Outdoor exercise during COVID-19
Are you confused about getting outside for exercise during this trying time of COVID-19? If so, you’re not alone. Like so much about the current situation, the advice about exercise right now can be confusing.
As a sports medicine specialist, I like to think physical activity is an elixir for better health and should be prescribed to most everyone. It’s one of the most effective treatments for multiple health issues (like cardiovascular disease, hypertension, depression, obesity, diabetes and others), and even moderate exercise has been shown to boost the immune system. Exercise is a medical prescription everyone should follow. However, the long-term benefits of exercise need to be pursued while also being smart about the serious risks of exposure to the virus.
As part of our state’s Stay Home, Stay Healthy order, many businesses including gyms are closed. Therefore, exercise needs to be done at home or outside. Yet, many options are unavailable—like parks, beaches and hiking trails that are closed to facilitate social distancing. In addition, the WHO and CDC are now recommending universal wearing of masks when leaving your home, but a mask can make exercise more difficult. All of this information can be hard to sort through.
So how do we exercise—while exercising caution—during the current public health crisis?
Is it safe to exercise outside?
Let’s start with what we know. We know that the virus that causes COVID-19 is spread through droplets released by infected people, such as when they sneeze or cough—and possibly even when talking or breathing. We know these droplets can hang in the air, especially in enclosed spaces. We also know people breathe more deeply during aerobic exercise. A person who is infected may have no symptoms and not know they are contagious. For these reasons, it is of the utmost importance to keep your distance from people you don’t live with—both to protect yourself and to help flatten the curve.
There is also much we do not know yet—but we can apply some common sense. When virus-carrying droplets occur outdoors, it is reasonable to think the concentration will be lower due to the open space. It is possible this would make the “viral dose” you might be exposed to less dangerous. You can lower your risk outdoors even more by maintaining a social distance of greater than 6 feet. One white paper (not yet peer reviewed) recommends staying out of the direct path or lane of people exercising 30-60 feet away, to avoid catching particles in their slipstream.
If you are running, walking or cycling, there is a risk of moving through a coronavirus droplet cloud—however, my assessment is this risk is small overall, so long as you follow the social distancing rules and avoid crowded areas. My recommendation for safety is to maintain a distance greater than 6 feet if you or others are running or cycling outdoors.
Do you need to wear a mask when exercising outside?
If you can use a mask when exercising outdoors, it too would help minimize your overall risk. However, I don’t believe it is absolutely necessary, and it may be difficult to do when exercising heavily. The CDC has information on wearing a cloth mask to slow the spread of COVID-19.
Remember, a cloth or paper mask plays the same role as covering your cough or sneeze: it protects those around you. And since any one of us may be infected with the coronavirus and not have symptoms, wearing a mask when exercising near others can help slow the spread of this disease.
Key takeaways. The risks of exercising outside can be minimized if you follow some guidelines:
- Avoid crowded areas.
- Head outside during slower times. Depending on your area, these may be early morning, during the day when others may be inside working, or in the dinner hour or evening.
- Cover your mouth and nose with a light mask, if feasible, while you exercise.
- For vigorous workouts, try cooler hours, when a mask might be more comfortable (or perhaps unnecessary, if fewer people are out).
- Keep your distance from others. Aim for more than 6 feet if you are walking, running, climbing stairs or cycling, or around others who are pursuing such activities.
- Avoid touching your face during your workout.
- When you return home, take off your gear/clothes and wash your hands thoroughly before touching your face.
- Avoid touching household items (knobs, counters, fridge door, etc.) until you have cleaned your hands.
- If you wear a cloth mask, clean it in a washing machine regularly.
There is risk in life and everyone needs to decide how much they are willing to accept. I think exercise is an important part of life, and while exercising outside has risks, these can be minimized.
I wish you the best in finding ways to maintain your health through exercise, while also taking precautions that make sense.
Chris Maeda, MD, practices sports medicine at Pacific Medical Centers. He sees patients at the PacMed clinics in Beacon Hill, Northgate, Canyon Park (Bothell) and Totem Lake. To schedule an appointment with Dr. Maeda, please call 1.888.472.2633.
Let us know if these tips helped you at StayHealthy@pacmed.org. Read more about PacMed’s response to COVID-19.
Parents Use Telemedicine to Get Daughter Life-Saving Care
Paying it forward: Physician’s mother was saved as a child by the same procedure
With stay-at-home orders in mind, many people are reluctant to venture out, even for needed health care. One family, however, learned firsthand that virtual visits—a new offering to keep medical appointments safe during COVID-19—are not only more convenient, but can also save lives.
On a Wednesday night this past April, 8-year-old Phoebe complained of not feeling well. She began throwing up. Her parents, Sara and Robbie, initially thought it might be her lactose intolerance acting up, thanks to recent quarantine dinners of pizza and ravioli.
“But every hour she kept vomiting,” her mother, Sara, said. “And I thought, Oh wow, she’s really got something.”
Sara stayed up with Phoebe through the night, posted near the bathroom. After a brief lull in early morning, they tried having Phoebe drink water, but the vomiting became worse and she began complaining of side pain. At 9:40, they decided to call PacMed.
PacMed Nurse Valentina heard the symptoms and, with extra stay-at-home precautions in place, immediately scheduled Phoebe for a 10 AM virtual visit. The family had never used the Zoom platform in MyChart (PacMed’s patient portal), so Medical Assistant Nyeelah called first and walked them through the technology. By 10:05, they were seeing the doctor, virtually.
“I’m glad they called and had the visit with us,” said Dr. Nawal Alkharouf, one of PacMed’s newest primary care physicians. “The alternative would have been a perforated appendix.”
Through the Zoom app on their computer, Dr. Alkharouf performed an initial assessment, including guiding the parents through a physical exam and asking clarifying questions to rule out similar conditions. “I tried to get her to do a jump test,” said Dr. Alkharouf, “to get up and just jump, but she couldn’t even get up. Just going from a laying to a sitting position was very difficult for her and she complained of pain. I could see on the camera that she was really guarding her right side.”
Based on the exam, Dr. Alkharouf suspected appendicitis, but there were a few atypical symptoms as well. With the added risks associated with exposure during COVID-19, the doctor wanted to be sure before sending them to the emergency room. So, she prescribed anti-nausea medicine, which the family picked up immediately. The doctor called them back 90 minutes later.
Phoebe was still vomiting, even on the medication, so once again, Dr. Alkharouf led them through a physical examination, with the parents’ assistance.
“She said, ‘Okay, you’re going to be my hands,’” related the mother, Sara. As Robbie held the camera up close to see Phoebe’s reactions, Sara performed the exam just as the doctor would have in the office, pressing down gently across Phoebe’s stomach to find the source of the pain.
They both noticed that Phoebe’s pain was more pronounced now on her right side—where the appendix is located—so they decided to bring her in to Seattle Children’s Hospital. After informing the hospital of Phoebe’s condition, Dr. Alkharouf called the parents back with details on the hospital’s COVID-19 visitor policy, as well as its valet service so Phoebe wouldn’t have to walk far.
After a wait (the hospital had to test Phoebe for COVID-19 before admitting her), she was cleared for laparoscopic surgery for her appendix later that night. When Dr. Alkharouf called the family in the hospital to follow up the next morning, Phoebe was already feeling better, keeping liquids down and enjoying Jell-O.
Looking back on the experience, Sara reflected, “The part I liked was using the camera like I did with the doctor. Phoebe could barely move, so if I had to go into the doctor to get it diagnosed, that would have been—torture for her.
“So, having her just lay on my bed and the doctor talking to us, just like we were sitting in front of her—that was really cool.”
Exactly 75 years earlier, another little girl was threatened by appendicitis, and a doctor took similarly innovative action at the time to save her life.
That little girl was Dr. Alkharouf’s mother.
It was in India, in 1945, before the country had partitioned into Pakistan, when the five-year-old began vomiting with abdominal pain and a fever. Her mother (Dr. Alkharouf’s grandmother) became very worried.
The only local hospital was British and was designated to treat only British military families in India. Still, the child’s uncle knew the hospital was their best hope. Against the odds, he biked to the hospital to plead with a doctor in person, saying she was only five and would die if they didn’t help her.
While it was against policy, the doctor was kind and agreed to visit the family in their home. After his examination, his face became grim. He told the family that the situation was dire, and she needed surgery right away. The family would later learn that the previous week, three British children had presented at the hospital with similar symptoms, indications of appendicitis. Sadly, all had died.
Immediately, they transported the young girl to the military base and operated—discovering that her appendix had already perforated. Nevertheless, they were able to perform a successful appendectomy. She became known around the hospital as “the miracle child.”
The hospital had a courtyard with a pond. During the girl’s recovery, the doctor would sit with her by the water. He taught her the ABC’s—her first exposure to English.
Rejuvenated and inspired by her introduction to this new world, that young girl grew up healthy and went into medicine herself. She became a family practice provider, married and started a family of her own. Her daughter, Nawal, would grow up and also become a physician, join PacMed—and save the life of young Phoebe the same way her mother had been saved.
“Seeing Phoebe made me remember my mom,” said Dr. Alkharouf. “I feel like it’s paying it forward, you know. Because if no one had saved my mom’s life, I wouldn’t be here. Not only that—they also inspired her and encouraged her; she became a doctor because of it. There’s a lot one person can do—sometimes we don’t realize our effect. Our words matter, our actions matter. They change lives, and we don’t always realize that.”
A few weeks after Phoebe’s surgery, PacMed called the family to check in. Phoebe was back to her normal self, facing the challenges of childhood these days. “Yeah she’s pretty active,” said Sara. “She keeps trying to do her math right now and she’s distracted, so I told her to run up and down the stairs, and move around.”
We shared the story of Dr. Alkharouf’s mother with Sara.
“That is very cool,” she said. “Since the surgery, we keep saying, Wow! We are just so thankful for medical care. Because if we didn’t have it”—she paused—“that would be awful.
“That would be terrible, just being in that much pain, and being able to do nothing about it. But the medical teams get it handled so quick these days, and help your child get out of pain.
“Yeah, it’s pretty awesome.”
You can schedule a virtual or in-person visit with PacMed by visiting doctors.pacificmedicalcenters.org, or by calling 1.888.472.2633.
Dr. Nawal Alkharouf provides care as a pediatrician out of PacMed’s Canyon Park clinic in Bothell.