Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature

Molecular aspects of COVID-19 and its relationship with obesity and physical activity: a narrative review

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 has several mechanisms of action related to inflammatory responses, especially in individuals diagnosed with obesity. This hyperinflammatory clinical profile resulting from the association between obesity and coronavirus disease 2019 (COVID-19) may be attenuated by regular physical activity.

OBJECTIVE

The aim of this study was to review the evidence on the consequences of physical inactivity and physical activity on COVID-19 in patients with obesity.

DESIGN AND SETTING

Narrative review at the Bahiana School of Medicine and Public Health in Salvador, Brazil.

METHODS

We searched evidence on the association of COVID-19 with physical activity and obesity using the following keywords: "covid-19," "physical activity," and "obesity". The databases used were MEDLINE (PubMed), ScienceDirect, and Virtual Health Library. Studies published from 2019 to 2021 and available in Portuguese, English, and Spanish were included. The final search was conducted on September 26, 2021.

RESULTS

We identified 661 studies in the database, among which 71 were considered for inclusion in the narrative review of the molecular aspects of COVID-19 and its relationship with physical activity and obesity.

CONCLUSION

This literature review enabled the perception of the relationship between the molecular mechanisms of COVID-19 and obesity. Regular physical activity had various benefits for the inflammatory condition of the studied population, highlighting moderate-intensity.

Sarcopenia and COVID-19 Outcomes

Coronavirus disease 2019 (COVID-19) spread rapidly and became a severe global public health threat. Older adults have a high risk of COVID-19 and its associated mortality. Sarcopenia has emerged as a predictor of poor outcomes in COVID-19 patients, including lengthy hospital stays, mortality, intensive care unit admission, need for invasive mechanical ventilation, and poor rehabilitation outcomes. Chronic inflammation, immune dysfunction, respiratory muscle dysfunction, and swallowing dysfunction may underlie the association between sarcopenia and the poor outcomes of COVID-19 patients. Interleukin 6 receptor blockers (tocilizumab or sarilumab) are recommended for treating patients with severe COVID-19, and their therapeutic effects on sarcopenia are of great interest. This review aimed to analyze the current reports on the association between sarcopenia and COVID-19 and provide an update on the contribution of sarcopenia to the severity and adverse outcomes of COVID-19 and its underlying mechanisms. We also aimed to explore the different screening tools for sarcopenia concurrent with COVID-19, and advocate for early diagnosis and treatment of sarcopenia. Given that the fight against the COVID-19 pandemic may be long-term, further research into understanding the effects of sarcopenia in patients infected with the Omicron variant is necessary.

Diabetes Prevention and Measures to Ensuring a Healthy Lifestyle during COVID-19 Pandemic and after

The incidence of diabetes mellitus (DM) is increasing exponentially globally, with 90% of the confirmed cases being type 2 DM. The global incidence of DM is expected to increase by 48% during 2017-2045. The coronavirus disease 2019 (COVID-19) pandemic continues to have a massive impact on human health, causing sudden lifestyle changes through quarantine measures, such as lockdown, social distancing, various curfews, and isolation at home. This in turn might increase the risk of developing numerous chronic diseases, such as DM, obesity, and cardiovascular diseases, which increase the severity of COVID-19. To this end, we performed a comprehensive review to determine viable measures for the prevention of DM and its subsequent upsurge globally. Additionally, we have determined strategies that should be adopted globally to ensure a healthy lifestyle during the COVID-19 pandemic and later.

Physical Activity Increases Immunity to COVID-19 Infection

Coronavirus are truly one of the maximum critical fantastic-stranded non-segmented RNA viruses, named after the approximately 126-nm-diameter envelope around the nucleic acid-protein complicated. The virus causes significant harm to human fitness, including direct injury to the respiratory system, immune system compromise, worsening of the underlying clinical conditions, and eventually systemic failure and death. Exercise affects the immune system's antiviral mechanisms. Modest exercise, done before or after infection, improves morbidity and mortality to the contamination, according to animal investigations using influenza and simplex virus in the respiratory tract. Moreover, preclinical research has demonstrated that overtraining has a negative impact on the body's response to viral infections. Follow-up research has shed some light on the mechanisms underlying these discoveries. Through the activation of muscle protein synthesis, physical activity (PA) and exercise are essential for maintaining muscle mass. On the other hand, a lack of muscle contractile activity throughout the country of no exercise, particularly in elderly people, is a major contributor to anabolic rigidity and muscle atrophy.

Recognizing risk factors associated with poor outcomes among patients with COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has affected >610 million people globally, exerting major social, economic, and health impacts. Despite the large number of global casualities and severe symptomatology associated with COVID-19, a large number of individuals remain at elevated risk of infection and severe outcomes related to poor lifestyle behaviors and/or associated comorbidities. Beyond the well-known social distance and masking policies, maintaining an active lifestyle, minimizing the consumption of tobacco products, and maintaining an adequate nutrition status are some of the key factors that, in an affordable and accessible way, have the potential to improve health and minimize COVID-19 impact. In addition, bringing awareness of the higher risks and poor prognosis of COVID-19 when other conditions are present seems to be essential to protect those individuals with the highest risks.

Symptom Number and Reduced Preinfection Training Predict Prolonged Return to Training after SARS-CoV-2 in Athletes: AWARE IV

PURPOSE

This study aimed to determine factors predictive of prolonged return to training (RTT) in athletes with recent SARS-CoV-2 infection.

METHODS

This is a cross-sectional descriptive study. Athletes not vaccinated against COVID-19 ( n = 207) with confirmed SARS-CoV-2 infection (predominantly ancestral virus and beta-variant) completed an online survey detailing the following factors: demographics (age and sex), level of sport participation, type of sport, comorbidity history and preinfection training (training hours 7 d preinfection), SARS-CoV-2 symptoms (26 in 3 categories; "nose and throat," "chest and neck," and "whole body"), and days to RTT. Main outcomes were hazard ratios (HR, 95% confidence interval) for athletes with versus without a factor, explored in univariate and multiple models. HR < 1 was predictive of prolonged RTT (reduced % chance of RTT after symptom onset). Significance was P < 0.05.

RESULTS

Age, level of sport participation, type of sport, and history of comorbidities were not predictors of prolonged RTT. Significant predictors of prolonged RTT (univariate model) were as follows (HR, 95% confidence interval): female (0.6, 0.4-0.9; P = 0.01), reduced training in the 7 d preinfection (1.03, 1.01-1.06; P = 0.003), presence of symptoms by anatomical region (any "chest and neck" [0.6, 0.4-0.8; P = 0.004] and any "whole body" [0.6, 0.4-0.9; P = 0.025]), and several specific symptoms. Multiple models show that the greater number of symptoms in each anatomical region (adjusted for training hours in the 7 d preinfection) was associated with prolonged RTT ( P < 0.05).

CONCLUSIONS

Reduced preinfection training hours and the number of acute infection symptoms may predict prolonged RTT in athletes with recent SARS-CoV-2. These data can assist physicians as well as athletes/coaches in planning and guiding RTT. Future studies can explore whether these variables can be used to predict time to return to full performance and classify severity of acute respiratory infection in athletes.

Exercise modulates the immune system in cardiorespiratory disease patients: Implications for clinical practice during the COVID-19 pandemic

BACKGROUND

Patients with cardiorespiratory problems often suffer from systemic inflammation. Stress due to the disease and continuous inflammation can undermine the success of the rehabilitation program.

OBJECTIVE

This review has been undertaken primarily to understand the effectiveness of exercise training on the immune system in individuals undergoing cardiorespiratory rehabilitation and its implications for further management during the COVID-19 pandemic.

METHODS

Assessors analyzed related studies identified in the MEDLINE, PROQUEST, PUBMED, Cochrane Library, CINAHL, EMBASE, Google Scholar, Physiotherapy Evidence, and Science Direct databases. The studies were divided into groups focused on the effect of exercise on blood leukocytes, the anti-inflammatory effect, and the role of nutrition and exercise in resolving inflammation.

RESULTS

Twenty-eight studies were included in this review. The number of studies included in each section was as follows: the effects of exercise training on leukocytes in cardiorespiratory conditions (n = 8), anti-inflammatory effect (n = 6), and the role of nutrition and exercise in resolving inflammation (n = 14). The bias risk assessment showed poor internal validity; most included studies were assigned no and unclear descriptors.

CONCLUSIONS

Substantive evidence is presented that emphasizes the role of moderate-intensity exercise in boosting the immune system in patients with cardiorespiratory diseases. Exercise has anti-inflammatory effects that are vital for overall well-being and resolving longstanding inflammation. Individuals with an active lifestyle had a better pathogen immune response than more sedentary individuals. Our findings highlight the current need to investigate the long-term effects of cardiorespiratory rehabilitation programs.

Exercise sustains the hallmarks of health

Exercise has long been known for its active role in improving physical fitness and sustaining health. Regular moderate-intensity exercise improves all aspects of human health and is widely accepted as a preventative and therapeutic strategy for various diseases. It is well-documented that exercise maintains and restores homeostasis at the organismal, tissue, cellular, and molecular levels to stimulate positive physiological adaptations that consequently protect against various pathological conditions. Here we mainly summarize how moderate-intensity exercise affects the major hallmarks of health, including the integrity of barriers, containment of local perturbations, recycling and turnover, integration of circuitries, rhythmic oscillations, homeostatic resilience, hormetic regulation, as well as repair and regeneration. Furthermore, we summarize the current understanding of the mechanisms responsible for beneficial adaptations in response to exercise. This review aimed at providing a comprehensive summary of the vital biological mechanisms through which moderate-intensity exercise maintains health and opens a window for its application in other health interventions. We hope that continuing investigation in this field will further increase our understanding of the processes involved in the positive role of moderate-intensity exercise and thus get us closer to the identification of new therapeutics that improve quality of life.

Marital status, household size, and lifestyle changes during the first COVID-19 pandemic: NIPPON DATA2010

Stay-at-home strategies taken during the COVID-19 pandemic changed our lifestyle drastically. Although marital status and household size are important social determinants of health that affect lifestyle, their impacts on lifestyle during the pandemic are still unclear. We aimed to evaluate the association between marital status, household size, and lifestyle changes during the first pandemic in Japan. Questionnaire surveys on lifestyle changes from before to during the first COVID-19 pandemic were conducted on October 2020 in Japan. Classified into age groups, multivariable logistic regression analysis was performed to examine the combined association of marital status and household size on lifestyle, adjusted for potential confounders including socioeconomic factors. In our prospective cohort study, 1928 participants were included. Among older participants, the singles living alone were likely to perceive more unhealthy lifestyle changes (45.8%), compared with the married (33.2%), and significantly associated with at least one unhealthy change [adjusted odds ratio (OR): 1.81, 95% confidence interval (CI): 1,18-2.78], mainly due to decreased physical activity and increased alcohol consumption. Meanwhile, the younger participants showed no significant association between marital status, household size, and unhealthy changes, while those living alone had 2.87 times higher odds of weight gain (≥ 3 kg) than the married (adjusted OR: 2.87, 95% CI: 0.96-8.54) during the pandemic. Our findings suggest that older singles living alone are potentially vulnerable subgroups to drastic social changes which warrant special attention to prevent adverse health outcomes and additional burden on health systems in the following future.

Physical Activity versus Selected Health Behaviors, Subjective Physical and Psychological Health and Multimorbidity in a Large Cohort of Polish Seniors during the COVID-19 Pandemic (Results of the National Test for Poles' Health )

National Test for Poles' Health is an online study conducted on a large group of Polish Internet users. For the purpose of this study, 64,732 subjects (48.8% female) over 65 years old were included. Subjects provided answers on the level of physical activity (PA) they engage in, prevalence of non-communicable diseases (obesity, hypertension, diabetes, heart diseases, chronic obstructive pulmonary disease (COPD), depression, cancer) and subjective physical and psychological health. Additionally, their Body Mass Index (BMI) and prevalence of multimorbidity was assessed. We found that older people who engage in at least 2 h of physical activity/week had significantly lower prevalence of hypertension, obesity and heart diseases than those who engaged in 1-1.5 h/week or less than 1 h/week. Multimorbidity was present in 33.2% of subjects from the most active group and 52.6% of the least active ones. Subjective physical and psychological health was rated as "very good" by 26.6% and 41.2%, respectively, by subjects from the most active group. Only 9.1% of the least active subjects rated their physical health as "very good" and only 27.4% rated their psychological health as such. Regular physical activity may be a helpful tool in combating the reduced well-being of older people affected by the isolation caused by the COVID-19 pandemic. Unfortunately, over 65% of respondents claimed to engage in less than 1 h of PA a week or less.

The Effects of Exercise Training on Recovery of Biochemical and Hematological Outcomes in Patients Surviving COVID-19: A Randomized Controlled Assessor-Blinded Trial

BACKGROUND

No previous research has investigated the direct effects of exercise interventions on COVID-19 outcomes. The aim is to investigate the effect of 8 weeks of home-based moderate-intensity continuous training (MICT), resistance training (RT), and combined aerobic and resistance training (CET) on biochemical and hematologic markers associated with COVID-19 symptoms and severity in COVID-19 survivors.

METHODS

A total of 547 male and female COVID-19 survivors were screened, and 296 (aged 20-93 years) were randomly assigned in a 1:1:1:1 ratio to one of four groups: MICT (n = 74), RT (n = 74), CET (n = 74), or non-exercise (NON-EX, n = 74). Blood samples were taken at baseline, at week 4, and week 8 after training.

RESULTS

After the intervention, compared with the NON-EX group, all 3 MICT, RT, and CET interventions caused significant improvements in the levels of creatine kinase (CK), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin-I, d-dimer, creatinine, urea, potassium (K), sodium (Na), white blood cell (WBC), neutrophils, lymphocytes, red blood cells (RBC), platelets, hemoglobin, and hematocrit concentrations (P < 0.05). CET was effectively superior to MICT and RT in the improvements in the biochemical and hematological variables studied (P < 0.05).

CONCLUSIONS

Overall, the present study demonstrates that long-term MICT plus RT interventions have a synergistic effect in accelerating and enhancing the recovery in patients surviving COVID-19. Trial registration IRCT20160605028270N3, 6 September 2020.

Physical Activity and Diet in Older Women: A Narrative Review

Physical activity and diet are essential for maintaining good health and preventing the development of non-communicable diseases, especially in the older adults. One aspect that is often over-looked is the different response between men and women to exercise and nutrients. The body's response to exercise and to different nutrients as well as the choice of foods is different in the two sexes and is strongly influenced by the different hormonal ages in women. The present narrative review analyzes the effects of gender on nutrition and physical activity in older women. Understanding which components of diet and physical activity affect the health status of older women would help target non-pharmacological but lifestyle-related therapeutic interventions. It is interesting to note that this analysis shows a lack of studies dedicated to older women and a lack of studies dedicated to the interactions between diet and physical activity in women. Gender medicine is a current need that still finds little evidence.

Neuropsychiatric Effects of COVID-19 Pandemic on Alzheimer's Disease: A Comparative Study of Total and Partial Lockdown

Objectives

Coronavirus disease 2019 (COVID-19)-related lockdown may have a negative effect on the neuropsychiatric status of Alzheimer's disease (AD) cases. In this study, it was aimed to find future implications by evaluating the neuropsychiatric conditions of AD cases during total and partial lockdown periods.

Methods

It is a prospective, cross-sectional, and multicenter study that includes AD cases which have been followed for at least 1 year by outpatient clinics from different regions of Turkey. Sociodemographic data, comorbidities, mobility, existence of social interactions, clinical dementia rating (CDR) scale, and neuropsychiatric inventory (NPI) for total and partial lockdown were questioned by the caregivers with the help of case files of the patients.

Results

A total of 302 AD cases were enrolled to the study (mean age: 78±8 years, mean duration of education: 5.8±9 years). The total comorbidity ratio was found to be 84%, with the most frequent comorbidity being hypertension. The mean NPI score was 22.9±21 in total lockdown and 17.7±15 in partial lockdown, which is statistically significantly different. When lockdown periods were compared with the total scores of NPI scores according to gender, existence of social interactions, mobility, and comorbidities were found higher in the total lockdown than the partial lockdown. When switching from total lockdown to partial lockdown, the presence of comorbidities, mobility, and CDR were found to be factors that had a significant effect on NPI scores. In regression analysis, CDR score was found as the most effective parameter on the neuropsychiatric status of AD cases for both lockdown periods.

Conclusion

When lockdown-related restrictions were reduced, the neuropsychological conditions of AD cases were significantly improved. Lockdown rules should be considered with these data in mind.

Inflammation in COVID-19 and the Effects of Non-Pharmacological Interventions during the Pandemic: A Review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the coronavirus disease 2019 (COVID-19) pandemic that hit the health systems worldwide hard, causing a collapse of healthcare systems. One of the main problems of this new virus is the high inflammatory response it provokes, which is the cause of much of the symptoms. Different pharmacological approaches tried to stop the advance of the pandemic, but it seems that only vaccines are the solution. In this line, different nonpharmacological approaches have been made in order to improve symptomatology, contagion, and spread of COVID-19, the principal factors being the physical activity, nutrition, physiotherapy, psychology, and life patterns. The SARS-CoV-2 virus produces a disproportionate inflammatory response in the organism of the guest and causes complications in this that can end the life of the patient. It has been possible to see how different nonpharmacological interventions based on physical activity, nutritional, psychological, and physical therapy, and lifestyle changes can be functional tools to treat this inflammation. Thus, in the present review, we aim to provide an overview of the role of inflammation in COVID-19 and the nonpharmacological interventions related to it.

Grounding (earthing) as related to electromagnetic hygiene: An integrative review

There are a growing number of studies investigating how grounding (earthing) the body may benefit biological performance and aid the treatment of non-communicable diseases. Research also indicates how biological grounding initiatives can sometimes be compromised, or inappropriate, and the need to take additional factors into account as potential contributory factors, or confounders, to expected results. It is proposed that expanding electromagnetic hygiene measures beyond biological grounding alone may help reduce spread of communicable diseases, incidence of respiratory conditions, neurodegenerative disease and all-cause mortality. Identifying potential synergies that exist could enable multilevel interventions to further increase the efficacy of measures. It is hoped that this review will help act as a catalyst to inspire and inform multi-disciplinary research within these topic areas, best practices and policies to help drive medical innovation, reduce health burdens, improve bioelectromagnetic-based therapies, and influence the general design of the built environment and next-generation technologies.

Physical Activity Counseling in Saudi Arabia: A Systematic Review of Content, Outcomes, and Barriers

OBJECTIVES

This study aimed to map the characteristics and the predominant components of clinical physical activity (PA) counseling in Saudi Arabia for adult patients and outline evidence of outcomes and prevalent barriers to its implementation.

METHODS

We conducted a systematic literature search of four online databases: Web of Science, PubMed, ScienceDirect, and The Cochrane Library. Each study was assessed and evaluated using the Mixed Methods Appraisal Tool (MMAT) for methodological quality.

RESULTS

A total of 120 studies were screened, and 47 studies were sought for retrieval. In total, 25 articles were eligible and were subjected to extensive review. After a detailed evaluation, only nine studies met the inclusion criteria. All included were quantitative studies that compiled descriptive and numerical data on physical activity counseling. Four studies described PA counseling information in Saudi Arabia or prescription as lifestyle modification and program structure. The programs used various techniques to motivate patients to adhere to PA protocols. In general, practitioners indicated a high perceived competence in helping patients meet PA guidelines. The most frequently stated barrier was a lack of time for PA discussions with patients, followed by a lack of training in PA counseling, and a lack of patient compliance. Significant improvements in clinical parameters and smoking, food, and exercise habits were detected in experimental trials with respective intervention programs.

CONCLUSION

This review provides preliminary insights into the delivered intervention and standard care content, its outcomes, and clinicians' perceived competence and barriers regarding current PA counseling approaches in Saudi Arabia. Despite the small number of studies included, this review contributes to the limited understanding of current PA counseling practices in Saudi Arabia and serves as an informational source for clinicians and policymakers and a starting point for further research.

[German S1 Guideline Long-/Post-COVID]

The German Society of Pneumology initiated 2021 the AWMF S1 guideline Long COVID/Post-COVID. In a broad interdisciplinary approach, this S1 guideline was designed based on the current state of knowledge.The clinical recommendations describe current Long COVID/Post-COVID symptoms, diagnostic approaches, and therapies.In addition to the general and consensus introduction, a subject-specific approach was taken to summarize the current state of knowledge.The guideline has an explicit practical claim and will be developed and adapted by the author team based on the current increase in knowledge.

Self-reported changes in sleep patterns and behavior in children and adolescents during COVID-19

The COVID-19 pandemic and lockdowns worldwide forced children and adolescents to change and adapt their lives to an unprecedented situation. Using an online survey, we investigated whether they showed changes in sleep quality and other related factors due to this event. Between February 21st, 2021 and April 19th, 2021, a total of 2,290 Austrian children and adolescents (6-18 years) reported their sleep habits and quality of sleep as well as physical activity, daylight exposure and usage of media devices during and, retrospectively, before the pandemic. Results showed an overall delay of sleep and wake times. Almost twice as many respondents reported having sleeping problems during the pandemic as compared to before, with insomnia, nightmares and daytime sleepiness being the most prevalent problems. Furthermore, sleeping problems and poor quality of sleep correlated positively with COVID-19 related anxiety. Lastly, results showed a change from regular to irregular bedtimes during COVID-19, higher napping rates, a strong to very strong decrease in physical activity and daylight exposure, as well as a high to very high increase in media consumption. We conclude that the increase in sleeping problems in children and adolescent during COVID-19 is concerning. Thus, health promoting measures and programs should be implemented and enforced.

Post-COVID-19 complications in home and hospital-based care: A study from Dhaka city, Bangladesh

A cross-sectional survey was undertaken to understand the management patterns and post-COVID-19 complications among hospital and home-treated participants. Retrospective information was collected from four COVID-19 dedicated hospitals and four selected community settings. Using probability proportional sampling, 925 participants were selected. Data were collected using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis and the exact chi-square tests were utilized to analyze the association between the studied variables. A total of 659 participants responded (response rate 70.93%); 375 from hospitals and 284 from communities. About 80% of participants were mild cases, 75% were treated at home, and 65% of hospital-treated participants were referred after home treatment. Participants treated at home-to hospital and directly in the hospital had 1.64 and 3.38 times longer recovery time respectively than what home-based participants had. A significant increasing trend (p < 0.001) of co-morbidities was found among referred and hospital treated participants. Age, level of education, physical exercise, practicing preventive measures, exposure to sunlight, and intake of carbohydrate, additional liquid, food supplements, and avoidance of junk foods were significantly associated with place of treatment. Post-COVID-19 difficulties of all factors were statistically significant for home treatment participants, whilst only depression (p = 0.026), chest pain (p = 0.017), and digestive disorders (p = 0.047) were significant (p < 0.05) for hospital treated participants. The outcomes from this study provide insight into a range of post-COVID-19 difficulties relating to at home and in hospital treatment participants. There are clear differences in the complications experienced, many of which are statistically significant. The health care professionals, the community people and COVID-19 survivors will be benefitted from the study findings, and the policy level people may use the information for designing health education program on post COVID-19 complications.

What is the relationship between physical activity and chronic pain in older adults? A systematic review and meta-analysis protocol

INTRODUCTION

Chronic pain is highly prevalent in older adults and can cause functional limitations, negatively affecting health and quality of life. Physical activity is a non-pharmacological approach used to prevent chronic pain as it promotes the release of endogenous opioids that block pain sensitivity. Therefore, we developed a systematic review protocol to analyse the relationship between physical activity and the occurrence and intensity of chronic pain in older adults.

METHODS AND ANALYSES

The systematic review will search PubMed, Scopus and Embase databases. The inclusion criteria will be observational studies that had primary chronic pain as an outcome, including persistent and intermittent pain. The population will include older adults from the community, living in a long-stay institution, or in outpatient follow-up. There will be no restriction regarding the year of publication and articles published in Portuguese, English and Spanish will be analysed. Effect or impact measures will be quantified, including OR, HR, prevalence ratio, incidence ratio and relative risk with their 95% CIs. If the data allow, a meta-analysis will be performed. The results may help understand the impact of physical activity as a potential protection factor against the occurrence of pain later in life as well as promote strategic prevention plans and public policies that encourage this practice in older adults.

ETHICS AND DISSEMINATION

Ethical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete.

PROSPERO REGISTRATION NUMBER

CRD42021282898.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study

Objectives

This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients.

Patients and methods

The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS.

Results

Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385).

Conclusion

The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Leisure-time regular exercise and prevention of the side effects of immune system activity in middle-aged healthy subjects

Regular exercise is recommended to improve immune system function and antioxidant activity, while conversely, it may cause inflammation by increasing neutrophil-derived main enzyme, myeloperoxidase, which produces reactive oxygen species. The present study aimed to investigate changes in myeloperoxidase level, its influence on total oxidant status, and the capacity of the antioxidant defence system to counteract oxidative stress in middle-aged men participating in leisure-time regular exercise compared to untrained peer subjects. Twenty trained (age 53.58±2.94 years, body mass index (BMI) 25.47±1.6) and 17 untrained (age 54.17±2.83 years, BMI 27.83±1.12) healthy middle-aged men participated in this study [Rasht, Gilan, Iran]. Participants performed a modified Bruce treadmill test as a model of progressive exercise training. Blood samples were taken before, immediately after, and one hour after the end of the test. A mixed ANOVA and Bonferroni post hoc test was used for the analysis of variables. A significant difference was observed in myeloperoxidase levels between groups, while the trained group showed a significantly lower concentration than the untrained group (P<0.018). This result was also consistent with the lower total oxidant status in this group (P<0.001). Total antioxidant capacity changed significantly in both groups with higher concentration in the trained group (P<0.001). The leisure-time regular exercise can reduce myeloperoxidase concentration and total oxidant status in healthy middle-aged men while increasing the total antioxidant capacity, which may potentially protect them from the side effects of immune system activity induced by exercise training.

Being Physically Active Leads to Better Recovery Prognosis for People Diagnosed with COVID-19: A Cross-Sectional Study

The regular practice of physical activity helps in the prevention and control of several non-communicable diseases. However, evidence on the role of physical activity in mitigating worsening clinical outcomes in people with COVID-19 is still unclear. The aim of this study was to verify whether different levels of physical activity provide protection for clinical outcomes caused by SARS-CoV-2 infection. A cross-sectional study was conducted with 509 adults (43.8 ± 15.71 years; 61.1% female) with a positive diagnosis of COVID-19 residing in Ribeirão Preto, São Paulo, Brazil. Participants were interviewed by telephone to determine the severity of the infection and the physical activity performed. Binary logistic regression was used to indicate the odds ratio (OR) of active people reporting less harmful clinical outcomes from COVID-19. Active people had a lower chance of hospitalization, fewer hospitalization days, less respiratory difficulty and needed less oxygen support. The results suggest that active people, compared to sedentary people, have a lower frequency of hospitalization, length of stay, breathing difficulty and need for oxygen support. These results corroborate the importance of public policies to promote the practice of physical activity, in order to mitigate the severity of the clinical outcomes of COVID-19.

Effects of physical activity on the severity of illness and mortality in COVID-19 patients: A systematic review and meta-analysis

Purpose: This systematic review and meta-analysis investigated the association between Physical activity (PA) before Coronavirus Disease 2019 (COVID-19) infection and the severity of illness and mortality in COVID-19 patients.

Methods: A comprehensive search was undertaken to identify retrospective and nonrandomized controlled trial studies comparing the severity and mortality of COVID-19 infection among COVID-19 patients who had previously reported their participation in PA with those who had not. The databases searched were PubMed, Cochrane Library, Scopus, Science Direct, EMBASE, OPENGREY.EU, and ClinicalTrials.gov. The risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for determining pairwise meta-analyses. The protocol was registered with PROSPERO (CRD42021262548).

Results: Eighteen studies met the inclusion criteria (5 cross-sectional, 12 cohort, and 1 case-control studies). All 1 618 680 subjects were adults. PA significantly decreased the risk of death in COVID-19 patients (odds ratio [OR] 0.34; 95% confidence interval [CI], 0.19–0.62; p < 0.001) and the risk of severe outcomes (OR 0.60; 95% CI, 0.48–0.76; p < 0.001). Subgroup analysis showed that PA for ≥150 min/wk at a moderate intensity or ≥75 min/wk at a vigorous intensity reduced the risks of severity and mortality. Vigorous PA reduced mortality risk, whereas moderate to vigorous PA reduced the risks of severity and mortality.

Conclusion: PA before infection might reduce severity and mortality in COVID-19 patients, especially PA ≥ 150 min/wk of moderate activity or ≥75 min/wk of vigorous activity. However, careful interpretations should be considered due to the difference in PA patterns and severity definitions among included studies. This finding implies that engaging in regular PA, even in different patterns, has beneficial effects on the severity and mortality of COVID-19 patients.

A higher frequency of physical activity is associated with reduced rates of SARS-CoV-2 infection

BACKGROUND

Physical activity (PA) is associated with health benefits. Previous studies have shown that regular PA decreases the incidence of viral respiratory tract infections, but data on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are unavailable.

OBJECTIVES

The objective of this study is to examine the association between PA frequency and SARS-CoV-2 infection.

METHODS

A population-based cross-sectional study was conducted on data from 1 February 2020 to 31 December 2020, using the registry of Leumit Health Services (LHS), a national health maintenance organisation in Israel. All LHS patients aged 18 to 80 years who underwent at least one RT-PCR test for SARS-CoV-2 during the study period were included. We examined the association between PA frequency (hours per week) and being tested positive for SARS-CoV-2.

RESULTS

Of 113,075 subjects tested for SARS-CoV-2 by RT-PCR (mean age 41.6 years, 54.4% female), 17,465 (15%) were positive. In the SARS-CoV-2-negative group, significantly more subjects were engaged with PA than in the SARS-CoV-2-positive group [crude odds ratio (OR) for any PA 0.75 (95% confidence interval (CI) 0.72-0.77)]. After adjusting for possible confounders, PA frequency had a significant negative association with the likelihood of being SARS-CoV-2 positive (adjusted OR 0.67, 95% CI 0.64-0.68). Moreover, as the frequency of PA increased, the ORs of being SARS-CoV-2-positive decreased (occasional PA: OR 0.71, 95% CI 0.67-0.74; PA 1-3 times/week: OR 0.62, 95% CI 0.58-0.65 and PA > 3 times/week: OR 0.54, 95% CI 0.49 - 0.59).

CONCLUSION

Our large population-based study in patients undergoing SARS-CoV-2 RT-PCR testing showed that a higher frequency of PA is associated with a lower rate of positive test results.

Impact of Physical Activity on COVID-19

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is seriously endangering human health worldwide. This study finds effective intervention modalities of physical activity on COVID-19 through a narrative review.

METHODS

In this study, 41 papers were selected for a narrative literature review after a comprehensive database search from 20 December 2019, to 30 August 2022.

RESULTS

41 articles meet the established criteria, and in this review, we comprehensively describe recent studies on exercise and COVID-19, including the impact and recommendations of exercise on COVID-19 prevention, patients with COVID-19, and noninfected populations.

CONCLUSIONS

The literature suggests that physical activity (PA) contributes to the prevention and treatment of COVID-19, can promote recovery of physical function, alleviate post-acute COVID-19 syndrome, and improve patients' psychological well-being. It is recommended to develop appropriate exercise prescriptions for different populations under the guidance of a physician.

[Delta of neutrophil lymphocyte index and mortality in covid-19 disease]

Background

Acute respiratory distress syndrome, due to SARS-CoV-2, is a worldwide health problem. The neutrophil-lymphocyte index allows risk stratification in patients with severe and poor prognostic data, since it reflects the inflammatory state.

Objective

To determine whether the Neutrophil-Lymphocyte Index delta predicts mortality in patients with COVID-19.

Material and methods

We conducted a longitudinal, comparative study in patients with COVID-19, older than 18 years, admitted to the ICU. We evaluated HAS, DM, obesity, COPD, asthma, PaO2/FiO2, tomographic severity. On admission and on days 3 and 7 we measured Neutrophil-Lymphocyte Index, SOFA and APACHE score. For statistical analysis, we performed ROC and Kaplan-Meyer curves.

Results

We included 180 patients with COVID-19, 63 died (35%). Delta INL1(Day1-day3)>4.11 was associated with mortality (AUC:0.633); sensitivity 55.56% and specificity 77.78%, CI95 0.55-0.70, for delta INL2 (Day1-day7)>8.95 (AUC:0.623); sensitivity 44.44% and specificity 84.62%, CI95 0.54-0.69. Difference in survival was observed for Delta1. SOFA scale >6, was associated with more days of mechanical ventilation and lower PaO2/FiO2 (p<0.001).

Conclusions

INL delta between the day of ICU admission and the 3rd day of evolution is a predictor of mortality in critically ill patients.

The Association between Lifestyle Risk Factors and COVID-19 Hospitalization in a Healthcare Institution

COVID-19 is an acute infectious respiratory disease caused by SARS-CoV-2, a subtype of the coronavirus. In addition to normal levels of biometric measures, a healthy lifestyle has been considered an indispensable element in preventing complications of coronavirus infection. Demographic characteristics are also critical in determining risk levels. Aim: Investigate potential significant associations between health behaviors, biometric screenings, demographics, and COVID-19 hospitalization in Loma Linda University Health employees. Methods: Participants are employees covered under the employer-sponsored health plan at Loma Linda University Health, Loma Linda, CA, who tested positive for COVID-19. Logistic regression models were applied to analyze demographics, biometric screenings, and lifestyle factors associated with COVID-19 hospitalization. In our study, 7% of participants required hospitalization. Variables independently associated with COVID-19 hospitalization included higher age (OR = 1.05 [1.01–1.08], P = .005), non-White race compared to the White race (OR = 3.2 [1.22–8.38], P = .018), higher HbA1C levels showing a marginal association (OR = 1.31 [.99–1.72], P = .057), and lower vegetable consumption (OR = 4.39 [2.06–9.40], P < .001). Lower protein consumption decreased the Odds of hospitalization (OR = .40 [.19–.87], P = .021). Our results suggest that a diet that includes more vegetables and lower protein may confer some protection against COVID-19 hospitalization.

The role of physical activity in the clinical outcomes of people diagnosed with Covid-19: A systematic review

Objective

This review aimed to compile the evidence on PA and clinical outcomes of people receiving a positive diagnosis of covid-19.

Design

Systematic review.

Methods

The search was performed in five databases: EMBASE, MEDLINE via PubMed portal, Scopus, SPORTDiscus via EBSCO platform, and Web of Science. In addition, the "gray" literature was searched through Google Scholar and medRxiv published between January 2020 and July 2022. Studies were assessed for risk of bias, with the extraction of relevant data. Our search revealed a total of 10,028 studies.

Results

After applying the eligibility criteria 32 studies were included. Thirty-one studies were at low to moderate risk of bias. Physically active individuals, who were diagnosed with covid-19, presented attenuation of clinical outcomes, such as decreased risk of hospitalization, recovery time, number of symptoms, severity, and ICU and death when compared to individuals with low levels of PA or classified as sedentary.

Conclusions

Physically active individuals when diagnosed with covid-19 may have decreased risk of several clinical outcomes related to covid-19, including but not limited to hospitalization and number of symptoms. Public health authorities should develop strategies and initiatives that promote safe PA environments to improve the clinical prognosis of people diagnosed with covid-19.

Study registration

Open Science Framework (OSF), DOI registry 10.17605/OSF.IO/PV6NF. It can be consulted through the access link: https://doi.org/10.17605/OSF.IO/PV6NF, October 07, 2021.

Long-COVID and long-term cancer survivorship-Shared lessons and opportunities

As of 2022, close to 90 million persons in the United States, 243 million persons in Europe and 585 million worldwide have been infected with the novel SARS‐CoV‐2 (COVID‐19) virus and survived. Estimates vary but suggest that up to 50% may experience long‐term sequelae, termed ‘Long‐COVID’. While Long‐COVID is a new condition, the phenomenon of disabling long‐term effects following an illness requiring ongoing surveillance and management is not. In this commentary, we discuss how Long‐COVID parallels the experiences of long‐term cancer survivors, highlight shared challenges and offer opportunities to improve research and clinical care for both growing populations of patients as well as other long‐term chronic, disabling conditions.

Bibliometric analysis of the top-50 cited articles on COVID-19 and physical activity

Background

Since the 2019 novel coronavirus (COVID-19) pneumonia outbreak in late 2019, an endless stream of research has emerged surrounding physical activity. This study analyzes the 50 most influential articles on COVID-19 and physical activity over the past 2 years to describe the research landscape and hotspots from bibliometric citation analysis.

Methods

The top-50 cited articles were extracted from the Web of Science Core Collection database, and bibliometric citation analysis was performed by Excel 2019 and VOSviewer software.

Results

The top-50 articles were cited 160.48 ± 106.90 (range: 70-587). Most of the articles were from the United States (14), followed by Italy (11) and England (9). The International Journal of Environmental Research and Public Health (n = 10) is the journal with the top-50 cited articles. The collaboration between authors was mainly among three teams, including Smith L, Musumeci G, and Napoli C. The hotspot of research around COVID-19 and physical activity focused on lifestyle change (sedentary behavior, sitting time), mental health (depressive, anxiety, loneliness), the credibility of physical activity assessment tools (reliability, validity), and physical activity of different populations (gender, youth, children).

Conclusions

Based on a bibliometric analysis of high-impact articles on COVID-19 and physical activity highlights physical activity as an essential lifestyle change and developments and hotspots in this field. These data will provide insights for future researchers regarding the direction of physical activity research in the COVID-19 pandemic.

COVID-19: Sports activity and health-related quality of life of Swiss children and adolescents before and during the initial stay at home period

The aim of this study was to investigate sports activity and health-related quality of life (HRQoL) of Swiss children and adolescents (7–16 years) during the national COVID-19 stay at home (SaH) period. In total, 237 parent-child pairs gave information about HRQoL and sports activity (duration and type) before and during SaH. Results show that sports activity decreased during SaH and was also positively related to HRQoL. These findings indicate that sports activity of children and adolescents should be promoted during SaH, for which innovative home-based interventions may be useful.

Comparison of trace element (selenium, iron), electrolyte (calcium, sodium), and physical activity levels in COVID-19 patients before and after the treatment

OBJECTIVE

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), a worldwide health problem, is the cause of 2019 coronavirus disease. This study aimed to compare the trace element (selenium and iron), electrolyte (calcium and sodium), and physical activity levels of COVID-19 patients before and after COVID-19 treatment.

METHOD

This prospective study was conducted in patients diagnosed with COVID-19 (n = 15). Trace element (selenium and iron), electrolyte (calcium and sodium), and physical activity levels of the patients were compared before and after the treatment.

RESULT

Most of patients had selenium deficiency (86.7 %), iron deficiency (73.3 %), calcium deficiency (66.7 %) and sodium deficiency (46.7 %) before COVID-19 treatment. The most important improvements were seen in iron deficiency (from 73.3 % to 26.7 %) and sodium deficiency (from 46.7 % to 13.3 %) after the treatment. Selenium, iron, calcium, and sodium levels of the patients were significantly higher after the treatment (p < 0.05). The patients had low physical activity before and after COVID-19 treatment. In addition, no statistically significant difference was found in the comparison of physical activity levels (p > 0.05).

CONCLUSION

This study indicated that selenium, iron, calcium, and sodium levels and deficiencies might improve after treating patients with COVID-19. However, the results of this study showed that the physical activity levels of COVID-19 patients might remain stable and low throughout the treatment process.

Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis

Among coronavirus disease 2019 (COVID-19) patients, physically active individuals may be at lower risk of fatal outcomes. However, to date, no meta-analysis has been carried out to investigate the relationship between physical activity (PA) and fatal outcomes in patients with COVID-19. Therefore, this meta-analysis aims to explore the hospitalisation, intensive care unit (ICU) admissions, and mortality rates of COVID-19 patients with a history of PA participation before the onset of the pandemic, and to evaluate the reliability of the evidence. A systematic search of MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and medRxiv was conducted for articles published up to January 2022. A random-effects meta-analysis was performed to compare disease severity and mortality rates of COVID-19 patients in physically active and inactive cases. Twelve studies involving 1,256,609 patients (991,268 physically active and 265,341 inactive cases) with COVID-19, were included in the pooled analysis. The overall meta-analysis compared with inactive controls showed significant associations between PA with reduction in COVID-19 hospitalisation (risk ratio (RR) = 0.58, 95% confidence intervals (CI) 0.46-0.73, P = 0.001), ICU admissions (RR = 0.65, 95% CI 0.52-0.81, P = 0.001) and mortality (RR = 0.47, 95% CI 0.38-0.59, P = 0.001). The protective effect of PA on COVID-19 hospitalisation and mortality could be attributable to the types of exercise such as resistance exercise (RR = 0.27, 95% CI 0.15-0.49, P = 0.001) and endurance exercise (RR = 0.41, 95% CI 0.23-0.74, P = 0.003), respectively. Physical activity is associated with decreased hospitalisation, ICU admissions, and mortality rates of patients with COVID-19. Moreover, COVID-19 patients with a history of resistance and endurance exercises experience a lower rate of hospitalisation and mortality, respectively. Further studies are warranted to determine the biological mechanisms underlying these findings.

Multi-organ system involvement in coronavirus disease 2019 (COVID-19): A mega review

Since the pandemic of the coronavirus disease 2019 (COVID-19) infection, many people have been affected in different ways. The majority of infected people experience mild to moderate symptoms and recover without the need for hospitalization. However, in some affected people, it may lead to catastrophic disease. The severity of COVID-19 infection is widely influenced by co-morbidities, immune system functions, and extra-pulmonary organ injuries. Since the emergence of COVID-19, multi-organ involvement has been documented. In order to implement preventative and protective measures, full attention to potential organ injuries is required. Most existing articles and review papers are focused on a specific organ system, and their numbers are growing. In this review paper, attempts were made to collect review papers and articles published on seven organ system involvements in COVID-19 infection published till 15 July and highlight conclusions and managements of all affected organs. We tried to add to the medical knowledge on COVID-19, pointing out its multi-organ system impact. Finally, we tried to facilitate access to organized information and optimum conclusion by representing review tables for each organ system. Besides, this review article can clarify and magnify the empty research space easily for future investigations.

Physical Exercise and Undergraduate Students’ Subjective Well-Being: Mediating Roles of Basic Psychological Need Satisfaction and Sleep Quality

This study aimed to examine the association between physical exercise and subjective well-being among undergraduate students, as well as its underlying mechanism—the potential mediating roles of basic psychological need satisfaction and sleep quality—from the perspective of self-determination theory. A sample of 770 undergraduate students (mean age was 19.90 ± 1.15 years old; 464 women) were recruited voluntarily to complete a set of measures examining physical exercise habits, psychological need satisfaction in exercise, sleep quality, and subjective well-being. The results indicated that (1) physical exercise was positively associated with undergraduate students’ subjective well-being; (2) psychological need satisfaction and sleep quality could significantly mediate this relation, which contained three pathways—the independent mediating effects of sleep quality and basic psychological need satisfaction and the sequential mediating effect of them. These findings not only reveal the mediating mechanism underlying the relation between physical exercise and subjective well-being by integrating the psychological and physical factors together but also provide an empirical basis for formulating prevention and intervention programs aimed at promoting the health and subjective well-being of undergraduate students.

Sports Participation and Anti-Epidemic: Empirical Evidence on the Influence of Regular Physical Activity on the COVID-19 Pandemic in Mainland China

This study aims to investigate the effects and influencing mechanisms of regular physical activity (RPA) on the COVID-19 pandemic. Daily data from 279 prefecture-level cities in mainland China were collected from 1 January to 17 March 2020. A two-way fixed-effects model was used to identify the causal relationship between physical activity and COVID-19, while also considering factors such as patterns of human behavior and socioeconomic conditions. The instrumental variable (IV) approach was applied to address potential endogeneity issues for a more accurate causal identification, and the mediating effect model was applied to examine the mechanisms of the influence of physical activity on the epidemic. We found that regular physical activity significantly improves individual immunity, which, in turn, leads to a reduction in the probability of being infected with COVID-19. Furthermore, we investigated the heterogeneity of the influence, finding that the negative impact of physical activity on the pandemic is more pronounced in the absence of adequate medical resources, strong awareness of prevention among residents, and fully implemented public health measures. Our results provide empirical evidence for the mechanisms of influence of physical activity on the pandemic. We would suggest that not only should physical activity be actively practiced during the pandemic, but also long-term regular exercise habits should be consciously cultivated to improve the ability of the individual immune system to better cope with sudden outbreaks of emerging infectious diseases.

The Potential Role of Growth Differentiation Factor 15 in COVID-19: A Corollary Subjective Effect or Not?

Coronavirus disease 2019 (COVID-19) is primarily caused by various forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) variants. COVID-19 is characterized by hyperinflammation, oxidative stress, multi-organ injury (MOI)-like acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Different biomarkers are used in the assessment of COVID-19 severity including D-dimer, ferritin, lactate dehydrogenase (LDH), and hypoxia-inducible factor (HIF). Interestingly, growth differentiation factor 15 (GDF15) has recently become a potential biomarker correlated with the COVID-19 severity. Thus, this critical review aimed to determine the critical association between GDF15 and COVID-19. The perfect function of GDF15 remains not well-recognized; nevertheless, it plays a vital role in controlling cell growth, apoptosis and inflammatory activation. Furthermore, GDF15 may act as anti-inflammatory and pro-inflammatory signaling in diverse cardiovascular complications. Furthermore, the release of GDF15 is activated by various growth factors and cytokines including macrophage colony-stimulating factor (M-CSF), angiotensin II (AngII) and p53. Therefore, higher expression of GDF15 in COVID-19 might a compensatory mechanism to stabilize and counteract dysregulated inflammatory reactions. In conclusion, GDF15 is an anti-inflammatory cytokine that could be associated with the COVID-19 severity. Increased GDF15 could be a compensatory mechanism against hyperinflammation and exaggerated immune response in the COVID-19. Experimental, preclinical and large-scale clinical studies are warranted in this regard.

A Review of COVID-19 in Relation to Metabolic Syndrome: Obesity, Hypertension, Diabetes, and Dyslipidemia

Although severe cases and mortality of coronavirus disease 2019 (COVID-19) are proportionally infrequent, these cases are strongly linked to patients with conditions of metabolic syndrome (obesity, hypertension, diabetes, and dyslipidemia). However, the pathophysiology of COVID-19 in relation to metabolic syndrome is not well understood. Thus, the goal of this secondary literature review was to examine the relationship between severe acute respiratory syndrome (SARS-CoV-2) infection and the individual conditions of metabolic syndrome.

The objective of this secondary literature review was achieved by examining primary studies, case studies, and other secondary studies, to obtain a comprehensive perspective of theories and observations of COVID-19 etiology with metabolic syndrome. The most extensive research was available on the topics of diabetes, hypertension, and obesity, which yielded multiple (and sometimes conflicting) hypothetical pathophysiology. The sources on dyslipidemia and COVID-19 were scarcer and failed to provide an equally comprehensive image, highlighting the need for further research.

It was concluded that hypertension had the strongest correlation with COVID-19 incidence (followed by obesity), yet the causative pathophysiology was ambiguous; most likely related to cardiovascular, angiotensin-converting enzyme 2 (ACE-2)-related complications from renin-angiotensin-aldosterone system (RAAS) imbalance. Obesity was also positively correlated to the severity of COVID-19 cases and was believed to contribute to mechanical difficulties with respiration, in addition to hypothetical connections with the expression of ACE-2 on abundant adipose tissue. Diabetes was believed to contribute to COVID-19 severity by producing a chronic inflammatory state and interfering with neutrophil and T-cell function. Furthermore, there were indications that COVID-19 may induce acute-onset diabetes and diabetic ketoacidosis. Lastly, dyslipidemia was concluded to potentially facilitate SARS-CoV-2 infection by enhancing lipid rafts and immunosuppressive functions. There were also indications that cholesterol levels may have prognostic indications and that statins may have therapeutic benefits.

Five-Year Trend in Adherence Rate to Aerobic Physical Activity Guidelines among Korean Adults in Metropolitan Cities: 2016-2020 Korea Community Health Survey

This study investigated the five-year (2016−2020) trend in physical activity adherence rate (PAR)—before and after the onset of the COVID-19 pandemic—and its association with socioeconomic status and community environment among Korean adults. Data were analyzed from the Korea Community Health Survey 2016−2020 concerning adults (19−65 years old) living in seven metropolitan municipalities of South Korea (N = 190,761). The independent variables were socioeconomic status (household income and educational attainment) and community environment (density of physical activity facilities and social cohesion), and the dependent variable was the PAR, as measured by the International Physical Activity Questionnaire-Short Form, a recall-based subjective survey. Multilevel logistic regression models with age, sex, and body mass index as covariates were applied. The results showed that the PAR increased from 37.26% (2016) to 40.84% (2019), during the pre-COVID-19 pandemic, but it sharply decreased to 31.59% (2020) during the COVID-19 confinement (trend p < 0.001); PAR disparities were observed following socioeconomic status, as indicated by household income (trend p < 0.001) and educational attainment (trend p < 0.001). Furthermore, significant moderation effects were observed from socioeconomic status and community environment, but the direction of the effects varied by indicator and COVID-19-related confinement period. Lower educational attainment and higher income were associated with a greater decrease in PAR during the pandemic. This study shows that PAR substantively decreased in South Korea during the COVID-19 pandemic, although it had shown a steady increase through 2019. In addition, PAR disparities by socioeconomic status were found, and socioeconomic status and community environment had distinct influences on PAR trends, depending on their indicators and pre- and post-pandemic periods. Lower educational attainment is associated with greater decreases in PAR during the pandemic, suggesting the necessity for a public campaign to maintain a physically active lifestyle during such social disaster.

Systematic Review of COVID-19-Related Physical Activity-Based Rehabilitations: Benefits to Be Confirmed by More Robust Methodological Approaches

The first emergency was to receive and treat COVID-19 patients in their acute phase; today, there is a clear need to propose appropriate post-acute rehabilitation programs. The aim of this research was to systematically review the effects of physical activity programs in the recovery of post-COVID-19 patients. The literature search followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, was registered in the PROSPERO database (CRD42022289219), and was conducted between August and December 2021. A total of 35 studies out of the 1528 initially identified were finally included in the analysis. The systematic review clearly showed the health benefits of rehabilitation including physical activity in post-COVID-19 recovery, regardless of exercise modalities. These positive results were even observed using minor muscle re-mobilization for severe cases (i.e., postural changes, few steps—2 times/day) or using low volumes of exercise for mild-to-moderate cases (i.e., 120 min/week). A total of 97% of the 29 studies that performed statistical analyses demonstrated a significant increase in at least one parameter of functional capacity, and 96% of the 26 studies that statistically investigated the effects on the quality of life, mental health, and general state reported improvements. Yet, most of the studies were retrospective, uncontrolled, and enrolled aged people with comorbidities presented in severe forms of COVID-19. Physical activity programs, in addition to their high heterogeneity, remained poorly described in 83% of the studies and were part of a multidisciplinary program for 89% of the studies. Despite promising results, there is today a real need for prospective well-designed studies specifically assessing the effects of physical activity. In addition, it might appear relevant to propose standardized programs further considering the main characteristics of patients such as age, comorbidities, or the severity of COVID-19.

Exercise in Cold Weather for COVID-19-Recovered Individuals (CRI)

Background: The sedentary lifestyle caused by the COVID-19 quarantine has resulted in a devastating threat to human health due to stress and anxiety. Although infected individuals must stop exercising, exercise is not prohibited when without symptoms and complications. Whereas exercise can be effective in immune system reinforcement during the prevention, recovery, and post-recovery stages, COVID-19-recovered Individuals (CRI) must exercise under accurate considerations. Objectives: This study aimed to study exercise in cold weather for the CRI. Methods: This article overviews how different exercises affect the immune system. PubMed, Science Direct, and Google Scholar Databases and keywords including cold weather, COVID-19, immune system, and combined exercise were used to access scientific articles. Results: Recent reports show that different sports and exercises significantly improve COVID-19 symptoms, although there are many discrepancies among researchers in prescribing exercise programs (various training protocols, duration, and intensity). Also, CRI should avoid exercise in cold weather due to breathing complications Conclusions: Based on the present study, regular exercises (aerobic, resistance, and combined) with moderate intensity improve COVID-19 symptoms and the immune system.

Lymphocytes are less sensitive to autophagy than monocytes during fasting and exercise conditions

The concomitant investigation of apoptosis (a regulated cell death) and autophagy (a conserved cell survival mechanism) in immune cells is rare. More detailed knowledge of these two types of self-consumption in circulating lymphocytes and monocytes would be important, since conditions such as fasting and acute exercise could promote health by a coordinated/linked modulation of autophagy and apoptosis in these mononuclear cells. In this study we performed flow cytometry to quantify numbers of apoptotic and autophagic mononuclear cells, lymphocytes and monocytes in fasting, standardized fed, and exercise conditions, using Annexin V, LC3B, and p62, respectively. We show that within total mononuclear cells lymphocytes are less apoptotic and autophagic than monocytes during fasting (p < 0.001, p < 0.05, respectively) and after acute exercise (p < 0.01, p < 0.05, respectively). Fasting increased circulating autophagic monocyte concentrations, but not lymphocytes compared to the fed control condition. Acute exercise elevated circulating autophagic lymphocyte concentrations, but not monocytes. Interestingly, Western blotting analysis of the fasting samples showed that higher LC3BII/I ratios were correlated with lower numbers of autophagic mononuclear cells (r = − 0.74, p = 0.02, n = 8), which could be attributed to the monocyte subgroup, but not lymphocytes. These results extend the current knowledge of the two types of self-consumption in circulating immune cells and underline their possible importance in pro-inflammatory monocytes during fasting and exercise as health promoting interventions.

RANTES and CD40L under Conditions of Long-Term Physical Exercise: A Potential Link to Adaptive Immunity

Regular physical exercise was found to be associated with an improved immune response in previous studies. RANTES and CD40L play a pivotal role in host defense, and individuals lacking adequate expression are prone to virus and opportunistic infections. A total of 98 participants were enrolled in this study. The probands were asked to perform moderate physical activity, and bicycle stress tests were performed at the baseline and after 8 months of training to evaluate individual performance. RANTES and CD40L were found to be increased by long-term physical exercise. In particular, probands with a performance gain of ≥3% displayed a pronounced elevation of both markers, paired with a decrease in circulating IL6 levels and an improved lipid profile. In summary, we were able to highlight rising levels of serum RANTES and CD40L under the conditions of physical exercise. Taking their role in host defense into account, a conjunction of physical activity and the adaptive immune system could therefore be assumed. Furthermore, low inflammatory profiles in probands with a significant performance gain suggest a modulation through exercise rather than a generalized pro-inflammatory status.

The effects of wearing a mask on an exercise regimen

Context

Masks have long been utilized to prevent the spread of airborne pathogens and diseases in the healthcare setting. Recently, due to the COVID-19 pandemic, mask use has been expanded to all public areas to help slow the spread of this virus. One such location where masks can be seen is gyms. While exercising, the needs of the body are altered due to the increased stress being placed upon it. Normal physiology is thus adjusted to meet these new demands and to maintain optimal functioning. Therefore, it is possible that adding a mask covering the mouth and nose while exercising could further exacerbate this physiologic alteration, causing potential concerns.

Objectives

The goal of this study is to identify the impact of mask use on normal perceived physiology (breathing, heart rate, temperature, exertion, stamina, and quality of workout) within the exercising population.

Methods

To obtain data focused on the research question, a self-reporting, online, anonymous Qualtrics survey was administered in local gyms and social media outlets. A total of 280 total participants were recruited between the ages of 18 and 65 who have ever exercised while wearing a mask. All results were analyzed utilizing descriptive statistics, bivariate correlations, Mann–Whitney U tests, and Kruskal–Wallis tests. A Cronbach’s alpha was also calculated to check internal validity. The significance level utilized was p≤0.05.

Results

Completion of a Kruskal–Wallis test revealed statistical significance regarding the perception of masks in general and the participants’ rating of the perceived physiological parameters (breathing: p<0.001; heart rate: p<0.001; temperature: p<0.001; exertion: p<0.001; stamina: p<0.001; and quality of workout: p<0.001), the duration of time the mask was utilized during the workout, and the participants’ rating of the perceived physiological parameters (breathing: p=0.001; heart rate: p=0.020; temperature: p<0.001; exertion: p<0.001; stamina: p=0.001; quality of workout: p<0.001; and perception of mask: p<0.001), and the change in the number of days that the participants exercised per week during the pandemic as well as some of the participants’ ratings of the perceived physiological parameters (breathing: p=0.042; exertion: p=0.015; stamina: p=0.027; and quality of workout: p=0.016).

Conclusions

Any alterations to normal physiology perception while exercising with a mask appear to be psychological and adaptive in nature. Masks alone did not contribute to the perception of their physiologic changes.

Improvements of Physical Activity Performance and Motivation in Adult Men through Augmented Reality Approach: A Randomized Controlled Trial

The COVID-19 pandemic had a global impact, increasing the prevalence of physical inactivity, which is mostly due to the lockdown and social distancing measures adopted during the pandemic. Hence, this study aimed to compare the efficacy of augmented reality-based training on physical activity performance and motivation in healthy adults to mirror visual feedback training and conventional physical therapy. This study used the randomized control trial pretest-posttest research design. Forty-eight healthy men aged 18–35 years who were engaged in recreational physical activities were enrolled and randomly divided into four groups: augmented reality-based training reality (ART), mirror visual feedback training (MVFT), therapist-based training (TBT), and control group. The total training program was held for four weeks. The isokinetic dynamometer, sit-and-reach test, Y balance test, and the intrinsic motivation inventory-22 were used to measure the outcomes before and after the intervention. Paired sample t-test was used to compare the changes before and after the intervention within groups, while the one-way ANOVA was used for the comparison between the groups. Results of the study showed that, after four weeks of intervention, balance, muscle strength, and muscle endurance in all groups significantly improved except for the control group. The ART group showed the highest increase in muscle strength, muscle endurance, and balance compared to the other groups. The motivation level increased in all three feedback groups and was observed in the following order: ART group > MVFT group > TBT group > control group. This study highlighted the most effective method that may be applied for home training during and after this period of the pandemic. The findings revealed that training while receiving real-time feedback via AR devices improves both physical performance and motivation. Augmented reality-based training can be used as an effective training option for improving physical activity and motivation and can be suggested for home training programs.

The Impact of the Highly Virulent SARS-CoV-2 Gamma Variant on Young Adults in the State of São Paulo: Was It Inevitable?

Background

The coronavirus disease 2019 (COVID-19) pandemic had and is still having a tremendous impact on people all over the world, but it has been particularly harsh in South America. Nine out of 13 South American countries are among the 50 countries with the highest COVID-19 death rates. The gamma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant that emerged by the end of 2020 in the Brazilian Amazon quickly spread throughout the country causing the harsh COVID-19 second wave. This variant displayed high viral loads, high transmissibility, and increased virulence as compared to previous variants.

Aims

The aim of this retrospective study is to revisit and analyse the epidemiology of the COVID-19 second wave in the state of São Paulo, the most populous Brazilian state. In addition to examining the possible factors that led to the emergence and propagation of the gamma variant, measures that could have prevented its spread and that of other highly virulent variants were also investigated.

Materials and methods

Data from São Paulo's official sources on morbidity, mortality, age distribution, and testing prior to and during the COVID-19 second wave (February - June 2021) and data regarding the distribution of SARS-CoV-2 variants in the country were parsed, analyzed, and compared to the period that anteceded the eruption of the second COVID-19 wave.

Results

In the state of São Paulo, the toll of the COVID-19 second wave surpassed that of the first 11 months of the pandemic (from March 2020 to January 2021), as 56% of the deaths occurred in the five months of the second wave between February and June 2021. The mean age of COVID-19 victims, which was already below life expectancy in the state dropped even further in the pandemic's second wave, reaching an average of 60 years of age. The years of life lost per death per month doubled and the case-fatality rate (CFR) of young adults (20-39 years old) more than trebled during this period. A number of hypotheses have been raised that might explain the emergence and spread of the gamma variant and the measures that could have been taken to prevent it and minimise its impact on the population.

Conclusions

Over 142,000 people died as a result of the SARS-CoV-2 gamma variant sweep in São Paulo in the first semester of 2021. Due to its high viral load, the gamma variant displayed high transmissibility and a high degree of virulence resulting in increased case fatality rates across most age tiers. Notably, this second wave was marked by a very significant increase in deaths among young adults. This increase was at least partially due to a deterioration in general health provoked by non-pharmaceutical interventions. In hindsight, a safer and more effective measure might have been to allow the free spread of the virus among the young and healthy in the first wave, thus conferring immunity against more virulent variants that emerged later on.

The Impact of the COVID-19 Pandemic on the Physical Fitness of Primary School Students in China Based on the Bronfenbrenner Ecological Theory

After the outbreak of the COVID-19 pandemic, nation lockdown became an effective way to isolate the spread of the virus. Schools were postponed, students had to stay at home and opportunities for physical activity amongst school children were severely affected. This research sought to determine the impact of the pandemic on the physical fitness of primary school students. In total, 1,235 students from grades one to five in a primary school in Beijing took part in this research. Using the Chinese National Student Physical Fitness Standard as a guide, the students were subjected to BMI, vital capacity, 50 m sprint, sit and reach, timed rope-skipping, timed sit-ups, and 50m × 8 shuttle run measurements. These tests were administered once before and once after the lockdown period. The results showed that the overall physical fitness of the participants was better after the lockdown [p = 0.000, r = -0.14, 95% CI (-0.219, -0.061)]. Specifically, vital capacity, sit and reach, timed rope-skipping and timed sit-ups had improved after the lockdown. Meanwhile, 50m × 8 shuttle run dropped slightly but not significantly whereas 50 m sprint dropped sharply after the lockdown. The proportion of overweight and obese students increased, but the difference before and after the lockdown was small. It appeared that during the pandemic, through the intervention of many comprehensive factors, home-based fitness was normalized and promoted the healthy development of students.

Extreme anaerobic exercise causes reduced cytotoxicity and increased cytokine production by peripheral blood lymphocytes

Exercise has many beneficial effects for our body, but can become detrimental at high intensity, especially for our immune system. Little is known about the underlying mechanism of impaired immune functionality under conditions of intense physical strain. Freedivers, people who dive to high depths on a single breath, perform extreme exercise under anaerobic conditions. In this study, we investigated the impact of freediving on the cytotoxic arm of the immune system. At rest, elite freedivers did not display changes in their immunological profile compared to non-diving controls. In contrast, after a freedive, granzyme B and IL-2 production were reduced, whereas IFNγ and TNF secretion were increased by cytotoxic immune cells. Using in vitro models mimicking freedive conditions, we could show that hypoxia in combination with stress hyperglycemia had a negative impact on Granzyme B secretion, whereas IL-2 production was inhibited by stress hormones. Our findings suggest that in response to extreme exercise, cytotoxic immune cells transiently change their functional profile to limit tissue damage.