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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">ijcs</journal-id>
      <journal-title-group>
        <journal-title>International Journal of Cardiovascular Sciences</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Int. J. Cardiovasc. Sci.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">2359-4802</issn>
      <issn pub-type="epub">2359-5647</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id specific-use="scielo-v3" pub-id-type="publisher-id">hTRMRZVkfvbggTVLhYChjcT</article-id>
      <article-id specific-use="previous-pid" pub-id-type="publisher-id">S2359-56472021005004209</article-id>
      <article-id specific-use="scielo-v2" pub-id-type="publisher-id">S2359-56472021000300324</article-id>
      <article-id pub-id-type="publisher-id">ijcs.20200274</article-id>
      <article-id pub-id-type="doi">10.36660/ijcs.20200274</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Letter to the Editor</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>The Big Mistake of not Considering Physical Activity an Essential Element of Care During the Covid-19 Pandemic</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0002-1033-8684</contrib-id>
          <name>
            <surname>Pitanga</surname>
            <given-names>Francisco Jos&#233; Gondim</given-names>
          </name>
          <xref ref-type="aff" rid="aff1">
            <sup>1</sup>
          </xref>
          <xref ref-type="corresp" rid="c1"/>
        </contrib>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0002-9429-9140</contrib-id>
          <name>
            <surname>Beck</surname>
            <given-names>Carmem Cristina</given-names>
          </name>
          <xref ref-type="aff" rid="aff2">
            <sup>2</sup>
          </xref>
        </contrib>
        <contrib contrib-type="author">
          <contrib-id contrib-id-type="orcid">0000-0001-8276-3738</contrib-id>
          <name>
            <surname>Pitanga</surname>
            <given-names>Cristiano Penas Seara</given-names>
          </name>
          <xref ref-type="aff" rid="aff3">
            <sup>3</sup>
          </xref>
        </contrib>
        <aff id="aff1">
          <label>1</label>
          <institution content-type="orgname">Universidade Federal da Bahia</institution>
          <addr-line>
            <named-content content-type="city">Salvador</named-content>
            <named-content content-type="state">BA</named-content>
          </addr-line>
          <country country="BR">Brazil</country>
          <institution content-type="original">Universidade Federal da Bahia, Salvador, BA &#8211; Brazil.</institution>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution content-type="orgname">Instituto Federal de Santa Catarina</institution>
          <addr-line>
            <named-content content-type="city">Florian&#243;polis</named-content>
            <named-content content-type="state">SC</named-content>
          </addr-line>
          <country country="BR">Brazil</country>
          <institution content-type="original">Instituto Federal de Santa Catarina, Florian&#243;polis, SC &#8211; Brazil.</institution>
        </aff>
        <aff id="aff3">
          <label>3</label>
          <institution content-type="orgname">Universidade Cat&#243;lica do Salvador</institution>
          <addr-line>
            <named-content content-type="city">Salvador</named-content>
            <named-content content-type="state">BA</named-content>
          </addr-line>
          <country country="BR">Brazil</country>
          <institution content-type="original">Universidade Cat&#243;lica do Salvador, Salvador, BA &#8211; Brazil.</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c1"><bold>Mailing Address: Francisco Jos&#233; Gondim Pitanga</bold>, Av. Reitor Miguel Calmon, s/n. Postal Code: <postal-code>40110-060</postal-code>, Vale do Canela, Salvador, BA &#8211; Brazil. E-mail: <email>pitanga@lognet.com.br</email> </corresp>
      </author-notes>
      <pub-date date-type="pub" publication-format="electronic">
        <day>30</day>
        <month>04</month>
        <year>2021</year>
      </pub-date>
      <pub-date date-type="collection" publication-format="electronic">
        <season>May-Jun</season>
        <year>2021</year>
      </pub-date>
      <volume>34</volume>
      <issue>3</issue>
      <fpage>324</fpage>
      <lpage>325</lpage>
      <history>
        <date date-type="received">
          <day>08</day>
          <month>09</month>
          <year>2020</year>
        </date>
        <date date-type="rev-recd">
          <day>26</day>
          <month>10</month>
          <year>2020</year>
        </date>
        <date date-type="accepted">
          <day>08</day>
          <month>11</month>
          <year>2020</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/" xml:lang="en">
          <license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <kwd-group xml:lang="en">
        <title>Keywords</title>
        <kwd>COVID-19, Betacoronavirus, Exercise</kwd>
        <kwd>Pandemics</kwd>
        <kwd>Hospitalization</kwd>
        <kwd>Physical Activity</kwd>
        <kwd>Quality of Life</kwd>
        <kwd>Epidemiology</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="0"/>
        <equation-count count="0"/>
        <ref-count count="10"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <p>Dear Editor,</p>
    <p>In response to the letter to the editor entitled &#8220;Declaring physical activity as 'essential' during the Covid-19 pandemic may not be a good measure&#8221;<xref ref-type="bibr" rid="B1"><sup>1</sup></xref> that presented contributions to our point of view entitled &#8220;Should physical activity be considered essential activity during the Covid-19 pandemic?&#8221;<xref ref-type="bibr" rid="B2"><sup>2</sup></xref> we thank you for the suggestions and we present a reply letter with our arguments:</p>
    <p>Although the benefits of physical activity for the cardiovascular, metabolic, immune systems, as well as for mental health are very well documented in the literature,<xref ref-type="bibr" rid="B3"><sup>3</sup></xref><sup>,</sup><xref ref-type="bibr" rid="B4"><sup>4</sup></xref><sup>,</sup><xref ref-type="bibr" rid="B5"><sup>5</sup></xref> the discussion about physical activity is considered essential during the new coronavirus pandemic remains with different positions on the part of the researchers.</p>
    <p>The main source of disagreement seems to be about the greater probability of infection when practicing physical activity in open environments or in fitness centers, a fact that lacks scientific proof. The study cited by the authors of the letter to the editor, about contamination by the new coranavirus in dance studios, was carried out at the beginning of the pandemic, when the biosafety protocols currently adopted did not exist, both for outdoor activities and for fitness centers.<xref ref-type="bibr" rid="B6"><sup>6</sup></xref> </p>
    <p>From a political point of view, which seems to be the main source of argument for the authors of the letter to the editor, we clarify that since February 2020, the Federal Government of Brazil published law n&#186; 13,979, of February 6, 2020, which provides for measures to facing the public health emergency of international importance resulting from the coronavirus responsible for the 2019 outbreak, a fact that leads us to believe that all necessary measures have been taken to face the pandemic.</p>
    <p>Specifically with regard to physical activity, both the Federal Government of Brazil and the Legislative Assembly of the State of Santa Catarina, Brail, published documents regarding physical activity as essential during the pandemic. In the case of the state of Santa Catarina, law n&#186; 17941 of 05/08/2020 was published and the Federal Government, Decree n&#186; 10,344, of May 11, 2020 was published.</p>
    <p>It is important to note that in the case of the state of Santa Catarina, despite the law that considered physical activity as essential, having been published in the beginning of May 2020, its capital Florian&#243;polis, it remains among the Brazilian capitals that it presents in relation to too, small number of deaths, as well as low lethality of the disease. It is noteworthy that in this capital, since the enactment of the state law, public spaces were released for physical activity and the fitness centers were opened so that people could attend them, obviously following strict biosafety protocols.</p>
    <p>On the other hand, as we have a recent disease, specific studies on physical activity as a protective factor for mortality due to Covid-19, as well as on the worsening of the clinical picture are still scarce, despite the fact that the first published recently of them when it was demonstrated that physical activity was a protective factor for hospitalizations due to the new coronavirus, despite the information on lifestyle having been collected in 2010.<xref ref-type="bibr" rid="B7"><sup>7</sup></xref> </p>
    <p>Another more recent study carried out in 45 African countries demonstrated an association between physical inactivity and mortality due to Covid-19. It is noteworthy that the association was observed only in accumulated deaths, not remaining statistically significant when deaths were adjusted per million inhabitants<xref ref-type="bibr" rid="B8"><sup>8</sup></xref>.</p>
    <p>It is important to note that despite the scarcity of studies on physical activity and Covid-19, there are several studies that demonstrate that physical activity can influence the reduction of the worsening of the clinical picture and mortality, as well as positively, in the effects of vaccination in relation to influenza/H1N1, with different authors suggesting that these results can be transported to Covid-19, since these are pandemics with similar viral characteristics.<xref ref-type="bibr" rid="B9"><sup>9</sup></xref><sup>,</sup><xref ref-type="bibr" rid="B10"><sup>10</sup></xref> </p>
    <p>Thus, in our view, physical activity should be considered essential during the pandemic of the new coronavirus. We go even further, suggesting that the increase in the practice of physical activity by the population may make us better prepared not only for the current pandemic, but also for future ones that may come to affect us. Therefore, we insist on suggesting to our government officials that they consider physical activity as an essential activity in any legal determination that may be published.</p>
  </body>
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