The compelling link between physical activity and the body's defense system

Physical Activity and Natural Products and Minerals in the SARS-CoV-2 Pandemic: An Update

Coronavirus-disease 19 (COVID-19) has rapidly become a global public health issue, and there is a desperate need for strategies of prevention, reduction, and treatment to halt the epidemic. The coronavirus affects the immune system, and individuals with a compromised immune system, such as those with diabetes, hypertension, obesity, are more susceptible to this virus. Lifestyle-related variables such as physical activity and nutritional supplements can decrease inflammatory markers, increase anti-inflammatory and antioxidant status, and improve the immune system. Lifesty-lerelated variables play preventive roles against various infectious diseases including COVID-19. This review highlights the effects of physical activity and nutrients supplements on the immune system and their possible benefits in combating the harms caused by infection with the COVID-19 virus.

Association between physical activity and digestive-system cancer: An updated systematic review and meta-analysis

BACKGROUND

Physical activity (PA) may have an impact on digestive-system cancer (DSC) by improving insulin sensitivity and anticancer immune function and by reducing the exposure of the digestive tract to carcinogens by stimulating gastrointestinal motility, thus reducing transit time. The current study aimed to determine the effect of PA on different types of DSC via a systematic review and meta-analysis.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for relevant studies in PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. Using a random effects model, the relationship between PA and different types of DSC was analyzed.

RESULTS

The data used for meta-analysis were derived from 161 risk estimates in 47 studies involving 5,797,768 participants and 55,162 cases. We assessed the pooled associations between high vs. low PA levels and the risk of DSC (risk ratio (RR)  = 0.82, 95% confidence interval (95%CI): 0.79-0.85), colon cancer (RR = 0.81, 95%CI: 0.76-0.87), rectal cancer (RR = 0.88, 95%CI: 0.80-0.98), colorectal cancer (RR = 0.77, 95%CI: 0.69-0.85), gallbladder cancer (RR = 0.79, 95%CI: 0.64-0.98), gastric cancer (RR = 0.83, 95%CI: 0.76-0.91), liver cancer (RR = 0.73, 0.60-0.89), oropharyngeal cancer (RR = 0.79, 95%CI: 0.72-0.87), and pancreatic cancer (RR = 0.85, 95%CI: 0.78-0.93). The findings were comparable between case-control studies (RR = 0.73, 95%CI: 0.68-0.78) and prospective cohort studies (RR = 0.88, 95%CI: 0.80-0.91). The meta-analysis of 9 studies reporting low, moderate, and high PA levels, with 17 risk estimates, showed that compared to low PA, moderate PA may also reduce the risk of DSC (RR = 0.89, 95%CI: 0.80-1.00), while compared to moderate PA, high PA seemed to slightly increase the risk of DSC, although the results were not statistically significant (RR = 1.11, 95%CI: 0.94-1.32). In addition, limited evidence from 5 studies suggested that meeting the international PA guidelines might not significantly reduce the risk of DSC (RR = 0.96, 95%CI: 0.91-1.02).

CONCLUSION

Compared to previous research, this systematic review has provided more comprehensive information about the inverse relationship between PA and DSC risk. The updated evidence from the current meta-analysis indicates that a moderate-to-high PA level is a common protective factor that can significantly lower the overall risk of DSC. However, the reduction rate for specific cancers may vary. In addition, limited evidence suggests that meeting the international PA guidelines might not significantly reduce the risk of DSC. Thus, future studies must be conducted to determine the optimal dosage, frequency, intensity, and duration of PA required to reduce DSC risk effectively.

Women in sports: the applicability of common national reference intervals for inflammatory and coagulation biomarkers (HemSter Study)

Introduction

Intensive physical activity causes functional and metabolic changes in the athlete’s organism. The study aimed to verify the common national available reference intervals (RIs) for common inflammatory and screening coagulation tests in a population of healthy young female athletes.

Materials and methods

One hundred and twenty-one female athletes (age range: 16–34), from various sports disciplines (water polo, handball, volleyball, football, basketball), were included in the study. All participants completed the international physical activity short-form questionnaire. Blood samples were collected between 8–10 am, after an overnight fast, before any physical activity. Reference intervals were determined according to Clinical & Laboratory Standards Institute EP28-A3C Guidelines.

Results

Calculated RIs for white blood cell count (WBC), prothrombin time (PT), and activated partial thromboplastin time (APTT) ratio were in accordance with the common national RIs. Calculated RI for C-reactive protein (CRP) was lower (< 2.9 mg/L) than the proposed cut-off for a healthy population (< 5.0 mg/L). Reference interval for fibrinogen was higher (1.9–4.4 g/L), than the available RIs (1.8–3.5 g/L). D-dimer cut-off value was set at 852 µg/L fibrinogen equivalent units (FEU), higher than the proposed 500 µg/L FEU for venous thromboembolism (VTE) exclusion.

Conclusions

The applicability of the available RIs for WBC count, PT, and APTT-ratio was confirmed. However, RIs for CRP and fibrinogen differed significantly than the available common national RIs for the healthy non-athletes’ population. A higher cut-off for D-dimers should be extensively verified before implementation for VTE diagnosis exclusion in a group of healthy young female athletes.

Sedentary behavior, exercise and COVID-19: immune and metabolic implications in obesity and its comorbidities

Many reports showed a dramatic decrease in the levels of physical activity during the current pandemic of SARS-CoV-2. This has substantial immune and metabolic implications, especially in those at risk or with metabolic diseases including individuals with obesity and Type 2 diabetes. In this study we discussed the route from physical inactivity to immune and metabolic aberrancies; focusing on how insulin resistance could represent an adaptive mechanism to the low physical activity levels and on how such an adaptive mechanism could shift to a pathognomonic feature of metabolic diseases, creating a vicious circle of immune and metabolic aberrancies. We provide a theoretical framework to the severe immunopathology of COVID-19 in patients with metabolic diseases. We finally discuss the idea of exercise as a potential adjuvant against COVID-19 and emphasize how even interrupting prolonged periods of sitting with short time breaks of very light activity could be a feasible strategy to limit the deleterious effects of the outbreak.

Acute leucocyte, muscle damage, and stress marker responses to high-intensity functional training

BACKGROUND

High-intensity functional training (HIFT) has become more popular, and the number of practitioners has increased; however, it remains unclear whether perturbations in the immune parameters occur, even after one single bout. Our aim was to examine acute leucocyte, muscle damage, and stress marker responses following a single 'Cindy' workout session, and compare the results between novice and experienced participants.

MATERIAL AND METHODS

Twenty-three HIFT practitioners (age 31.0 ± 1.0 years) completed the 'Cindy' workout. They were categorized as novice (3-8 months of experience; n = 10) and experienced (≥18 months; n = 13). White blood cell (WBC) count, plasma creatine kinase (CK) activity, blood cortisol level, and lactate concentration were measured. Blood analysis was performed before (pre-ex), immediately after (post-ex), 30 min after (post-30 min), and 24 h after (post-24 h) a single 'Cindy' workout session.

RESULTS

WBC count was higher post-ex (6.8 to 11.8x103/μL) and returned to baseline values within post-30 min (p<0.01). Neutrophil (3.3 to 4.5x103/μL) and lymphocyte levels (2.8 to 5.9x103/μL) were higher post-ex and returned to baseline values after post-24 h, yet lymphocytopoenia (2.2x103/μL) was observed at post-30 min (p<0.01). CK increased post-ex (174.9 to 226.7 U.L-1) and remained elevated post-24 h. Cortisol (14.7 to 17.0 μg/dL) and lactate (1.9 to 13.5 mmol.l-1) responses increased post-ex, but only the lactate level was reduced at post-30 min (p<0.01). The experienced participants had higher WBC, lymphocyte, and cortisol concentrations post-ex than the novice ones (p<0.01).

CONCLUSIONS

A single HIFT session elicited significant acute perturbations in WBC count, stress markers, and muscle tissue, which is like other similar regimens. Importantly, the experienced participants showed greater lymphocyte and cortisol responses than the novice ones.

COVID-19: A Challenge to Physiology of Aging

The death toll of the current COVID-19 pandemic is strongly biased toward the elderly. COVID-19 case fatality rate (CFR) increases with age exponentially, its doubling time being about 7 years, irrespective of countries and epidemic stages. The same age-dependent mortality pattern known as the Gompertz law is featured by the total mortality and its main constituents attributed to cardiovascular, metabolic, neurological, and oncological diseases. Among patients dying of COVID-19, most have at least one of these conditions, whereas none is found in most of those who pass it successfully. Thus, gerontology is indispensable in dealing with the pandemic, which becomes a benchmark for validating the gerontological concepts and advances. The two basic alternative gerontological concepts imply that either aging results from the accumulation of stochastic damage, or is programmed. Based on these different grounds, several putative anti-aging drugs have been proposed as adjuvant means for COVID-19 prevention and/or treatment. These proposals are reviewed in the context of attributing the molecular targets of these drugs to the signaling pathways between the sensors of resource availability and the molecular mechanisms that allocate resources to storage, growth and reproduction or to self-maintenance and repair. Each of the drugs appears to reproduce only a part of the physiological responses to reduced resource availability caused by either dietary calories restriction or physical activity promotion, which are the most robust means of mitigating the adverse manifestations of aging. In the pathophysiological terms, the conditions of the endothelium, which worsen as age increases and may be significantly improved by the physical activity, is a common limiting factor for the abilities to withstand both physical stresses and challenges imposed by COVID-19. However, the current anti-epidemic measures promote sedentary indoor lifestyles, at odds with the most efficient behavioral interventions known to decrease the vulnerability to both the severe forms of COVID-19 and the prevalent aging-associated diseases. To achieve a proper balance in public health approaches to COVID-19, gerontologists should be involved in crosstalk between virologists, therapists, epidemiologists, and policy makers. The present publication suggests a conceptual background for that.

Changes in Inflammatory Cytokines and Irisin in Response to High Intensity Swimming in Adolescent versus Adult Male Swimmers

Swimming is a popular youth sport that is considered beneficial for cardiovascular fitness. However, the potential inflammatory outcomes of high intensity swimming in younger swimmers are unclear, as is the response of irisin, a myokine released during exercise with anti-inflammatory properties. This study compared the plasma concentrations of interleukins 1-beta (IL-1β), 6 (IL-6), 10 (IL-10), tumor necrosis factor alpha (TNF-α) and irisin in response to intense swimming between adolescent and adult male swimmers. Thirty-two swimmers (16 adolescents, 14 ± 1 years; 16 adults, 21.5 ± 3.1 years) completed a high intensity interval swimming trial. At rest, only TNF-α was higher (33%, p < 0.05) in adolescents compared with adults. There was an overall significant increase in IL-1β from pre- to post-swimming (3% in adolescents, 24% in adults), but no significant interaction. IL-10 significantly increased in both groups (+34% in adolescents, +56% in adults). IL-6 and TNF-α increased significantly (+32% and +26%, respectively) in adults, but not in adolescents (+2% and -9%, respectively). Adults showed a small, but significant decrease in irisin (-5%), with no change in adolescents. The lack of an IL-6, TNF-α and irisin response to intense swimming in adolescent swimmers may suggest a blunted inflammatory and myokine response following high intensity exercise in trained youth.

Susceptibility of the obese population to COVID-19

Obesity is a risk factor for disease severity in individuals with coronavirus disease (COVID-19). However, the increased susceptibility of this population to COVID-19 is unclear. We outline several underlying mechanisms that may explain the relationship between obesity and COVID-19 severity. Obesity has an adverse effect on respiratory physiology because increased intra-abdominal adipose tissue can interfere with lung expansion, resulting in reduced lung compliance. Further, fat accumulation in the soft tissue of the pharynx can increase inspiratory resistance, and obesity may be associated with sleep apnea. Obesity is associated with several defects in cell-mediated immunity, including increased levels of pro-inflammatory cytokines. Impaired adipocyte-mediated immune function results in chronically high leptin levels, low adiponectin levels, and anti-inflammatory adipokines. Reduced physical activity can impair several steps of the immune response to viruses. Obesity also promotes a hypercoagulable state, leading to severe consequences. These factors may synergistically play a role in promoting the severity of the disease in obese individuals. A better understanding of the mechanisms by which obesity contributes to the severity of COVID-19 is important for developing more effective treatments.

Lifestyle factors in the prevention of COVID-19

Confinement to the home and psychological distress due to the coronavirus disease 2019 (COVID-19) pandemic may lead to harmful health behaviors, such as overeating, sedentary behavior with reduced physical activity, elevated alcohol and tobacco use and increased screen time causing impaired sleep. All of these behaviors are associated with non-communicable diseases and can interfere with immunity. While no foods, single nutrients or dietary supplements are capable of preventing infection with COVID-19, a balanced diet containing sufficient amounts of macronutrients and diverse micronutrients is a prerequisite of an optimally functioning immune system. High-energy "Western" diets and obesity are major risk factors for a more severe course of COVID-19. Alcohol use and tobacco also have detrimental effects on the immune system. Therefore, population-wide body weight control, reduction of smoking rates and limitation of alcohol consumption are important preventive measures. Furthermore, sufficient restorative sleep is needed for adequate immune functioning. Appropriate lifestyle changes in regard to nutrition, exercise, sleep, smoking and alcohol intake may help shift the population distribution of infection risk and aid in preventing severe COVID-19 disease. Large-scale surveys should explore the effects of lifestyle changes, and the provision of reliable lifestyle information and effective interventions to individuals and communities during the pandemic is a pressing need.

Forging Forward Together: Transforming Scientific Practice to Accelerate Scientific Progress

Rapidly advancing solutions requires our community to continuously re-examine successes of yesterday to inspire new approaches for today while collaboratively envisioning what’s needed for tomorrow.

Molecular mechanisms involved in the positive effects of physical activity on coping with COVID-19

PURPOSE

Physical activity (PA) represents the first line of defence against diseases characterised by increased inflammation status, such as metabolic and infectious diseases. Conversely, a sedentary lifestyle-associated with obesity, type 2 diabetes and cardiovascular disorders-negatively impacts on general health status, including susceptibility to infections. At a time of a pandemic SARS-CoV2 infection, and in the context of the multiorgan crosstalk (widely accepted as a mechanism participating in the pathophysiology of all organs and systems), we examine the complex interplay mediated by skeletal muscle contraction involving the immune system and how this contributes to control health status and to counteract viral infections. In so doing, we review the molecular mechanisms and expression of molecules modulated by PA, able to provide the proper molecular equipment against viral infections such as the current SARS-CoV2.

METHODS

A critical review of the literature was performed to elucidate the molecular mechanisms and mediators induced by PA that potentially impact on viral infections such as SARS-CoV2.

RESULTS

We showed the effects mediated by regular moderate PA on viral adverse effects through the regulation of biological processes involving the crosstalk between skeletal muscle, the immune system and adipose tissue. Evidence was provided of the effects mediated by modulation of the expression of inflammation markers.

CONCLUSION

A tigth association between PA and reduction in inflammation status allows effective counteracting of SARS-CoV2 infection. It is therefore essential to persuade people to keep active.

The Effect of Physical Training on Peripheral Blood Mononuclear Cell Ex Vivo Proliferation, Differentiation, Activity, and Reactive Oxygen Species Production in Racehorses

Physical activity has an influence on a variety of processes in an athlete's organism including the immune system. Unfortunately, there is a lack of studies regarding racehorse immune cells, especially when the horse model is compared to human exercise physiology. The aim of the study was to determine changes in immune cell proliferation, lymphocyte populations, and monocyte functionality in trained and untrained racehorses after exercise. In this study, field data were collected. The cells from 28 racehorses (14 untrained and 14 well-trained) were collected before and after exercise (800 m at a speed of about 800 m/min) and cultured for 4 days. The expression of CD4, CD8, FoxP3, CD14, MHCII, and CD5 in PBMC, and reactive oxygen species (ROS) production, as well as cell proliferation, were evaluated by flow cytometry. In addition, IL-1β, IL-4, IL-6, IL-10, IL-17, INF-γ, and TNF-α concentrations were evaluated by ELISA. The creation of an anti-inflammatory environment in well-trained horses was confirmed. In contrast, a pro-inflammatory reaction occurred in untrained horses after training. In conclusion, an anti-inflammatory state occurs in well-trained racehorses, which is an adaptational reaction to an increased workload during training.

Physical Exercise and Immune System in the Elderly: Implications and Importance in COVID-19 Pandemic Period

Physical exercise is seen as the main ally for health promotion, preventing and protecting the organism from several diseases. According to WHO, there is a tendency of constant growth in the elderly population in the coming years. The regular practice of exercises by the elderly becomes relevant to minimize the deleterious effects of the aging process and to increase the fitness index. Recently, the world population started a confrontation against Corona Virus Disease (COVID-19), which is the most significant public health challenge globally. Although social isolation is a reasonable measure in an attempt to stop contamination by COVID-19, this measure has limited the ability of individuals to exercise outdoors or in gyms and health clubs, which increased the risk of developing chronic illnesses related to a sedentary lifestyle. The critical point is that the recent recommendations on exercise prescription to combat the potentially harmful effects of COVID-19 failure to adequately address resistance exercise interventions as home-based exercise strategy. Thus, in this paper, we discussed the physical exercise as medicine if the training status is enough to protect the elderly against COVID-19 infection, about the role of physical activity on immunosuppression. Possible risks for COVID-19 infection, and the old training methods, such as no-load resistance training as possible resistance exercise strategies and high-intensity interval training, as new proposals of home-based exercise interventions, could perform during the current COVID-19 pandemic.

Overweight/obesity as the potentially most important lifestyle factor associated with signs of pneumonia in COVID-19

Objective

The occurrence of pneumonia separates severe cases of COVID-19 from the majority of cases with mild disease. However, the factors determining whether or not pneumonia develops remain to be fully uncovered. We therefore explored the associations of several lifestyle factors with signs of pneumonia in COVID-19.

Methods

Between May and July 2020, we conducted an online survey of 201 adults in Germany who had recently gone through COVID-19, predominantly as outpatients. Of these, 165 had a PCR-based diagnosis and 36 had a retrospective diagnosis by antibody testing. The survey covered demographic information, eight lifestyle factors, comorbidities and medication use. We defined the main outcome as the presence vs. the absence of signs of pneumonia, represented by dyspnea, the requirement for oxygen therapy or intubation.

Results

Signs of pneumonia occurred in 39 of the 165 individuals with a PCR-based diagnosis of COVID-19 (23.6%). Among the lifestyle factors examined, only overweight/obesity was associated with signs of pneumonia (odds ratio 2.68 (1.29–5.59) p = 0.008). The observed association remained significant after multivariate adjustment, with BMI as a metric variable, and also after including the antibody-positive individuals into the analysis.

Conclusions

This exploratory study finds an association of overweight/obesity with signs of pneumonia in COVID-19. This finding suggests that a signal proportional to body fat mass, such as the hormone leptin, impairs the body’s ability to clear SARS-CoV-2 before pneumonia develops. This hypothesis concurs with previous work and should be investigated further to possibly reduce the proportion of severe cases of COVID-19.

Clinical Characteristics and Survival Analysis in a Small Sample of Older COVID-19 Patients with Defined 60-Day Outcome

The older population is one of the most vulnerable to experience adverse outcomes of COVID-19. Exploring different clinical features that may act as detrimental to this population’s survival is pivotal for recognizing the highest risk individuals for poor outcome. We thus aimed to characterize the clinical differences between 60-day survivors and non-survivors, as well as analyze variables influencing survival in the first older adults hospitalized in Poznan, Poland, with COVID-19. Symptoms, comorbidities, complications, laboratory results, and functional capacity regarding the first 50 older patients (≥60 years) hospitalized due to COVID-19 were retrospectively studied. Functional status before admission (dependent/independent) was determined based on medical history. The 60-day survivors (n = 30/50) and non-survivors (n = 20/50) were compared across clinical parameters. The patients had a mean age of 74.8 ± 9.4 years. Overall, 20/50 patients died during hospitalization, with no further fatal outcomes reported during the 60-day period. The non-survivors were on average older (78.3 ± 9.7 years), more commonly experienced concurrent heart disease (75%), and displayed functional dependence (65%) (p < 0.05). When assessing the variables influencing survival (age, heart disease, and functional dependence), using a multivariate proportional hazards regression, functional dependence (requiring assistance in core activities of daily living) was the main factor affecting 60-day survival (HR, 3.34; 95% CI: 1.29–8.63; p = 0.01). In our study, functional dependence was the most important prognostic factor associated with mortality. Elderly with COVID-19 who required assistance in core activities of daily living prior to hospitalization had a three times increased risk to experience mortality, as compared to those with complete independence. Exploring geriatric approaches, such as assessment of functional capacity, may assist in constructing comprehensive survival prognosis in the elderly COVID-19 population.

Effects of whole-body cryotherapy on the innate and adaptive immune response in cyclists and runners

The study aimed to identify the effects of whole-body cryotherapy (WBC) on immunological, hormonal, and metabolic responses of non-professional male athletes. Ten cyclists and ten middle-distance runners received 3 once-a-day sessions of WBC. Before initiating and after the final WBC session, a full set of hematologic parameters, serum chemistry profile, hormones, circulating mitochondrial (mt) DNA levels, cytokines, and chemokines concentration were evaluated. The phenotype of monocyte, T cells, and B cells was analyzed. mRNA expression of 6 genes involved in inflammasome activation (NAIP, AIM2, NLRP3, PYCARD, IL-1β, and IL-18) was quantified. WBC reduced glucose and C and S protein and increased HDL, urea, insulin-like growth factor (IGF)-1, follicle-stimulating hormone, IL-18, IL-1RA, CCL2, and CXCL8. Intermediate and non-classical monocyte percentages decreased, and the CD14, CCR5, CCR2, and CXCR4 expressions changed in different subsets. Only IL-1β mRNA increased in monocytes. Finally, a redistribution of B and T cell subsets was observed, suggesting the migration of mature cells to tissue. WBC seems to induce changes in both innate and adaptive branches of the immune system, hormones, and metabolic status in non-professional male athletes, suggesting a beneficial involvement of WBC in tissue repair.

Barriers and facilitators to changes in adolescent physical activity during COVID-19

OBJECTIVES

COVID-19 restrictions reduced adolescents' opportunities for physical activity (PA). The purpose of this study was to examine how adolescent PA changed during school closures, to identify the key barriers and facilitators for these changes during lockdown and to use this information to understand how to manage future crises' situations positively to prevent physical inactivity.

METHODS

Irish adolescents (N=1214; ages 12-18 years) participated in an online cross-sectional study during April 2020, including items on PA level, changes in PA and reasons for change in an open-ended format. Numeric analyses were through multiple binary logistic regressions, stratified by changes in PA during lockdown and inductive analysis of open coding of text responses.

RESULTS

Adolescents reported they did less PA (50%), no change (30%) or did more PA during lockdown (20%). Adolescents who did less PA were more likely to be overweight (OR=1.8, CI=1.2-2.7) or obese (OR=2.2, CI=1.2-4.0) and less likely to have strong prior PA habits (OR=0.4, CI=0.2-0.6). The most cited barriers to PA were coronavirus, club training cancelled and time. Strong associations for doing more PA included participation in strengthening exercises at least three times in the past 7 days (OR=1.7, CI=1.3-2.4); facilitators were more time, coronavirus and no school.

CONCLUSION

COVID-19 restrictions were both a barrier to and an opportunity for PA. Parents, schools, public health, communities and industries must collaborate to prevent physical inactivity at times of crisis, especially for vulnerable groups.

Type 1 Diabetes and Physical Exercise: Moving (forward) as an Adjuvant Therapy

Type 1 diabetes is characterized by an autoimmune β-cell destruction resulting in endogenous insulin deficiency, potentially leading to micro- and macrovascular complications. Besides an exogenous insulin therapy and continuous glucose monitoring, physical exercise is recommended in adults with type 1 diabetes to improve overall health. The close relationship between physical exercise, inflammation, muscle contraction, and macronutrient intake has never been discussed in detail about type 1 diabetes. The aim of this narrative review was to detail the role of physical exercise in improving clinical outcomes, physiological responses to exercise and different nutrition and therapy strategies around exercise. Physical exercise has several positive effects on glucose uptake and systemic inflammation in adults with type 1 diabetes. A new approach via personalized therapy adaptations must be applied to target beneficial effects on complications as well as on body weight management. In combination with pre-defined macronutrient intake around exercise, adults with type 1 diabetes can expect similar physiological responses to physical exercise, as seen in their healthy counterparts. This review highlights interesting findings from recent studies related to exercise and type 1 diabetes. However, there is limited research available accompanied by a proper number of participants in the cohort of type 1 diabetes. Especially for this group of patients, an increased understanding of the impact of physical exercise can improve its effectiveness as an adjuvant therapy to move (forward).

Studies of Physical Activity and COVID-19 During the Pandemic: A Scoping Review

BACKGROUND

This scoping review aimed to identify the available evidence related to physical activity (PA) and the coronavirus disease (COVID-19) pandemic.

METHODS

A search in 6 databases (PubMed, Embase, SPORTDiscus, Scopus, Web of Science, and CINAHL) was conducted on July 23, 2020. Medical subject headings and keywords related to PA and COVID-19 were combined to conduct the online search, which covered the period from January to July 2020.

RESULTS

Overall, 1784 articles were retrieved. After duplicate removal and title, abstract, and full-text screening, 41 articles were included. Most of the included studies were quantitative and collected data through online interviews/questionnaires, with sample sizes larger than 100 and composed by adults and older adults. Changes in PA levels due to the COVID-19 pandemic were the most assessed outcome, followed by the association between mental health issues and PA. Only 2 studies assessed the direct effects of PA on COVID-19.

CONCLUSION

Most of the evidence identified a decrease in PA levels due to social distancing measures and that PA might help to decrease the mental health burden related to the COVID-19 outbreak.

Physical activity during COVID-19 pandemic in the Iranian population: A brief report

COVID-19 pandemic and restrictive public health measures due to it can have many effects on physical activity. Our study aimed to compare the levels of physical activity levels (expressed as MET-minute/week), among Qom city (Iran) adults in pre and during the COVID-19 pandemic (January 2020 and 20 to 29 May 2020, respectively). 670 adults were included in this study and grouped based on age and gender. The short-form International physical activity questionnaire (IPAQ, SF) was distributed to the participants through an online survey. The Wilcoxon signed-rank test was used for statistical analyses. The present study showed that the level of physical activity decreased significantly during COVID-19 compared to pre-COVID-19 in both sexes and age groups (p < 0.001). Also, this study found that a total of 78% of the participants did not meet the physical activity guidelines during COVID-19 in Iran. Our results indicate the necessity to consider an integrated and comprehensive approach to reduce the inactivity caused by COVID-19.

Exercise, nutrition, and medication considerations in the light of the COVID pandemic, with specific focus on geriatric population: A literature review

The pandemic of severe acute respiratory syndrome coronavirus 2 has spread across the world, causing causalities and inflicting chronic complications in those who survive the infection. Disruptions in the immune system and lowered physical levels caused by quarantine protocols are the major causes of chronic dysfunction and impaired life independency, especially in elderly patients. Multiple exercise suggestions and novel program delivery methods, including telerehabilitation/tele-exercise programs, home-gym strategies, and exergames, have emerged. Patients with underlying obesity, diabetes mellitus, malnutrition, or binge-eating problems are at a high risk of serious infection and sequela. Adequate education and coping strategies can lessen the potential infection complications and improve the quality of life. Acknowledging the possible benefits and risks of nonsteroidal anti-inflammatory drug usage in chronic pain patients, and the supplementation of vitamin D may also aid in treating post-infected patients.

Postexercise Inflammasome Activation and IL-1β Production Mitigated by Flavonoid Supplementation in Cyclists

Inflammasomes are multiprotein signaling platforms of the innate immune system that detect markers of physiological stress and promote the maturation of caspase-1 and interleukin 1 beta (IL-1β), IL-18, and gasdermin D. This randomized, cross-over trial investigated the influence of 2-week mixed flavonoid (FLAV) versus placebo (PL) supplementation on inflammasome activation and IL-1β and IL-18 production after 75-km cycling in 22 cyclists (42 ± 1.7 years). Blood samples were collected before and after the 2-week supplementation, and then 0 hr, 1.5 hr, and 21 hr postexercise (176 ± 5.4 min, 73.4 ± 2.0 %VO2max). The supplement (678 mg FLAVs) included quercetin, green tea catechins, and bilberry anthocyanins. The pattern of change in the plasma levels of the inflammasome adaptor oligomer ASC (apoptosis-associated speck-like protein containing caspase recruitment domain) was different between the FLAV and PL trials, with the FLAV ASC levels 52% lower (Cohen's d = 1.06) than PL immediately following 75-km cycling (interaction effect, p = .012). The plasma IL-1β levels in FLAV were significantly lower than PL (23-42%; Cohen's d = 0.293-0.644) throughout 21 hr of recovery (interaction effect, p = .004). The change in plasma gasdermin D levels were lower immediately postexercise in FLAV versus PL (15% contrast, p = .023; Cohen's d = 0.450). The patterns of change in plasma IL-18 and IL-37 did not differ between the FLAV and PL trials (interaction effects, p = .388, .716, respectively). These data indicate that 2-week FLAV ingestion mitigated inflammasome activation, with a corresponding decrease in IL-1β release in cyclists after a 75-km cycling time trial. The data from this study support the strategy of ingesting high amounts of FLAV to mitigate postexercise inflammation.

Physical Activity and Sociodemographic Profile of Brazilian People during COVID-19 Outbreak: An Online and Cross-Sectional Survey

The Coronavirus Disease 2019 (COVID-19) outbreak has created an unprecedented impact on global health and further aggravated the physical inactivity pandemic. For this reason, the understanding of sociodemographic variables in the context of physical activity levels are important for the field of public health in order to assist in relevant public health decisions. Our main aim was to characterize sociodemographic variables and physical activity levels and their association with COVID-19 aspects. We applied an online Google survey with closed questions in Brazilian people of different age and regions, both sexes and physical activity levels (n = 1.726). Our main results were that participants who had symptoms of COVID-19 had the highest percentage of level 1 of physical activity (the lowest level according to the classification used) and those who showed no symptoms had the highest percentage of levels 2 and 3 of physical activity; that is, close to the light/moderate levels of physical activity. This cross-sectional study in the Brazilian population provided important sociodemographic data and COVID-19 aspects regarding the level of physical activity. It is possible to assume that the regular practice of physical activity could positively impact health status and quality of life and be a tool in the field of public health to cope (from a physical and mental point of view) with disease scenarios that require quarantine.

Physical and Metabolic Changes after Ileal Pouch-Anal Anastomosis: A Case Study

This case study examined changes in body composition, resting metabolic rate (RMR), aerobic capacity, and daily physical activity in a patient who had ulcerative colitis and underwent ileal pouch-anal anastomosis (IPAA) surgery. Body composition, RMR, and peak oxygen consumption (VO₂peak) were assessed prior to surgery and four, eight, and 16 weeks after IPAA surgery. Daily physical activity data were extracted from a wrist-worn activity tracker preoperatively and 16 months postoperatively. At baseline, total body mass was 95.3 kg; body fat, 11.6%; lean body mass, 81.1 kg; RMR, 2416 kcal/d; and VO₂peak, 42.7 mL/kg/min. All values decreased from baseline at four weeks postoperatively, body mass was 85.2 kg (-10.5%); body fat, 10.9% (-6.0%); lean body mass, 73.1 kg (-9.9%); RMR 2210 kcal/d (-8.5%) and VO₂peak, 25.5 mL/kg/min (-40.3%). At 16 weeks postoperatively, most parameters were near their baseline levels (within 1-7%), exceptions were VO₂peak, which was 20.4% below baseline, and RMR, which increased to nearly 20% above baseline. After the patient had IPAA surgery, his total and lean body masses, RMR, and aerobic capacity were markedly decreased. Daily physical activity decreased postoperatively and likely contributed to the decreased aerobic capacity, which may take longer to recover compared to body composition and RMR parameters.

Mitochondria: In the Cross Fire of SARS-CoV-2 and Immunity

The pathophysiology, immune reaction, and differential vulnerability of different population groups and viral host immune system evasion strategies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are not yet well understood. Here, we reviewed the multitude of known strategies of coronaviruses and other viruses to usurp mitochondria-associated mechanisms involved in the host innate immune response and put them in context with the current knowledge on SARS-CoV-2. We argue that maintenance of mitochondrial integrity is essential for adequate innate immune system responses and to blunt mitochondrial modulation by SARS-CoV-2. Mitochondrial health thus may determine differential vulnerabilities to SARS-CoV-2 infection rendering markers of mitochondrial functions promising potential biomarkers for SARS-CoV-2 infection risk and severity of outcome. Current knowledge gaps on our understanding of mitochondrial involvement in SARS-CoV-2 infection, lifestyle, and pharmacological strategies to improve mitochondrial integrity and potential reciprocal interactions with chronic and age-related diseases, e.g., Parkinson disease, are pointed out.

Impact of COVID-19 Lockdown on Physical Activity in a Sample of Greek Adults

It is well known that physical inactivity increases the risk of global death; however, the impact of the coronavirus disease 2019 (COVID-19) lockdown strategy on physical activity (PA) remains unclear. This study compared PA-i.e., daily occupation, transportation to and from daily occupation, leisure time activities, and regular sporting activities-prior (PRE) and during (POST) the on-going COVID-19 outbreak in the Greece lockdown environment. A Greek version of the web-based Active-Q questionnaire was used to access PA. The questionnaire was filled out twice (once each for the PRE and POST conditions) by 8495 participants (age = 37.2 ± 0.2 years (95% confidence interval (CI), 36.9-37.5); males = 38.3% (95%CI, 36.7-40.0); females = 61.7% (95%CI, 60.4-63.0). The relative frequency of overall sporting activities, which, prior to lockdown, occurred at least once per month, and overall participation in competitive sports was significantly reduced (8.6% (95%CI, 7.9-9.3) and 84.7% (95%CI, 82.9-86.6) respectively). With the exception of overall leisure time activities, which were significantly increased in the POST condition, daily occupational, transportation, and sporting activities significant reduced (p < 0.05). Overall PA was reduced in all genders, age, body mass index (BMI) and PA level subgroups in the POST condition, and an interaction between the males and High PA subgroups was observed. The change in overall PA (from PRE to POST conditions) was -16.3% (95%CI, -17.3 to -15.4), while in daily occupational, transportation, and sporting activities, it was -52.9% (95%CI, -54.8-51.0), -41.1% (95%CI, -42.8-39.5) and -23.9% (95%CI, -25.1-22.8), respectively. Thus, the lockdown period is highly associated with a negative change in overall PA. During lockdown, inactivity increased dramatically, with males and the high PA population affected significantly more. The decline in PA is a great concern due to possible long-term consequences on public health and healthcare system.

Anthropometry, physical activity and cancer of unknown primary (CUP) risk: Results from the Netherlands cohort study

BACKGROUND

Cancer of Unknown Primary (CUP) is a metastatic disease for which the primary tumour origin could not be identified during life. Few studies have investigated the risk factors associated with this disease. This study investigates anthropometry, physical activity and CUP risk.

METHODS

Data is used from the Netherlands Cohort Study, which includes 120,852 participants aged 55-69 years. All cohort members completed a self-administered questionnaire on cancer risk factors at baseline in 1986. Cancer follow-up was established through record linkage to the Netherlands Cancer Registry and the Dutch Pathology Registry. After a follow-up of 20.3 years, 926 incident CUP cases and 4099 subcohort members were available for case-cohort analyses. Proportional hazards models were used to compute multivariable adjusted hazard ratios (HRs).

RESULTS

We found no associations between height, body mass index (BMI) at baseline, BMI at age 20 years, change in BMI since age 20 years, clothing size (trouser/skirt size), or non-occupational physical activity and CUP risk.

CONCLUSION

Our findings indicate that neither anthropometry nor physical activity are associated with the development of CUP.

Physical Activity and Breast Cancer Prevention: Possible Role of Immune Mediators

There is strong evidence that physical activity (PA) reduces risk, recurrence, and mortality from breast cancer. Emerging data suggest that PA induces changes in inflammatory and immune mediators that may contribute to beneficial effects on breast cancer outcomes. Thus, the goal of this review was to evaluate the evidence linking the protective benefit of PA to modulation of immune responses in breast cancer. A literature search was conducted to identify studies that evaluated the impact of PA on tumor and immune outcomes in breast cancer patients and in mammary tumor models. Nineteen studies investigated the effect of PA interventions on cancer immune outcomes using preclinical breast cancer models. Tumor growth was reduced in 11 studies, unchanged in three studies, and increased in one study. Spontaneous metastasis was reduced in two studies and survival was improved in four studies. Frequently assessed immune outcomes include splenic cell number and function, circulating inflammatory cytokines, and intratumoral immune cells and inflammatory markers. Circulating inflammatory cytokine responses were heterogeneous in preclinical models. Within the tumor microenvironment (TME), several studies documented a change in the infiltration of immune cells with an increase in effector cells and a reduction in immune suppressive cells. Twenty-three studies investigated the effect of PA interventions on immune outcomes in breast cancer patients. Thirteen studies used aerobic PA interventions and 10 studies used a combination of aerobic and resistance exercise interventions. Cycling and treadmill activities were the most commonly used PA modalities. Circulating immune cells and inflammatory cytokines were the most frequently assessed immune outcomes in the clinical studies. Among the 19 studies that evaluated a PA intervention during the post treatment period, 10 reported a reduction in the levels of at least one inflammatory cytokine. No inflammatory cytokines were quantified in the three studies that evaluated a PA intervention during treatment with chemotherapy. Immune outcomes within the tumor were assessed in only one study performing a PA intervention prior to surgery. Results from preclinical and clinical studies suggest that PA exerts heterogeneous effects on inflammatory cytokines, but may alter the gene expression profile and immune infiltrates in the tumor which may result in a reduction in immunosuppressive factors. However, additional studies are needed to better understand the effect of PA on immune outcomes in the TME.

Exploring the pathophysiology of post-sepsis syndrome to identify therapeutic opportunities

Sepsis is a major health problem worldwide. As the number of sepsis cases increases, so does the number of sepsis survivors who suffer from “post-sepsis syndrome” after hospital discharge. This syndrome involves deficits in multiple systems, including the immune, cognitive, psychiatric, cardiovascular, and renal systems. Combined, these detrimental consequences lead to rehospitalizations, poorer quality of life, and increased mortality. Understanding the pathophysiology of these issues is crucial to develop new therapeutic opportunities to improve survival rate and quality of life of sepsis survivors. Such novel strategies include modulating the immune system and addressing mitochondrial dysfunction. A sepsis follow-up clinic may be useful to identify long-term health issues associated with post-sepsis syndrome and evaluate existing and novel strategies to improve the lives of sepsis survivors.

Immune Response in Young Thoroughbred Racehorses under Training

Simple Summary

Stressful stimuli, both infectious and non-infectious, can modify and trigger an innate immune response and inflammation, via an attempt to restore a homeostatic state. Coping with stressors can be measured by different procedures, including the evaluation of immunological parameters. These are also modulated by exercise, which can be considered stress prototypic in the Thoroughbred racehorse. To evaluate the complex of physiological regulations during the training period, twenty-nine clinically healthy, two-year-old Thoroughbred racehorses were followed during their first 3 months of sprint training. Blood collection was performed at rest, three times until 90 days of training, for testing immunological parameters during incremental sprint training to evaluate its effect on the immunological status of the animals. During the training period, we observed the following: (A) an increase in red blood cell parameters that are crucial for exercise performance adaptation, improving O₂ transport and muscle cell respiration; (B) variations of blood granulocytes; and (C) changes in inflammatory cytokine gene expression. On the basis of clinical and laboratory findings, training exercise probably played a major role in the modulation of the above parameters. These latter changes could be seen as a preparation of the innate immune system to respond quickly and adequately to environmental conditions.

Abstract

Training has a great impact on the physiology of an athlete and, like all stressful stimuli, can trigger an innate immune response and inflammation, which is part of a wider coping strategy of the host to restore homeostasis. The Thoroughbred racehorse is a valid animal model to investigate these changes thanks to its homogeneous training and highly selected genetic background. The aim of this study was to investigate modifications of the innate immune response and inflammation in young untrained Thoroughbred racehorses during the first training season through haematological and molecular investigations. Twenty-nine Thoroughbred racehorses were followed during their incremental 3-month sprint exercise schedule. Blood collection was performed at time 0 (T0; before starting the intense training period), 30 days after T0 (T30), and 90 days after T0 (T90). Haematological parameters (red and white blood cells, haemoglobin, and platelets) were evaluated and haematocrit (HCT), mean corpuscular haemoglobin concentration (MCHC), and red cells width distribution + standard deviation (RDW-SD) were calculated. Moreover, via RT-qPCR, we investigated the expression of, Interleukin 1β (IL-1β), Interleukin 4 (IL-4) Interleukin 6 (IL-6), Interleukin 2 (IL-2), Interleukin 3 (IL-3), Interleukin 5 (IL-5) Interleukin 8 (IL-8), Trasformig Growth Factor β and α (TGF-β), Tumor necrosis factor α (TNF-α), and Interferon γ (IFN-γ)genes. Main corpuscular volume (MCV) showed a significant (p = 0.008) increase at T90. Main corpuscular haemoglobin (MCH) and haemoglobin concentration (MCHC) values were significantly augmented at both T30 (p < 0.001) and T90 (p < 0.001). Basophils were significant increased at T30 (p = 0.02) and eosinophils were significantly increased at T90 (p = 0.03). Significant differences in gene expression were found for all the genes under study, with the exception of IFN-γ and TNF-α. In particular, IL-2 (T30, p = 0.011; T90, p = 0.015), IL-4 (T30, p = 0.009; T90, p < 0.001), and IL-8 (T30, p < 0.001; T90, p < 0.001) genes were significantly upregulated at both T30 and T90 with respect to T0, TGF-β was intensely downregulated at T30 (p < 0.001), IL-5 gene expression was significantly decreased at T90 (p = 0.001), while IL-1β (p = 0.005) and IL-3 (p = 0.001) expression was strongly augmented at the same time. This study highlighted long-term adjustments of O₂ transport capability that can be reasonably traced back to exercise adaptation. Moreover, the observed changes of granulocyte numbers and functions and inflammatory cytokine gene expression confirm a major role of the innate immune system in the response to the complex of stressful stimuli experienced during the training period.

Improvement in histological endpoints of MAFLD following a 12-week aerobic exercise intervention

BACKGROUND

Lifestyle interventions are the primary treatment for metabolic (dysfunction) associated fatty liver disease (MAFLD). However, the histological and cardiometabolic effects of aerobic exercise in MAFLD remain unclear.

AIMS

To assess the effects of a 12-week aerobic exercise intervention on histological and cardiometabolic endpoints in MAFLD.

METHODS

Patients with biopsy-confirmed MAFLD participated in a 12-week aerobic exercise intervention. Liver histology, cardiorespiratory fitness (estimated V̇O_2max ), physical activity, anthropometry and biochemical markers were assessed at baseline, intervention completion, and 12 and 52 weeks after intervention completion.

RESULTS

Twenty-four patients completed the exercise intervention (exercise group n = 16, control group n = 8). In the exercise group, 12 weeks of aerobic exercise reduced fibrosis and hepatocyte ballooning by one stage in 58% (P = 0.034) and 67% (P = 0.020) of patients, with no changes in steatosis (P = 1.000), lobular inflammation (P = 0.739) or NAFLD activity score (P = 0.172). Estimated V̇O_2max increased by 17% compared to the control group (P = 0.027) but this level of improvement was not maintained at 12 or 52 weeks after the intervention. Patients with fibrosis and ballooning improvement increased estimated V̇O_2max by 25% (P = 0.020) and 26% (P = 0.010), respectively. Anthropometric reductions including body mass (P = 0.038), waist circumference (P = 0.015) and fat mass (P = 0.007) were also observed, but no patient achieved 7%-10% weight loss.

CONCLUSION

This study highlights the potential benefits of a 12-week aerobic exercise intervention in improving histological endpoints of MAFLD. The development of strategies to ensure continued engagement in aerobic exercise in MAFLD are needed.

Can moderate intensity aerobic exercise be an effective and valuable therapy in preventing and controlling the pandemic of COVID-19?

•Moderate intensity exercises modulate immunity. •Moderate intensity exercise may boost immunity thereby prevent incidences of COVID-19. •Moderate intensity exercises can benefit those affected with noncommunicable diseases. •Moderate intensity exercise can promote psychological wellbeing. •Home based exercise program can be initiated using Borgs scale to determine intensity.

Exercise-induced immune system response: Anti-inflammatory status on peripheral and central organs

A wide array of molecular pathways has been investigated during the past decade in order to understand the mechanisms by which the practice of physical exercise promotes neuroprotection and reduces the risk of developing communicable and non-communicable chronic diseases. While a single session of physical exercise may represent a challenge for cell homeostasis, repeated physical exercise sessions will improve immunosurveillance and immunocompetence. Additionally, immune cells from the central nervous system will acquire an anti-inflammatory phenotype, protecting central functions from age-induced cognitive decline. This review highlights the exercise-induced anti-inflammatory effect on the prevention or treatment of common chronic clinical and experimental settings. It also suggests the use of pterins in biological fluids as sensitive biomarkers to follow the anti-inflammatory effect of physical exercise.

The equine mononuclear phagocyte system: The relevance of the horse as a model for understanding human innate immunity

The mononuclear phagocyte system (MPS) is a family of cells of related function that includes bone marrow progenitors, blood monocytes and resident tissue macrophages. Macrophages are effector cells in both innate and acquired immunity. They are a major resident cell population in every organ and their numbers increase in response to proinflammatory stimuli. Their function is highly regulated by a wide range of agonists, including lymphokines, cytokines and products of microorganisms. Macrophage biology has been studied most extensively in mice, yet direct comparisons of rodent and human macrophages have revealed many functional differences. In this review, we provide an overview of the equine MPS, describing the variation in the function and phenotype of macrophages depending on their location and the similarities and differences between the rodent, human and equine immune response. We discuss the use of the horse as a large animal model in which to study macrophage biology and pathological processes shared with humans. Finally, following the recent update to the horse genome, facilitating further comparative analysis of regulated gene expression between the species, we highlight the importance of future transcriptomic macrophage studies in the horse, the findings of which may also be applicable to human as well as veterinary research.

Exercise Behavior and Mood during the COVID-19 Pandemic in Taiwan: Lessons for the Future

The Coronavirus disease 2019 (COVID-19) pandemic and its associated governmental recommendations and restrictions have influenced many aspects of human life, including exercise and mental health. This study aims to explore the influence of COVID-19 on exercise behavior and its impact on mood states, as well as predict changes in exercise behavior during a similar future pandemic in Taiwan. A cross-sectional online survey was conducted between 7 April and 13 May 2020 (n = 1114). Data on exercise behavior pre and during the pandemic and mood states were collected. A cumulative link model was used to predict changes in exercise frequency during a similar future pandemic by exercise frequency during the pandemic. A linear model was used to predict the influence of exercise frequency before and during the pandemic on mood states during the pandemic. A total of 71.2%, 67.3%, and 58.3% of respondents maintained their exercise intensity, frequency, and duration, respectively, during the pandemic. Frequent exercisers are more likely to maintain their exercise frequency during a similar pandemic (p < 0.001). Higher exercise frequencies during the pandemic were associated with better mood states (p < 0.05). Moreover, the effects of prepandemic exercise frequency on mood states are moderated by changes in exercise frequency during the pandemic (p < 0.05). Additionally, maintenance of exercise frequency during a pandemic specifically for frequent exercisers are recommended to preserve mood states. These results may provide evidence for health policies on exercise promotion and mental health before and during a future pandemic.

Gut Microbiota, Probiotics and Physical Performance in Athletes and Physically Active Individuals

Among athletes, nutrition plays a key role, supporting training, performance, and post-exercise recovery. Research has primarily focused on the effects of diet in support of an athletic physique; however, the role played by intestinal microbiota has been much neglected. Emerging evidence has shown an association between the intestinal microbiota composition and physical activity, suggesting that modifications in the gut microbiota composition may contribute to physical performance of the host. Probiotics represent a potential means for beneficially influencing the gut microbiota composition/function but can also impact the overall health of the host. In this review, we provide an overview of the existing studies that have examined the reciprocal interactions between physical activity and gut microbiota. We further evaluate the clinical evidence that supports the effects of probiotics on physical performance, post-exercise recovery, and cognitive outcomes among athletes. In addition, we discuss the mechanisms of action through which probiotics affect exercise outcomes. In summary, beneficial microbes, including probiotics, may promote health in athletes and enhance physical performance and exercise capacity. Furthermore, high-quality clinical studies, with adequate power, remain necessary to uncover the roles that are played by gut microbiota populations and probiotics in physical performance and the modes of action behind their potential benefits.

Coronavirus disease 2019 (COVID-19) and obesity. Impact of obesity and its main comorbidities in the evolution of the disease

The COVID-19 pandemic is posing a great challenge worldwide. Its rapid progression has caused thousands of deaths worldwide. Although multiple aspects remain to be clarified, some risk factors associated with a worse prognosis have been identified. These include obesity and some of its main complications, such as diabetes and high blood pressure. Furthermore, although the possible long-term complications and psychological effects that may appear in survivors of COVID-19 are not well known yet, there is a concern that those complications may be greater in obese patients. In this manuscript, we review some of the data published so far and the main points that remain to be elucidated are emphasized.

The Potential Mediation of the Effects of Physical Activity on Cognitive Function by the Gut Microbiome

The population of older adults is growing dramatically worldwide. As older adults are at greater risk of developing disorders associated with cognitive dysfunction (i.e., dementia), healthcare costs are expected to double by 2040. Evidence suggests dementia may be slowed or prevented by lifestyle interventions, including physical activity (PA). PA is associated with improved cognitive function and may reduce risk for dementia by mitigating known risk factors (i.e., cardiovascular diseases) and/or by enhancing neurochemical processes. An emerging area of research suggests the gut microbiome may have similar neuroprotective effects. Altering the gut microbiome has been found to target physiological processes associated with dementia risk, and it influences gut-brain-microbiome axis signaling, impacting cognitive functioning. The gut microbiome can be altered by several means (i.e., disease, diet, prebiotics, probiotics), including PA. As PA and the gut microbiome independently influence cognitive function and PA changes the composition of the gut microbiome, cognitive improvement due to PA may be partially mediated by the gut microbiome. The present article provides an overview of the literature regarding the complex associations among PA, cognitive function, and the gut microbiome, as well as their underlying biological mechanisms. A comprehensive, theoretical model integrating evidence for the potential mediation is proposed.

Resistance Training Safety during and after the SARS-Cov-2 Outbreak: Practical Recommendations

In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.

The effects of exercise on COVID-19 therapeutics: A protocol for systematic review and meta-analysis

BACKGROUND

At the end of 2019, peoples normal lives were disrupted by a sudden plague (COVID-19), the huge impact of COVID-19 on society has never been appeared. How to effectively prevent and treat COVID-19 is a concern for all health care workers. Exercise as a green and cheap complementary therapy, which has been proven to improve the immune capacity of the body and prevent infection. The main purpose of this study is to provide a reliable methodological guidance and credible evidence for exercise on COVID-19 therapeutic.

METHODS

This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. We will search the following database sources for the Randomized controlled trials: the Cochrane Library, PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database (CNKI), Chinese Science and the Wanfang Database. All randomized controlled trials of exercise therapy for COVID-19 in the above database will be considered for inclusion, and high-quality articles will be screened for data extraction and analysis, to summarize the therapeutic effect of exercise on COVID-19 patients.

RESULTS

In this study, we hope to find strong evidence for the treatment of COVID-19 by exercise.

CONCLUSION

The conclusion of our study will provide credible evidence to judge whether exercise is an effective intervention on the COVID-19 patients therapeutic, and guide future researches.PROSPERO registration number: CRD42020200883.

Promising effects of exercise on the cardiovascular, metabolic and immune system during COVID-19 period

With 4 billion people in lockdown in the world, COVID-19 outbreak may result in excessive sedentary time, especially in the population of vulnerable and disabled subjects. In many chronic disorders and diseases including type 2 diabetes mellitus and hypertension, cardiovascular and immune beneficial effects of exercise interventions should be reminded.

Novel stretching and strength-building exercise recommendations for computer-based workers during the COVID-19 quarantine

BACKGROUND

Prolonged home stays due to the COVID-19 quarantine can increase the use of computers and other technologies that may lead to significant reduction in activity, contributing to musculoskeletal problems, anxiety and depression.

OBJECTIVE

The aim of this study was to develop a novel multicomponent exercise program for individuals who work with computers during the COVID-19 quarantine.

METHODS

Researchers collaborating cross-institutionally and cross-nationally performed a careful literature search for exercise and stretching regiments with particular attention to methodologies that can be applied during the lockdown in the wake of the COVID-19 pandemic. Methodologies were then compiled and truncated for ease of use for the computer-based office worker during the COVID-19 pandemic quarantine.

RESULTS

The resulting program is broken down into three categories: aerobic, strengthening and stretching components. Each component can then be further modified to meet the frequency, intensity, time and type (FITT) specifications for the participant.

CONCLUSIONS

We present a novel, evidence-based strategy for functional fitness for office workers who have remained home-bound during the COVID-19 pandemic quarantine. Further research should seek to validate the efficacy of the proposed protocol.

Clinical Update for Physical Therapists: Coagulopathy and COVID-19

Physical therapists have a unique role in both prevention of venous thromboembolism (VTE) through the promotion of early mobility and physical activity and diagnosis through discovery of signs and symptoms of VTE. This Perspective updates clinicians on the latest information regarding pathophysiology of coagulopathy associated with COVID-19 and applies VTE clinical practice guidelines to COVID-19 in order to provide guidance on physical therapist management.