More Activity, Lower Mortality in People with Chronic Disease

The Health Benefits of Exercise Report is a newsletter and article series in which we select three peer-reviewed articles, summarize the key findings, and provide social media images for you to share with your community. You can read previous articles here.

As the COVID-19 pandemic persists, maintaining a physically active lifestyle continues to present a challenge. However, we know that exercise is a key measure to help prevent chronic health conditions that still affect millions of people and increase the risk of severe COVID-19. This month’s edition of the Health Benefits of Exercise Report covers:

1. A systematic review and meta-analysis of evidence regarding the dose-response relationship between mortality and physical activity in people with type 2 diabetes, breast cancer, chronic obstructive pulmonary disease, and ischemic heart disease.
2. The benefits of physical activity for immune system function, quality of life, and protection against COVID-19 in people with Parkinson’s disease.
3. A review of evidence supporting the efficacy of physical activity for controlling blood glucose in women with gestational diabetes.

Higher Physical Activity Levels After a Chronic Disease Diagnosis Reduced Mortality

There is clear and abundant evidence supporting an association between physical activity levels and decreased mortality in the general population. However, in adults with a chronic disease, the evidence supporting a dose-response relationship between higher physical activity levels and decreased mortality is less clear. In this case, a dose response relationship would mean as physical activity increases, mortality decreases.

A study published in the International Journal of Behavioral Nutrition and Physical Activity involved a systematic review and meta-analysis of the dose-response relationship between post-diagnosis physical activity and mortality in people with certain chronic conditions. Ultimately the study included 28 articles on:

• type 2 diabetes,
• chronic obstructive pulmonary disease (COPD),
• breast cancer, and
• ischemic heart disease (IHD).

According to the study results, there is a link between physical activity and lower mortality from any cause. For every 10 MET-hours (10 MET-hours could be equivalent to several hours of light intensity exercise or one hour of very intense activity) increase in weekly physical activity, the probability of mortality decreased. More active groups saw reductions of 22% for breast cancer, 12% for IHD, by 30% for COPD, and by 4% for type 2 diabetes compared to less active groups. Dose-response relationships became less defined for physical activity levels exceeding five times the weekly recommendations. Though there may be the risk of bias—due to reliance on self-reported physical activity and observational versus randomized controlled trials—these findings align with previous research suggesting higher physical activity levels are linked to lower risk of mortality.

Exercise Improves Quality of Life, May Protect Against COVID-19 in People with Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disease that can cause tremors, muscle stiffness, trouble sleeping, and cognitive challenges. The etiology—or causes—of Parkinson's disease are complex and can include neuroinflammation (inflammation of the brain or spinal cord) and immune system dysfunction. Older adults with Parkinson’s may have a higher infection risk, putting them at increased odds of contracting COVID-19. An article published in the journal Brain Sciences examines what we know about the effect of exercise on immune system health, neuroinflammation, health outcomes in Parkinson’s disease, and how exercise may help protect against COVID-19 infection.

Several animal models suggest the anti-inflammatory effects of exercise may be neuroprotective. Human studies have shown that regular moderate-intensity exercise can improve quality of life and help decrease neuroinflammation.

Studies have shown that exercise helps improve several outcomes for people with Parkinson’s disease, including:

• quality of life,
• motor and nonmotor skills,
• gait,
• balance,
• muscle stiffness,
• mobility, and
• cognitive functioning.

Research has established that physical activity can promote a healthy, well-functioning immune system. The authors of this article point out four ways exercise could potentially help protect against COVID-19:

1. Short-term proinflammatory and long-term anti-inflammatory responses to exercise help prevent acute and chronic tissue damage,
2. Restoring elasticity and strength of lung tissue,
3. Reducing oxidative stress, and
4. Decreasing other health risks for COVID-19, including diabetes, hypertension, and heart problems.

The authors conclude that, “exercise, when correctly performed, improves [quality of life] and outcomes in [people with Parkinson’s], and that the enhanced immune response from moderate-intensity exercise could potentially offer additional protection against COVID-19.”

Physical Activity Programs Effective for Controlling Gestational Diabetes

Gestational diabetes is a form of elevated blood sugar that affects pregnant women. Gestational diabetes can lead to health risks for both mothers (high blood pressure or preeclampsia, need for a caesarian section, and type 2 diabetes later on) and babies (large birth weight, hypoglycemia, and breathing difficulties). A study published in the International Journal of Environmental Research and Public Health reviewed physical activity in women with gestational diabetes. The authors reviewed seven studies that include 782 women from Italy, Croatia, Brazil, Thailand, Australia, Nigeria, and the United Kingdom.

They demonstrated that physical activity exerts beneficial effects on post-meal blood glucose, fasting glucose, and hemoglobin A1C, a longer-term blood glucose measure. In studies that measured insulin use, insulin needs were lower in the active group. Despite diverse physical activity interventions—40 minutes of walking three to four times per week, increasing cycling intervals up to 45 minutes, a set of eight resistance circuits building in intensity throughout the pregnancy, yoga, and aerobic dance—all studies showed similar benefits.

The authors conclude that, “Aerobic, resistance exercise, or a combination of both are effective in controlling glucose, HbcA1, and insulin… any type of physical activity of sufficient intensity and duration can have benefits for pregnant women with [gestational diabetes].”

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