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  • Writer's pictureDr. Adrian Pujayana

A Guide to COVID Era Exercise and Group Activity

Updated: Sep 22, 2020

Author's note: This article has evolved since it's conception back in June, to the time of writing in September. What started out as a health and fitness focused article progressively became something more urgent and dire with respect to your health, wellness and function. As I scoured the news for references, I realized that the value we have on our health and function goes way beyond muscle tone and feeling good...and perhaps these physical abilities may be a necessary for something way more important and imminent.

This article, or dissertation as it later eveolved, is not just a guide about your health and fitness. It addresses healthy return to play guidelines, addresses current events and health hazards, and the need for healthy bodies in the middle of a turbulent world and ever increasing civil unrest and disintegration. If the U.S. falls apart, then where is there a safe place for a republic where people's liberties and free will to pursue happiness can thrive? Is there no safer place to have free thought without persecution than in the United States of America? People flee from all around the world to come to the land of the free, and yes, the home of the brave! Americans have defended the rights for others who desire a democracy in their own country. American gravestones of fallen soldiers in foreign soil mark this committment to a decmocratic state not just in America but in other countries as well...I know, I'm off the subject...sorry.

Hundreds of US, French citizens gather to honor thousands who gave their all.

What started out as a health and fitness topic progressed into something more urgent... perhaps alarming. Why? Because I'm addressing the value of your health and fitness as it relates to those your love, and the lives of those you want to protect. It's a value on health and fitness as it relates to sudden home evacuations during a fire, in the middle of a global pandemic, with the possibility of encountering looters and opportunists along your escape route...and trying not to hurt yourself in the process. Yeah, it's alarming, and if you want to spare the details, just skip to the end of this article! (I won't be offended.)

I hope I'm wrong, and do not wish these scenarios on anyone. But your health and fitness in the COVID era...and perhaps I joke about calling it "the apocalypse era" more about resiliency and durability to adapt to hardship, maybe suffering. I didn't start out this article with this premonition, but take a look around you and you can draw your own conclusion.

Over 3 million acres of land have been burned just in 2020, approximately 1 million of these acres burned in just this Summer. Our air is filthy, smoke-filled and dangerous to exercise in. Those with respiratory conditions suffer the most, and the rest of us "normal" folks are quickly experiencing the downside of breathing the Southern California air. Therefore, I want to address the effect of short and long-term smoke inhalation syndromes before delving into our topic...A guide to COVID era exercise and group activity.

Here we are (September 17, 2020), about 6 months into the COVID lockdown and gyms, massage therapy and yoga studios are still not officially allowed to operate. Even hair and nail salons were barely allowed to operate under very strict guidelines and limited customer load of 25% a day. As a result, business owners of these establishments have operated outdoors, in some cases, by invitation only. These industries can't possibly thrive under these conditions, and customers are left to find alternatives to an active lifestyle, and find ways to maintain fitness levels without any access to their usual facilities. The following guide is for healthy individuals who want to find a way to keep their lifestyle active but still reduce the risk of COVID exposure.

Those who have contracted the coronavirus or have pre-existing conditions like COPD, asthma, and pneumonia must take extra precautions-even extra time- in order to resume an active lifestyle. This vulnerable group (Myself included! I've had pneumonia 2x in 6 years, the first one was near fatal!) should be more selective and use good judgment when it comes to exertion and load selection as well as considering the benefit of active-rest, or straight-up rest as a means to accellerate exercise gains.

Smoke inhalation...a sucky problem!

For most healthy adults, the effects of smoke inhalation may only be temporary in many cases, but for many people, can cause lasting effects not just on the respiratory system, but the cardiovascular system as well. Inhaling smoke can cause various damage to lung tissue depending on the following factors:

1. The kind of smoke that was inspired.

2. The length of exposure.

3. The density of the exposure.

4. The health status of the individual.

All 4 variables can cause individuals to respond differently, and thus determine the amount of time required to recover.

Kind of smoke inspired:

Most combustible fuels in nature are wood, plants, and grass. The hydrocarbon print of these materials is predictable, and likely to be the least toxic compared to other kinds of smoke. When homes and businesses burn, synthetic materials like plastic, steel, gasoline and other fuels can easily combust and mix with the naturally burning wood and grass. This mixture can be intensely toxic even in small doses, and small doses can mean a lot when exposure time is increased and the health of the individual is compromised. Particulates, especially the microscopic ones like PM2.5 (meaning smaller than 2.5 micrometer) cause haze in our atmosphere and can lodge deep into our lungs. The effect is inflammation within our lung tissue and the production of mucous and fluid which increases the amount of actual fluid mass inside our lungs. Instead of air occupying space in our aleveoli, fluid and inflammatory biochemical compounds begin to flood these healthy spaces. The effect is inability to have oxygen exchange, like drowning in your own body fluids. Hypoxia, or lack of oxygenation begin to take place, which produces a cascade of symptoms affecting your mental ability to think and focus, causes insidious stress that can lead to panic and anxiety, and loss of body control...all symptoms of impending cell death due to lack of oxygen! This is very serious and can be fatal if someone is not rescued from timely exposure. Smoke inhalation, in mild doses and temporary exposure times, may produce short-term symptoms like burning and itching to the mucous membranes of the eyes, throat, and lungs. Healthy adults have more tolerance to smoke exposure than children, and most times these symptoms are temporary.

Length of exposure:

In any context of toxic exposure, whether it is chemical, airborne, or physical stress, the amount of time exposed matters. Small doses add up no matter what the toxic context entails. Our bodies are remarkable auto-detoxers due to our liver and kidney function. When a toxin enters our bloodstream or lungs, our bodies begin the process of clearing theses substances. When the rate of intoxication exceeds that of clearance, we begin to develop symptoms...usually inflammatory in nature which leads to edema and pain. The longer the exposure time, the greater the toxicity.

Density of exposure:

Particulate matter in the air can become increasingly dense in areas of low ventilation. Smoke that enters a home and is trapped indoors can accumulate to unhealthy levels, and produce a greater toxic effect on the body. Density can also be dependent on temperature and elevation. Since heat rises up, toxic fumes that are hot are likely to be more dense around the ceiling of a room. Staying low to the floor is helpful and can reduce exposure. Some compounds like Carbon Monoxide do stay low to the ground because it is molecularly heavier than oxygen. In a low ventilated room, Carbon Monoxide density can collect low on the floor, and be fatal in large doses and prolonged exposure.

Health Status of the Individual:

No two people respond to toxicity identically, not even twins! I'm talking about biomolecular responses between individuals are vast. It's the kind of uniqueness that makes individuals respond a certain way to exercise, nutritional supplements, and even toxic loads from smoke. Simply put, if you are sick, vulnerable, elderly or an infant, you will not tolerate smoke inhalation for very long before symptoms are triggered. And once triggered, symptoms may persist for longer periods because the rate of clearance of toxic exposure may be compromised.

Smoke Inhalation Syndrome

Symptoms that develop as a result of smoke or particulate inhalation can be mild to severe in range depending on the above factors. These would include the following symptoms:

- Itchy throat, eyes, and nose

- Mucous production in the nose and throat

- Tears in the eyes

- Coughing, sneezing

- Asthma-like or allergy-like symptoms

- Dizziness

- Headache

- Irritability

- Confusion and anxiousness

- Difficulty concentrating or focusing

- Fatigue or sleepiness

- Loss of consciousness and death from hypoxia

Smoke inhalation syndrome is the development of symptoms due to smoke and particulate exposure which can be deadly if it leads to hypoxia. When exposure levels are mild and in low dose, symptoms can be mild but cummulative over time. Mild inhalation syndromes produce temporary symptoms that can begin to resolve when the exposure to smoke inhalation is eliminated. But such mild syndromes like itchiness in the eyes, nose, and throat, and mild headaches can cause a cascade of other symptoms that lead to mental and physical stress on the body in subtle but meaningful ways on an individual.

Mild inhalation syndrome can trigger a cascade of hormonal effect by raising the stress level of a person. Cortisol, a hormone that naturally occurs but increases during stress, may stay elevated in your body during mild inhalation syndrome, and lead to systemic body inflammation. This cascade could trigger a cytokine storm (please look this up) which can trigger old dormant conditions to emerge in andy body systems like joint pains, swelling, digestive problems, even cognition! Mild inhalation syndromes are temporary but insidious. Many times it goes undiagnosed and over time, can be more difficult to reverse because of the stress it has produced on the body.

Carbon monoxide, a heavy molecule, tends to settle to the ground or floor when indoors and un-diluted. When carbon monoxide permeates our breathing space such as from a nearby fire, it can mix with our breathing air and cause mild inhalation syndromes in an insidious way to reduce oxygen exchange leading to hypoxia. Any particulate, mucous, or compound like carbon monoxide that competes or obstructs oxygen exchange, even in small amounts, begins the process of mild inhalation syndromes putting stress on our body.

Persistent mild inhalation syndromes weaken and stress the body which over time can cause colds, allergies and trigger asthma. Beware of small or frequent exposure over time since stress and symptoms accumulate over time.

Smoke Inhalation, toxicity and it worth exercising when you are surrounded?

Inhalation syndromes can have subtle or profound effects on your health depending on the four variables mentioned above. If you find yourself in a situation where the air quality index (AQI) is unhealthy, such as > 100, then it is worth considering the risk-to-benefit of attempting to exercise outdoors. If the air quality is so poor that you can smell smoke inside your own home (such is the case at the time of this writing), then you need to consider being able to exercise in a safe air-space. This could be an indoor gym or an air-tight room with a HEPA filtration system. Exertion during exercise, Met-Cons, and cardio will demand increased oxygen consumption (VO2) during the activity, and taper off after the activity is complete (oxygen debt). Going into an unsafe air-space, like outdoors or in a contaminated room, can increase your smoke inhalation exposure as you recover. Be aware of this. Just because your exercise room is 'clean' doesn't mean you are free from exposure during rest, which is also an essential time period which you make gains from your workout. To find out what your AQI is in your area, you can click here.

Exercising with or without a mask. Some pros and cons.

There have never been so many options and styles for protective face masks. There are surgical masks, N95, fabric, DIY, scarves, T-shirts, leather, many options! Most masks can slow down or obstruct air and aerosol passage to and from your respiratory tract when worn properly. Surgical type of masks and N95's give you more assurance of filtering particulate matter and microscopic particles and germs. But it's not perfect. If you are in the line of fire of a cough or sneeze, and you have gaps in your mask, you can potentially have a breach in your mask and inhale aerosols or particles. But it's still safer to be in the line of fire in a mask than without.

When face masks are worn during exercise, they can gather humidity or sweat at a very rapid rate. This can cause airflow resistance during inhale-exhale cycles. If inhalation is obstructed, your oxygen exchange will be compromised, and fatigue will set in quickly, and lactic acid threshold is lowered and body wide fatigue begins. Any mask that has been exposed to high mositure have a greater chance of bacterial growth if set aside without drying properly. One way to quickly sanitize your mask is to place it on the dash of your car as you drive in the sun. Let it dry and let the UV rays destroy bacteria and viruses. Don't put your mask in the microwave (as I did earlier this year) because the wire inside or on the mask will spark and cause the mask to combust in flames (which is what happened!).

There are a few benefits for wearing your mask as you exercise. Here's the short list:

- Reduction of pollen and other particulates from being inhaled

- Slows down your exhaled particulates to protect others around you

- Slows down and prevents aerosols from being inhaled

Risk vs. Benefit. Not just a respiratory concern.

Exercising during poor air quality certainly challenges your respiratory system. It can trigger sinus, chest, eyes and mucous membrane irritation and inflammation. But the other concern is cardiovascular, not just respiratory. Wearing a wet mask during heavy metabolic demands will deprive your cardiovascular system of efficient oxygen exchange, and cause a cascade of performance degradation including cognition decline. These are serious effects on physical performance, and could compromise the quality of your exercise as well as your ability to recover.

The goal of exercise is adaptation. Overloading your body with metabolic demands, resistance sources, or exertion causes your cells to adapt and overcome hardship. Exercise is an investment into your'll be better adapted, healthy, and look and feel better. But exercise also required rest and recovery to be effective. If the air quality around you is poor during and after exercise, you are likely to be at risk for a kind of overload and stress that is related to hypoxia and respiratory irritation. The result, in this case, is that your body ends up in worse shape than when you started the exercise. You need good judgment, knowledge of your own body's response during stress, and an honest sense of your health status before taking on exercise exertion in bad air. Ask yourself if the risk of respiratory and cardiovascular stress is likely to do your body good, or more harm. Don't forget to be mindful of the exposure to bad air quality during your recovery process, as it could practically cancel out all the hard work you did during activity.

And now, the article I meant to write before the California fires...

As I scour the internet for recent photos of California life, I'm overwhelmed at the shocking images and stories I read about the coronavirus pandemic, the recent violence throughout our nation, the fires that are still uncontained and destroying the west coast, and I'm supposed to write an article on exercise and group activity. Add political unrest into the mix, and a volatile presidential election in about 6 weeks, and we just might have a recipe for what could be an apocalyptic like situation. If this is true, you better get your ass in shape...I mean it in all seriousness!

I believe that your fitness to withstand hardship may be more than just hard lifting of weights and kettlebells, but possibly your ability to lift the stuff in your home and those you love during a crisis...this is true functional fitness. I've realized the importance of your health can have serious repercussions not just to you, but those you want to protect and love. With this thought, let us take getting into shape with more sense of importance, and have a goal that is more function and practical than vanity. Let's go!

In the last 6 1/2 months, the gyms opened for about 1 month in May. As COVID cases increased (which I attribute to massive gatherings and protests), gyms were shut down once again. Many of us were cautious about re-entering the gyms. There was a certain calculated risk of being inside a building with others who are breathing heavily, touching weights with sweaty hands, and not knowing who among your are potentially COVID positive.

Access to the gym meant options. Heavier weights, cardio equipment, heavy machinery. Many of us found a way to exercise and workout at home with much less options, which is a topic of another article. But after such a large gap without exercise or access to heavy equipment, many of us have some degree of deconditioning syndrome. These can include the following:

- Shortness of breath

- Easy fatigue

- Loss of muscle mass and tone

- Loss of motivation

- Weight gain

- Loss of flexibility, mobility and agility

- Muscle tension, pain and joint aches

- Degrees of depression

- Increased anxiety

- Spinal tension and pain

- Posture distortion

- Increased falls

- Elevated blood pressure, cholesterol and insulin resistance

- Dormant medical conditions emerge

- Difficulty sleeping

Perhaps soon the gyms will re-open. If so, a strategy of progressive and systematic transition is necessary to get back to where you were. Think of it in phases, each one is a building block that acts as a platform for you to stand on to get to the next level. Here's a suggested phase by phase goal that can make transitioning more successful and systematic. In addition, we will discuss what exercise in group settings can mean for you in this COVID/Apocalypse era.

PHASE 1: Re-establish routine, focus on mobility.

Showing up seems like a low bar for returning to the gym, but the large gap in your gym routine can be substantial in the deconditioning process whether you feel it or not. Focus on extended stretching before AND after your workout. Use discipline to choose less intense weights and resistances during your workout, and use your full range of motion. Don't try to do new moves or routines you saw on Youtube during your lockdown. The time to be adventurous in your workout will come soon enough.

PHASE 2: Include cardio with your strength training.

Crosstraining routines involve developing your cardiovascular capacity as you train for resistance routines. Cardio machines like eliptical machines and treadmills are great for cardio. Be mindful to transition and ease into your cardio routine. You can also include cardio into your weight lifting by implementing Circuit training (station to station routine) or HIIT (time dependent stations). Again, be mindful of using full ROM, and don't force the work if there is new pain!

PHASE 3: Start attempting 90% max loads.

Have reasonable expectations about hitting the upper limits of your abilities. Be honest with yourself and ask yourself..."am I ready or am I ambitious?". Olympic lifts (bench press, squat, deadlifts, snatches and even kettlebell swings) should be performed cautiously, and only when you have established regular intensities of at least 75% of your pre-COVID lifts on a regular basis.

PHASE 4: Return to pre-COVID loads

You may need 4-6 weeks in order to reach PHASE 4. Take your time as injuries and illness can put you at risk for other medical conditions.

Gym etiquette 2020

Gym facilities can be a high risk activity in the COVID era. However, we know that viral infection transmission is very specific as we know now. COVID is contagious through aerosol droplets that are inhaled into the respiratory tract, according to the CDC. Touching objects, metal, paper or items infected with the coronavirus has not been known to be the typical mode of transmission of COVID between individuals. Therefore, it is prudent to avoid dense portions of the gym where people are gathering or breathing heavy. Avoid being around those who are wearing masks that have the exhale spouts and these types of masks release respiratory content into the ambient air without filtration.

Carry a small bottle of spray alcohol and towel. Don't be afraid to use it on your hands between stations, but if you are not touching your face or mouth, it shouldn't be a problem. Carry a towel that you can put into your pocket and not touch other gym items with. Use it only on your face, so a wash cloth is adequate.

Hand washing rules! Wash your hands with soap and water before you leave. This is better than wearing a rubber glove that you used in the gym and drive home spreading the germs all over your car. If you were wearing gloves, take them off in the gym bathroom before you wash your hands thoroughly. Wash your hands again when you get home.

Group classes and COVID protection

Many local bootcamps and gyms have taken their routines to the streets for group exercise sessions. Some groups wear masks while others don't. If you are outside, in the heat and sunlight, chances are in your favor to dilute or kill COVID as it leaves someone's breath. But keep your distance anyway, and if you are around a water aerosol sprayed by a fan, try to move into a position where someone's breathing is not captured by the mist and blown into your face. Choose dry locations as you conduct your bootcamp or yoga activities when you are around others.

The bottom line...Don't just get in physical shape...there's so much more!

Fitness, strength and agility are great but it's not everything. It gives you options to withstand physical hardship and maintain function. If we are headed towards an apocalypse, you're gonna want more than your physical fitness, but your spiritual health to be absolutely intact and assured in salvation. The Bible promises us that our relationship with God the Father can only be accomplished by trusting and accepting His Son, Jesus, who took on the form of man, lived on this earth without sin, and was killed on the cross unjustly for proclaiming the good news that our sins, our disobedience and denial of our God, can and will be reconciled through His death and resurrection. As a result, we are no longer slaves to sin, and have the strength and power to overcome evil in an unjust world through the power of the Holy Spirit, who is one with the Father and the Son (John 4: 47-51).

I hope and pray that by looking at our world, you would come to an urgency to restore not just your health, but the health of the spirit that lives in you, a spirit who wishes to be restored to the God of the universe; the God of the Bible who knew you before you were born and formed you in His image; the God that desires a life that is full of gratitude and thanksgiving for His people; the God who wants you to be ready for His return. This is the God of the Bible, the God above all others, worthy of praise, the one from Genesis...."In the beginning, God...", yeah, THAT God!

May God bless you and keep you protected in uncertain times, giving you discernment for truth and to live in love.

With all sincerity,

Dr. Adrian Pujayana


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