Interesante articulo (1) publicado en European Journal of Preventive Cardiology sobre lo que ha supuesto el confinamiento, la permanencia en casa como consecuencia de la nueva enfermedad por coronavirus 2019 (COVID-19). Durante unos meses como medida para evitar la propagación del virus, se tomaron decisiones de “cierre total” de actividades y salidas al exterior, con los posibles efectos nocivos de la inactividad física. En muchos casos, el trabajo en las oficinas se sustituyó por “teletrabajo”, y las actividades deportivas fueron suspendidas al aire libre, de tal modo que se vieron peligrar las recomendaciones básicas sobre ejercicio en el grupo de edad más comprometido por el coronavirus, es decir, entrenamiento semanal de al menos 150 minutos de actividad física de intensidad moderada o 75 minutos de actividad física de intensidad vigorosa, o una combinación correspondiente de actividad de intensidad moderada e intensiva.
En otro artículo, en el que he tenido la suerte de participar (2) publicado en Nutrients, revisamos el imparto metabólico del confinamiento. Está claro que durante este periodo hemos vivido muchas experiencias, se han ido acumulando momentos de depresión, irritabilidad, desasosiego e incluso desesperanza. Y el ejercicio es una excelente “válvula de escape” que nos ayuda a aliviar muchos problemas. Se ha comprobado que alcanzar los niveles de actividad física recomendados por la OMS se asocia con un riesgo 17% menor de eventos cardiovasculares, un 23% menor riesgo de mortalidad cardiovascular y un 26% menor incidencia de diabetes tipo 2.
Se describen los efectos nocivos tras un cese abrupto de la actividad física, como el que ha sucedido con la cuarentena del covid19, con aparición rápida de resistencia a la insulina en el tejido muscular y disminución de la utilización de glucosa muscular, con la consiguiente atrofia muscular, así como deterioro de la capacidad aeróbica y problemas de hipertensión arterial. Muy interesante es la mención al consumo reducido de energía por los músculos que puede fomentar la producción de lipoproteínas aterogénicas, promoviendo acumulación de lípidos dentro de los vasos sanguíneos y acelerar la enfermedad aterosclerótica.
Uno de los aspectos que más se ha descrito durante esta fase de confinamiento ha sido la reducción de urgencias hospitalarias cardiovasculares, con una disminución impresionante de eventos coronarios (anginas, infartos, revascularizaciones). Pero tras esa fase hemos comprobado que esos eventos si que se han producido, pero los pacientes no acudían a los centros hospitalarios, probablemente por miedo a sufrir infecciones por coronavirus. Hay que resaltar que el cese de la actividad física puede provocar una disminución del retorno venoso y una menor perfusión coronaria, aumentando el riesgo de anginas e infartos de miocardio.
Por eso desde amplios sectores médicos se ha estado insistiendo en la necesidad de mantenerse activo durante esta fase (no sabemos si habrá nuevos rebrotes), manteniendo una actitud activa, realizando ejercicios aeróbicos simultaneando con ejercicios de resistencia y fuerza. Y esa actitud positiva debe mantenerse una vez que se nos permita salir a la calle y poder realizar una vida “más normal”, pero recordando siempre mantener distancia de seguridad y emplear mascarillas cuando sea necesario.
REFERENCIAS
- Physical inactivity and cardiovascular disease at the time of coronavirus disease 2019 (COVID-19). Lippi G, Henry BM, Sanchis-Gomar F. European Journal of Preventive Cardiology Volume: 27 issue: 9, page(s): 906-908. Issue published: June 1, 2020. https://doi.org/10.1177/204748732091682
- Metabolic Impacts of Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits. Martinez-Ferran M, de la Guía-Galipienso F, Sanchis-Gomar F, Pareja-Galeano H. Nutrients 2020, 12(6), 1549; May 26,2020 https://doi.org/10.3390/nu12061549 – 26 May 2020
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