, Luiz OC: Sedentary behaviour and health outcomes among older adults: a systematic review. BMC Public Health 2014, 14(333).
8. Campbell JP, Turner JE: Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Front Immunol 2018, 9:648.
9. Dominski FH, Dominski BH: Exercise and infectioud diseases – Covid-19. BJSM blog 2020.
10. Barton J, Griffin M, Pretty J: Exercise-, nature- and socially interactive-based initiatives improve mood and self-esteem in the clinical population. Perspect Public Health 2012, 132(2):89-96.

 

Contributions

PL devised the manuscript, wrote the first draft and contributed to revisions.  KH made intellectual contributions and revised the manuscript.  All authors approved the final version

 

Data Sharing Statement

There are no data to share

Funding

NA

Patient and Public Involvement

Current research and professional work in the area of physical activity for older people and those reside in aged care facilities led to the initial decision to generate an opinion piece.  The authors intend to involve seniors group and aged care facilities in dissemination of the article once published.