Declaring Physical Activity as ‘ Essential ’ during the COVID-19 Pandemic May not be a Good Measure

Dear Editor, We congratulate the authors on the viewpoint entitled “Should Physical Activity Be Considered Essential During the COVID-19 Pandemic?”,1 and we are thankful for the opportunity to provide some contributions on this current and relevant topic. We agree with the evidence that the practice of physical activity improves the immune response and promotes benefits for the mental health and cardiovascular and metabolic systems, and that this practice might not be interrupted during the pandemic. We highlight that exercise should be performed at home or in the neighborhood areas whenever possible, and always following the recommendations of local governments, according to recommended by the American College of Sports Medicine. We also agree that people should avoid remaining seated, lying down or using electronic gadgets for long periods – in other words, a sedentary behavior should be avoided. However, we do not agree that there is enough scientific evidence to justify a government declaration stating that the practice of physical activity is an essential activity, and herein we present our arguments. The Brazilian legislation, according to the Decree number 10282 (March 20, 2020), defines essential activities as indispensable services that, if not provided, would endanger the survival, health, and safety of the population. Nevertheless, the subjectivity of the term “essential” cannot be disregarded and may cause diverse interpretations. There is strong consensus among epidemiologists that, in face of the high transmissibility of the new coronavirus (SARS-CoV-2), even among asymptomatic individuals, and absence of a vaccine or specific treatment for COVID-19, social distancing is the most efficient measure to flatten the epidemic curve.2 In the opposite direction, the Brazilian government published the Decree number 10344 on May 11, 2020, defining, among others, activities performed in “sports centers (all modalities), following the determinations of the Ministry of Health, as “essential”. In our opinion, this could lead to a boom in the number of cases in the country. In a study held in Cheonan, South Korea, 112 people were infected by SARS-CoV-2 after 24 days of dance fitness classes in 12 sports centers.3 We believe that the best way for the government to establish different levels of social distancing is by considering risk classification, taking into account the reality of each state and city, as it has been happening in countries that managed to overcome the most critical phase of COVID-19 pandemic. It is true that Brazil, beyond the economic and sanitary crisis caused by COVID-19, also goes through a political crisis, with resignation of two health ministers during the pandemic, and lead of the Ministry of Health under an interim minister for more than 15 days already. Furthermore, there are frequent statements by the Brazilian President minimizing the severity of the pandemic situation and the increasing number of deaths, which has even caused foreign reactions.4 Public opinion polls, published by the Datafolha Institute, held on May 2526, 2020, with 2,069 adult Brazilian from all states of the country, (all had a mobile phone), with a margin of error of 2%, showed that the percentage of people supporting social distancing decreased from 76% in the beginning of April to 65%. The authors of the viewpoint commented that when both France and the United Kingdom declared more severe restrictive measures admitted the possibility of the practice of physical activity in open spaces. However, the French capital, after evaluating the non-deceleration of the disease, banned the practice of activities in open areas between 10 a.m. and 7 p.m. In addition, the epidemiological situation in Brazil today is much worse than when these countries enacted such measures, with a total of 498,440 cases, 33,274 new COVID-19; Pandemics; Betacoronavirus; Motor Activity; Exercise; Sports; Social Distancing; Mental Health. Keywords

We agree with the evidence that the practice of physical activity improves the immune response and promotes benefits for the mental health and cardiovascular and metabolic systems, and that this practice might not be interrupted during the pandemic. We highlight that exercise should be performed at home or in the neighborhood areas whenever possible, and always following the recommendations of local governments, according to recommended by the American College of Sports Medicine. We also agree that people should avoid remaining seated, lying down or using electronic gadgets for long periods -in other words, a sedentary behavior should be avoided. However, we do not agree that there is enough scientific evidence to justify a government declaration stating that the practice of physical activity is an essential activity, and herein we present our arguments.
The Brazilian legislation, according to the Decree number 10282 (March 20, 2020), defines essential activities as indispensable services that, if not provided, would endanger the survival, health, and safety of the population. Nevertheless, the subjectivity of the term "essential" cannot be disregarded and may cause diverse interpretations.
There is strong consensus among epidemiologists that, in face of the high transmissibility of the new coronavirus (SARS-CoV-2), even among asymptomatic individuals, and absence of a vaccine or specific treatment for COVID-19, social distancing is the most efficient measure to flatten the epidemic curve. 2 In the opposite direction, the Brazilian government published the Decree number 10344 on May 11, 2020, defining, among others, activities performed in "sports centers (all modalities), following the determinations of the Ministry of Health, as "essential". In our opinion, this could lead to a boom in the number of cases in the country. In a study held in Cheonan, South Korea, 112 people were infected by SARS-CoV-2 after 24 days of dance fitness classes in 12 sports centers. 3 We believe that the best way for the government to establish different levels of social distancing is by considering risk classification, taking into account the reality of each state and city, as it has been happening in countries that managed to overcome the most critical phase of COVID-19 pandemic.
It is true that Brazil, beyond the economic and sanitary crisis caused by COVID-19, also goes through a political crisis, with resignation of two health ministers during the pandemic, and lead of the Ministry of Health under an interim minister for more than 15 days already. Furthermore, there are frequent statements by the Brazilian President minimizing the severity of the pandemic situation and the increasing number of deaths, which has even caused foreign reactions. 4 Public opinion polls, published by the Datafolha Institute, held on May 25-26, 2020, with 2,069 adult Brazilian from all states of the country, (all had a mobile phone), with a margin of error of 2%, showed that the percentage of people supporting social distancing decreased from 76% in the beginning of April to 65%.

References
This is an open-access article distributed under the terms of the Creative Commons Attribution License daily cases and more than 1,000 deaths per day, registered on more than three consecutive days. 5 Then, it is needed to consider cultural and epidemiologic differences of these countries in comparison with Brazil, a country of continental dimensions with huge social inequalities, and where part of the population lives in extreme poverty.
It is worth pointing out that, out of the three articles mentioned by the authors, highlighting the importance of being physically active during the COVID-19 pandemic, two articles are points of view and one is a comment, and one of them were published by the same authors of the referred text. The two opinions indicate the importance of the practice of physical activities at home or in open areas, but they also reinforce the need to observe and respect the recommendations of the local sanitary authorities about the use of public spaces.
There is no scientific evidence supporting that the deaths caused by the interruption or lowering of a regular practice of physical activities, even for a short time, could be more harmful than the risk of a massive contamination by SARS-CoV-2. Other issues must be investigated, such as: does the practice of physical activities on a daily basis do promote immunological benefit against COVID-19? How much time of physical exercise would be necessary? How long would it take to a person lose this supposed benefit?
It is a challenge for governments to determine when the benefits of reduction in cardiovascular risk and improvement in mental health and immune system, promoted by physical activity, overcome the need for strict measures to contain the pandemic.
In our opinion, it is the role of the governments to hold educational campaigns that stimulate and guide the practice of physical activities at home, through a variety of medias, while the restrictive measures are in force. But, to officially decree that physical activities are "essential" activities, seems to be a risky and reckless alternative considering the epidemiological and political contexts in Brazil today. The incentive to the circulation of people in the present sanitary conjuncture can cost lives and lead to the need of a more prolonged time of restrictive measures, or even a lockdown.

Erratum
On pages 589-590: Where it read: "We congratulate the authors on the viewpoint entitled "Should Physical Activity Be Considered Essential During the COVID-19 Pandemic?", and we are thankful for the opportunity to provide some contributions on this current and relevant topic."