COVID-19 and India’s chronic disease burden: How exercise can be beneficial

Closures of parks and gyms, make it more difficult for people to be active, but physical activity should not be an afterthought during this pandemic.
COVID-19 and India’s chronic disease burden: How exercise can be beneficial
COVID-19 and India’s chronic disease burden: How exercise can be beneficial

Exercising is probably not on the top of our minds as we struggle with how to protect ourselves, our families, and our communities during the COVID-19 pandemic. Perhaps it should be, because physical activity is one of the most powerful forces for good health and can be a valuable tool for reducing the risk of major illnesses and maintaining quality of life.

More than half of India’s population is physically inactive, putting them at greater risk of heart disease, diabetes, dementia, and numerous cancers. Heart diseases have become the leading cause of mortality, with one in four deaths in India attributed to coronary heart disease and stroke. India is known as the diabetes capital of the world with as many as 50 million people suffering from type 2 diabetes. Even though physical activity is widely recommended by health authorities as a protective factor for prevention and treatment of these leading chronic diseases, efforts to promote active lifestyles are minimal in India.

During the current pandemic, staying home, while a safe measure, may have unintended negative consequences as there may be less opportunity for exercising. It is likely that prolonged homestay may lead to increased sedentary behaviours, such as spending excessive amounts of time sitting, reclining, or lying down for screening activities (playing games, watching television, using mobile devices). It makes sense now to encourage people, especially those with chronic conditions, to be moderately active prior to being infected, to reduce severity of illness after infection. People need to be aware of actions they can take themselves to stay fit and healthy.

Physical activity could help ease the consequences of the coronavirus pandemic in four ways. First, physical activity has the potential to reduce the severity of COVID-19 infections as it has immediate effects on immune functions. When we are physically active, our muscles produce compounds that improve functioning of the immune system and reduce inflammation, thus strengthening our biological response to fight the infection. Moderately intense physical activity, such as walking, has the best impact, but extreme vigorous exercise, like running a marathon, temporarily reduces immune function. The potential for increased physical activity to reduce the number of infected people who require hospitalisation and use of ventilators could help reduce the extent to which health care systems become overwhelmed by cases of severe infection.  

Second, physical activity is effective for both preventing and treating heart disease, type 2 diabetes, and eight types of cancers, all of which increase the risk of severe illness and death among those infected with coronavirus. So, the millions of Indians who already have these diseases could benefit the most by modestly increasing regular physical activity.

Third, being physically active has important mental health benefits, and encouraging people to be active could help many cope with ongoing stress. Each session of physical activity reduces symptoms of depression and anxiety, so being active every day can be a partial antidote to the stress of the pandemic. For people already feeling distress, being active is as effective as medications and psychotherapy.

Fourth, the body’s response to psychological stress creates imbalances between cortisol and other hormones that negatively affect the immune system and inflammation. Thus, psychological stress worsens the underlying biological processes of COVID-19, but restoring cortisol balance is another mechanism by which physical activity benefits immunity and inflammation. The most effective strategies for improving cortisol balance are physical activity and stress management, including meditation. Older adults tend to have disrupted cortisol physiology and weaker immune systems, and physical activity may be particularly important for this large population at high risk for COVID-19.

Due to its multiple benefits, physical activity should not be an afterthought during this pandemic. Rather, being active should be a key public health recommendation. The most common physical activity is walking, which is free and accessible to most people of all ages. Walking lends itself well to maintaining safe distances from others, but you might need to seek out less-busy streets. Similar to taking a medication daily, people can reduce their risk of severe viral infections and their risk from multiple chronic diseases by simply taking a walk every day. It is not too late in the pandemic for people to benefit from modest increases in their physical activity.

Closures of parks, trails, gyms, and beaches make it more difficult for people to be active. Places for activity should be retained as much as possible, but it may be necessary to monitor popular outdoor places to ensure people maintain safe physical distancing. The internet is now full of exercise and dance classes for adults and children, giving many options for indoor activity. Any kind of enjoyable moderate activity, indoors or outdoors, is great for mind and body. But, going for a walk outdoors can be a high point of the day for millions that helps us get through this pandemic while preserving as much quality of life as possible.

Dr. Deepti Adlakha ( is an architect and urban designer with public health expertise at Queen’s University Belfast, UK; Prof. James F. Sallis ( is a health psychologist at The University of California, San Diego, USA; Prof. Michael Pratt ( is a preventive medicine physician at The University of California, San Diego, USA.

Views expressed are the authors' own.

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