Moderate Intensity Aerobic Exercise Potential Favorable Effect Against COVID-19: The Role of Renin-Angiotensin System and Immunomodulatory Effects

Abstract

The coronavirus disease (COVID-19) pandemic is caused by a novel coronavirus (CoV) named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As the angiotensin converting enzyme 2 (ACE2) is the cellular receptor of SARS-CoV-2, it has a strong interaction with the renin angiotensin system (RAS). Experimental studies have shown that the higher levels of ACE2 or increasing ACE2/ACE1 ratio improve COVID-19 outcomes through lowering inflammation and death. Aerobic moderate intensity physical exercise fights off infections by two mechanisms, the inhibition of ACE/Ang II/AT1-R pathway and the stimulation of ACE2/Ang-(1–7)/MasR axis. Exercise can also activate the anti-inflammatory response so that it can be a potential therapeutic strategy against COVID-19. Here, we summarize and focus the relation among COVID-19, RAS, and immune system and describe the potential effect of aerobic moderate intensity physical exercise against CoV as a useful complementary tool for providing immune protection against SARS-CoV-2 virus infection, which is a novel intervention that requires further investigation.

Commentary: Moderate exercise may prevent the development of severe forms of COVID-19, whereas high-intensity exercise may result in the opposite

“…The same also applies to the idea that a MICE-induced increase in sACE2 concentration can prevent the development of severe forms of COVID-19 in a person infected by SARS-CoV-2. From the immunological point of view, there appears to be an agreement in the literature that MICE could be beneficial in preventing both susceptibility and severity of COVID-19 ( Arazi et al, 2021 ; Da Silveira et al, 2021 ; Furtado et al, 2021 ; Laddu et al, 2021 ; Rahmati-Ahmadabad et al, 2020 ; Ranasinghe et al, 2020 ). There is also evidence that HIIE can induce immune-boosting effects in individuals accustomed to this form of exercise ( Born et al, 2017 ; Monje et al, 2020 ).…”

IFNL4, ACE1, PKR, IFNG, MBL2 genetic polymorphisms and severe COVID-19

“…This signature may be useful for the assessment of prognostic features [ 15 ] of COVID-19 and the therapeutic targeting of potential drugs. [ 7 , 17 ] PKR plays a role in the course of COVID-19 infection, including a regulatory role [ 6 , 18 ] in the virus-induced stress response and induces possible insulin resistance, [ 6 ] contributing to the progression of pathophysiological processes in COVID-19 patients with co-morbid diabetes. MBL2 gene polymorphisms [ 19 ] are thought to be associated with the severity of COVID-19 infection, and the presence of the B allele (rs1800450) [ 20 ] due to MBL deficiency is associated with poorer clinical presentation of patients, including the need for hospitalization and the need for ventilator use.…”

“…The pathogenic process of SARS-Cov-2 is related to the mechanism by which the virus enters the host cell through binding to angiotensin-2 converting enzyme (ACE-2). [ 7 ] Currently, it has been proposed that genetic polymorphisms among different populations may influence the progression of COVID-19 reassortment. These genes include HLA, ACE1, OAS-1, MxA, PKR, MBL, E-CR1, FcγRIIA, MBL2.…”

Importance of maintaining and improving immune function by diet, nutrition and exercise before specific vaccinations and therapeutic drugs for COVID-19

“…In COVID-19, preventive measures against infection are essential. For this purpose, it is important to enhance individual immune function, that is, resistance to infection, by improving lifestyle habits such as diet, nutrition [10][11][12] and moderate exercise [13][14][15][16][17]. The spread of infection may continue to occur due to the emergence of new variant strains or drug resistance.…”