# Editorial: Exercise intervention for prevention, management of and rehabilitation from COVID-19

Marcel Bonay, Osama Abdelkarim, Achraf Ammar

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Marcel Bonay, Osama Abdelkarim, Achraf Ammar. Editorial: Exercise intervention for prevention, management of and rehabilitation from COVID-19. Frontiers in Physiology, 2023, 14, 10.3389/fphys.2023.1293229. [hal-04290285](https://hal.science/hal-04290285v1)

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OPEN ACCESS

EDITED AND REVIEWED BY
Giuseppe D'Antona,
University of Pavia, Italy

*CORRESPONDENCE

Marcel Bonay,
✉ marcel.bonay@aphp.fr

RECEIVED 12 September 2023

ACCEPTED 14 September 2023

PUBLISHED 26 September 2023

CITATION

Bonay M, Abdelkarim O and Ammar A (2023), Editorial: Exercise intervention for prevention, management of and rehabilitation from COVID-19.

Front. Physiol. 14:1293229.

doi: 10.3389/fphys.2023.1293229

COPYRIGHT

© 2023 Bonay, Abdelkarim and Ammar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

# Editorial: Exercise intervention for prevention, management of and rehabilitation from COVID-19

Marcel Bonay<sup>1,2*,</sup> Osama Abdelkarim<sup>3,4</sup> and Achraf Ammar<sup>5,6,7,8</sup>

KEYWORDS

exercise, prevention, rehabilitation, infection, COVID-19

## Editorial on the Research Topic

### Exercise intervention for prevention, management of and rehabilitation from COVID-19

Caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus disease 2019 (COVID-19) pandemic has greatly stimulated health research with numerous benefits for patient care, ranging from the development of new vaccines to the identification of at-risk populations and the recognition of the value of physical exercise interventions as an effective method of prevention, management, and rehabilitation of patients. In this Research Topic “Exercise intervention for Prevention, Management of and Rehabilitation from COVID-19”, studies explore the effects of physical activity on COVID-19 illness and mortality, the impact of rehabilitation programs on different populations of COVID-19 patients, and characterize difficulties and needs of patients or athletes with disabilities during COVID-19 lockdown.

An increase in mortality among hospitalized COVID-19 patients with previous sedentary lifestyles has been shown in many studies. Conversely, the beneficial effects of physical activity on COVID-19 outcomes and disease severity have been suggested. Recently, a meta-analysis involving one million patients assessed the hospitalization, intensive care unit (ICU) admissions, and mortality rates of COVID-19 patients with a history of physical activity involvement before the beginning of the pandemic (Rahmati et al., 2022). Interestingly, the types of exercises were also studied. Resistance exercise and combined aerobic and muscle strength training were significantly associated with reductions in COVID-19 hospitalizations, and COVID-19 ICU admissions, respectively. The authors reported a positive association between endurance exercise and reduction in COVID-19 mortality. In this Research Topic, a Mendelian randomization study assessed the causal influence of light and moderate-to-vigorous physical activity on COVID-19 susceptibility, hospitalization and severity (Zhang et al.). No significant effects were found for moderate to vigorous physical activity on COVID-19 outcomes. However, light physical activity reduced the risk of COVID-19 hospitalization and severe complications. Another review and meta-

<footnote n="1"><sup>1</sup>Université Paris-Saclay, Université de Versailles St Quentin (UVSQ), INSERM END-ICAP, Versailles, France,</footnote>

<footnote n="2"><sup>2</sup>Service de Physiologie-Explorations Fonctionnelles bi-sites, Hôpitaux Ambroise Paré et Bicêtre,</footnote>

<footnote>Assistance Publique-Hôpitaux de Paris, Boulogne, France, <sup>5</sup>Faculty of Physical Education, Assiut</footnote>

<footnote>University, Assiut, Egypt, <sup>4</sup>Institute for Sport and Sport Science, Karlsruhe Institute for Technology,</footnote>

<footnote>Karlsruhe, Germany, <sup>5</sup>Department of Training and Movement Science, Institute of Sport Science,</footnote>

<footnote>Johannes Gutenberg-University Mainz, Mainz, Germany, <sup>6</sup>High Institute of Sport and Physical Education</footnote>

<footnote>Sfax, University of Sfax, Sfax, Tunisia, <sup>7</sup>Research Laboratory, Molecular Bases of Human Pathology,</footnote>

<footnote>LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia, <sup>8</sup>Interdisciplinary Laboratory in</footnote>

<footnote>Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS</footnote>

<footnote>(Faculty of Sport Sciences), Université Paris Lumières (UPL), Paris Nanterre University, Nanterre, France</footnote>
analysis assessed the association between physical activity before
COVID-19 and the severity of illness and mortality in COVID-19
patients (Sittichai et al.). Subgroup analysis showed that physical
activity for ≥150 min/week at a moderate intensity or ≥75 min/week
at a vigorous intensity reduced the risks of severity and mortality.
Vigorous PA reduced mortality risk, whereas moderate to vigorous
PA reduced the risks of severity and mortality. Although the
heterogeneity in physical activity patterns and severity definition
constitutes a limitation of these meta-analysis studies, engaging in
regular physical activity was shown to decrease the severity and
mortality of COVID-19 patients. Several studies suggest that
exercise intervention improves the functional capacities and
psychological health status of COVID-19 patients who were
discharged from the hospital. Focusing on the management and
rehabilitation of post-COVID-19 Tunisian patients, Toulgui et al.
assessed the effect of 4-week cardiorespiratory rehabilitation
program including aerobic cycle endurance, strength training,
and educational sessions. The authors reported significant
improvements in dyspnea, lung function, 6-min walk work, and
resting heart rate and diastolic blood pressure in 14 moderate to
severe COVID-19 patients (Toulgui et al.). Another clinical trial
showed that an 8-week multi-professional intervention increased
physical fitness, reduced biomarkers of inflammation, and improved
lipid and glucose metabolism in overweight COVID-19 survivors
from southern Brazil (Sordi et al.). In a critical scoping review of the
literature, Puce et al. evaluated the effects of COVID-19 on athletes
with disabilities and para-athletes. Interestingly, the authors
highlighted the lack of follow-up studies in these populations and
recommended more attention towards their needs. In a case report,
Crisafulli et al. highlighted the importance of personalized adapted
motor activity in a COVID-19 patient with critical illness
polyneuropathy and myopathy. Numerous studies have reported
the psychological effects of COVID-19 lockdown. AlMarzooqi et al.
found an association between body image perception and
demographic factors among physically active individuals during
the COVID-19 lockdown in Saudi Arabia. In Malaysia, Washif
et al. evaluated the extent of changes in training practices, recovery,
mental health, and sleep patterns of athletes during the COVID-19

lockdown. Finally, Wedig et al. discussed the potential interest of
blood flow restriction to decrease loss of muscle mass and strength
during acute infection, and to mimic high-intensity exercise
intervention during convalescence.

The studies published in this Research Topic report promising
findings on the beneficial effects of regular physical activity and/or
adopting exercise interventions on promoting functional capacities
and psychological status in COVID-19 survivors while reducing the
severity and mortality of COVID-19 patients. However, most of
these studies agreed on the difficulty of adapting a rehabilitation
program and finding the optimal levels of physical activity in a given
individual.

Author contributions

MB: Writing–original draft, Writing–review and editing. OA:
Writing–review and editing. AA: Writing–review and editing.

Conflict of interest

The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be
construed as a potential conflict of interest.

The authors declared that they were an editorial board member
of Frontiers, at the time of submission. This had no impact on the
peer review process and the final decision.

Publisher’s note

All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed or
endorsed by the publisher.

Reference

Rahmati, M., Shamsi, M. M., Khoramipour, K., Malakoutinia, F., Woo, W., Park, S., et al. (2022). Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis. *Rev. Med. Virol.* 32 (5), e2349. doi:10.1002/rmv.2349