COVID-19 pandemic is an urgent time for older people to practice resistance exercise at home

The Impact of COVID-19 on Functional Capacity and Pulmonary Outcomes in the Hail Region: A Cross-Sectional Study

Background/Objectives: COVID-19, caused by the novel coronavirus SARS-CoV-2, has had a significant impact on life worldwide since its emergence in late 2019. The virus has caused a global pandemic, leading to widespread health, social, economic, and psychological effects. COVID-19 mainly affects the respiratory system. This study aimed to compare the functional capacity and pulmonary function outcomes between COVID-19 patients and individuals who have not been infected in the Hail region. Methods: Individuals of both genders above 18 years old who had been infected with COVID-19 in the previous 6 months or had never been infected were eligible to participate. Local hospitals and social media apps were used to recruit willing participants. Heart rate, pulse oxygen saturation, blood pressure, pulmonary function test, hand grip strength, and functional tests (6 min walk test, 30 s sit-to-stand test, and timed up and go test) were measured and compared between the groups. Statistical analysis was performed using SPSS Version 25. Results: Forty individuals affected with COVID-19 and forty-one healthy individuals were recruited. Our results showed that in individuals affected with COVID-19, scores on the minute ventilation, 30 s sit-to-stand, and 6 min walk tests were significantly lower than among healthy individuals. Other outcomes did not show any statistical differences between the groups. Conclusion: This study contributes to a greater understanding of the functional capacity status of individuals with COVID-19. Patients affected by COVID-19 may develop an impaired lung capacity and a decreased function capacity. These factors may negatively affect physical and cognitive health status. Future studies should evaluate the benefits of interventions with rehabilitation exercises following COVID-19. In light of the functional capacity and pulmonary function decline in individuals affected by COVID-19, interventions encompassing pulmonary and functional rehabilitation exercises are recommended to improve physical fitness and pulmonary function post-COVID-19.

A prospective non-randomized feasibility study of an online membership-based fitness program for promoting physical activity in people with mobility impairments

BACKGROUND

People with mobility limitations have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes. These conditions often result from poor access to home and community-based health promotion/wellness programs. The aim of this project was to determine the feasibility of delivering an online community membership-based fitness program for individuals with mobility impairments.

METHODS

For this prospective single-arm study, participants were recruited from members of a community fitness facility that serves people with physical disabilities and chronic health conditions. While all members had access to the online platform, individuals had to opt-in to participate in the research component. Activity options included 16 pre-recorded videos and 9 live exercise classes. During the 8-week program, participants had an opportunity to earn three exercise incentives for reaching certain activity milestones. Enrollment percentage, attendance, and attrition were tracked to assess program feasibility and acceptability. Changes in participant-reported outcomes including self-reported physical activity, psychosocial outcomes, and health-related quality of life (HRQOL) were examined using non-parametric analyses.

RESULTS

A total of 146 eligible individuals were screened of which 33 enrolled (22.6%). Two participants withdrew from the study, so a total of 31 were used for analyses. Participants included 29 women and 12 Black people with an average age of 60 (± 15.9) years. Health conditions included stroke, post-polio, arthritis, neuropathy, cerebral palsy, and obesity. Ten participants used an assistive device to get around inside the home. Twenty-six participants (78.8%) completed the online program, and 5 participants earned all 3 participation incentives. The mean number of live Zoom exercise classes attended by the participants was 12.8 (range = 0-43) over 8 weeks; 3 of 31 participants did not attend any classes. On average, participants watched 128 min (range = 0-704 min) of pre-recorded videos; 6 of 31 participants did not view any pre-recorded videos. Self-reported physical activity showed the largest improvement (11.15 units; 95% CI, 3.08, 19.56) with an effect size of 0.51 (Cohen's d).

CONCLUSIONS

This pilot study of an online membership-based fitness program for people with mobility impairments demonstrated preliminary effectiveness in increasing physical activity and was found to be feasible and acceptable. Feasibility endpoints do indicate potential to improve retention. These results suggest that online delivery of exercise programs can broaden the reach of specialized community fitness programs and is a promising direction for future work and fully powered trials are warranted to assess intervention efficacy.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05138809. Registered September 2, 2021, ClinicalTrials.gov PRS: Record Summary NCT05138809.

The Effects of Cognitive Ability, Mental Health, and Self-Quarantining on Functional Ability of Older Adults During the COVID-19 Pandemic: Results From the Canadian Longitudinal Study on Aging

OBJECTIVES

Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability.

DESIGN AND SETTING

Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018).

PARTICIPANTS

17 541 CLSA participants.

MEASUREMENTS

Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study.

RESULTS

Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01).

CONCLUSIONS

Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.

The impact of a mixed reality technology-driven health enhancing physical activity program among community-dwelling older adults: a study protocol

Background

Physical inactivity and a sedentary lifestyle among community-dwelling older adults poses a greater risk for progressive physical and cognitive decline. Mixed reality technology-driven health enhancing physical activities such as the use of virtual coaches provide an emerging and promising solution to support healthy lifestyle, but the impact has not been clearly understood.

Methods and analysis

An observational explanatory sequential mixed-method research design was conceptualized to examine the potential impact of a user-preferred mixed reality technology-driven health enhancing physical activity program directed toward purposively selected community-dwelling older adults in two senior centers in the Philippines. Quantitative components of the study will be done through a discreet choice experiment and a quasi-experimental study. A total of 128, or 64 older adults in each center, will be recruited via posters at community senior centers who will undergo additional screening or health records review by a certified gerontologist to ensure safety and proper fit. Treatments (live coaching with video-based exercise and mixed reality technology-driven exercise) will be assigned to each of the two senior center sites for the quasi-experiment. The participants from the experimental group shall be involved in the discreet choice experiment, modeling, and usability evaluations. Finally, a qualitative sample of participants (n = 6) as key informants shall be obtained from the experimental group using purposive selection.

Discussion

This study protocol will examine the health impact of a promising mixed reality program in health promotion among older adults. The study utilizes a human-centered mixed method research design in technology development and evaluation in the context of developing nations.Clinical trial registration: ClinicalTrials.gov, identifier NCT06136468.

Effects of social distancing provoked by COVID-19 pandemic in the functional capacity and cognitive function in nonagenarians and centenarians

INTRODUCTION

Due to the rapid advance of coronavírus SARS-CoV-2 (COVID-19) pandemic in 2020, social distancing was the main way to reduce the transmission of the virus. Although this measure was efficient and necessary, the social distancing had severe consequences for physical function, mainly in older individuals. Thus, the aim of this study was to investigate the effects of social distancing in the functional and cognitive capacity of community-dwelling oldest-old adults.

METHODS

The present study is part of a larger prospective cohort study. Fifteen participants aged 90 years old or older were assessed in the 8-foot-timed-up-and-go test (8-footTUG), sit-to-stand-up test (STS), handgrip strength test (HGS), Mini Mental State Examination (MMSE), Katz Index and Lawton Scale before and after one year of social distancing.

RESULTS

A significant worsening in the 8-footTUG and MMSE score was observed, while there were no significant changes in the other variables. When analyzing the decreases in relation to previous functional capacity, it was observed that individuals categorized as dependent by STS cut-off points had the worst decreases in functional capacity.

CONCLUSION

The social distancing provoked by COVID-19 pandemic negatively affected the 8-footTUG and cognition. Moreover, individuals dependents showed greater decline in their functional capacity.

Factors associated with worsening in the self-rated health status of Brazilian women who lived with dependent elderly people during the first wave of COVID-19

The objective is to analyze the factors associated with the worsening of the self-rated health (SRH) of Brazilian women who live with elderly people with functional dependence (EFD) during the first wave of COVID-19. ConVid - Behavior Research was used as a data source. For the analysis, the group of women who lived with EFD was compared with those who lived with the elderly without any dependence. Hierarchical prevalence ratio (PR) models were estimated to test the associations between sociodemographic characteristics, changes in income, routine activities and health in the pandemic, with the outcome of worsening SRH. This worsening was more frequent in the group of women living with EFD. After adjusting for hierarchical factors, being black (PR=0.76; 95%CI 0.60-0.96) and having a per capita income lower than minimum wage (PR=0.78; 95%CI 0.64- 0.96) were shown to be protective factors for SRH worsening among EFD co-residents. Indisposition, emergence/worsening of back problems, affected sleep, poor SRH, feeling loneliness and difficulty in carrying out routine activities during the pandemic were positively associated factors. The study demonstrates that living with EFD was associated with a worsening in the health status of Brazilian women during the pandemic, especially among those of higher social status.

Power Training Prescription in Older Individuals: Is It Safe and Effective to Promote Neuromuscular Functional Improvements?

Muscle power has been reported to be critical in counteracting age-related declines in functional performance. Muscle power output in functional performance exercises can be greatly improved in a short period of time (i.e., ≤ 12 weeks) using specific exercise interventions such as power training (i.e., exercises attempting to move loads ranging from 20 to 70% of 1-repetition maximum as fast as possible during the concentric muscle action, followed by a controlled, slower eccentric muscle action). Despite the widespread evidence on the effectiveness of power training in older adults (~ 300 scientific articles published on this topic in the past 10 years), some scientists do not recommend the use of explosive-type muscular contractions during resistance training (i.e., power training) for the older population; indeed, some international guidelines do not mention this type of exercise for older people. The reasons underlying this absence of mention and recommendation for the use of power training as a fundamental exercise strategy for older people are still not well known. Therefore, we attempted to point out the main issues about safety, feasibility, and effectiveness of muscle power training to promote neuromuscular functional improvements in older people.

The Study of COVID-19's Perceptions as a Motivation to Exercise and Keep Fit Among Older Adults

Since the end of 2019, a novel coronavirus pandemic (COVID-19), characterized by solid infectivity, rapid communication and diverse communication routes, has become widespread worldwide. This study investigates the motivations of older adults to exercise and keep fit due to the COVID-19 pandemic. The research is based on a survey of older adults in Chengdu, Sichuan Province, China. It adopts the event strength system theory as a conceptual framework and the stimulus-organism-response (S-O-R) theory for causal inferences. (1) the perception of COVID-19's novelty had a significant negative impact on older adults" intention to exercise and stay fit, and the perception of COVID-19's disruptiveness and criticality had a significant positive impact on older adults" intention to exercise and fitness; (2) The perception of COVID-19's novelty had a significant negative effect on risk cognition, and the disruptive and critical cognitions had a significant positive effect on risk perceptions; (3) risk perceptions had a prominent positive effect on older adults" intention to exercise and fitness; and (4) risk communication played an important moderating role between COVID-19 event strength cognition and older adults' intention to exercise and fitness. The study revealed that the perception of COVID-19's seriousness significantly impacted older adults" intentions to exercise and keep fit and that risk perception and communication acted as mediating factors.

Impact of COVID-19 pandemic on mobility of older adults: A scoping review

AIMS AND OBJECTIVES

To identify the most frequent determinants of contact limitation on older adults' mobility addressed by the recommendations to mitigate mobility limitation during the COVID-19 pandemic and identify the recommendations characteristics and means of dissemination that might guide coping actions.

BACKGROUND

Measures for physical contact restriction were implemented to prevent COVID-19 spread. These measures directly impacted older people, reducing their mobility, especially outside home environment. Health systems worldwide need to be prepared to implement strategies to mitigate negative effects of reduced mobility in this population.

DESIGN

Scoping review using Arksey and O'Malley's methodological framework.

METHOD

Therefore, a scoping review was conducted in LILACS, CINAHL, MEDLINE, WEB OF SCIENCE and SCOPUS databases. Documents and reports with recommendations from government agencies were also consulted. Results were presented in a narrative synthesis based on a conceptual model of mobility proposed by Webber (The Gerontologist, 2010, 50, 443) regarding the most frequently addressed determinants, characteristics of the proposed interventions, and means of dissemination for the older person population.

FINDINGS

Twenty-eight studies were selected for the final sample. According to Webber's model, most articles (n = 14) presented the impacts on mobility from the perspective of physical determinants, relating this aspect to biological losses in the musculoskeletal system, and a minority assessed mobility in vital spaces, encompassing environmental (n = 3) and financial (n = 1) determinants. Also, the most frequent recommendation was that physical activity promotes maintenance of mobility and prevents the occurrence of adverse results, such as falls, fractures and functional decline. As to dissemination, digital technologies were recognised as a strategy to motivate, instruct and monitor exercise practice to increase mobility in older adults.

CONCLUSION

The main conditions related to the decline in mobility of older adults during COVID-19 pandemic were physical inactivity and sedentary lifestyle. The practice of physical activity is widespread and needs to be adapted according to individual needs. Finally, digital technologies are essential tools in this period, but other alternatives should also be considered for low-income seniors.

IMPLICATIONS FOR PRACTICE

It is hoped that the gaps identified through this scoping review can help enhance the discussion on the broader assessment of mobility in older adults and the design of interventions when contact restriction is a reality.

Impacts of Remote Physical Exercises on Functional Status and Mobility among Community-Dwelling Pre-Disabled Seniors during the Covid-19 Lockdown

OBJECTIVES

To assess whether remote physical exercise interventions helped maintain function in daily life, level of physical activities, basic mobility and frailty status in pre-disabled seniors during the first Covid-19 lockdown.

DESIGN

This is an interventional study conducted from May 2020 to May 2021.

SETTING

Community-dwelling older adults in 2 Canadian cities.

PARTICIPANTS

84 pre-disabled seniors.

INTERVENTION

12-week physical exercise programs (1 hour/ 3 times/ week) in kinesiologist-guided groups using Zoom or phone-supervised individual booklet-based home-program (n=44) vs. Control (usual life habits; n=40).

MEASUREMENTS

Functional status in daily activities (OARS scale); Daily level of aerobic (TAPA-1) and strengthening/flexibility (TAPA-2) physical activities; Basic mobility abilities (SPPB: balance, lower limbs strength, walking speed; Timed Up-and-Go) and Frailty (SOF index) were assessed at baseline and at 3, 6, 9 and 12-month follow-ups.

RESULTS

The participants' mean age was 78.5 ± 7.2 and 76.5 % were women. There was a group * time effect for the OARS scale (p=0.02), the TAPA-1 (p=0.06) and the TAPA-2 (p=0.007) scores. For these outcomes, scores significantly improved during the first 3 months of follow-up and then stabilised in the intervention group whereas they remained constant in the control group over time. There was an overall time effect for the SPPB (p=0.004), the 4-m walking speed (p=0.02) and for the SOF index (p=0.004), with no between-group differences. Finally, no effect was observed for the TUG.

CONCLUSION

Remote home-based physical exercise interventions and monitoring during the first Covid-19 lockdown seemed to have helped maintain seniors' level of physical activities without impacting on basic mobility abilities. Further studies are needed to identify parameters of remote exercise programs that can improve daily function and mobility in this population.

COVID-19 Era and the Constantly Reemerging Novel SARS-CoV-2 Variants Calls for Special Attention for the Geriatrics: A Real Challenge

Global public health is significantly challenged due to the continuing COrona VIrus Disease 2019 (COVID-19) outbreak brought forth by the severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) [...].

The Efficient Antiviral Response of A549 Cells Is Enhanced When Mitochondrial Respiration Is Promoted

When exposed to a viral infection, the attacked cells promptly set up defense mechanisms. As part of the antiviral responses, the innate immune interferon pathway and associated interferon-stimulated genes notably allow the production of proteins bearing antiviral activity. Numerous viruses are able to evade the interferon response, highlighting the importance of controlling this pathway to ensure their efficient replication. Several viruses are also known to manipulate the metabolism of infected cells to optimize the availability of amino acids, nucleotides, and lipids. They then benefit from a reprogramming of the metabolism that favors glycolysis instead of mitochondrial respiration. Given the increasingly discussed crosstalk between metabolism and innate immunity, we wondered whether this switch from glycolysis to mitochondrial respiration would be beneficial or deleterious for an efficient antiviral response. We used a cell-based model of metabolic reprogramming. Interestingly, we showed that increased mitochondrial respiration was associated with an enhanced interferon response following polyriboinosinic:polyribocytidylic acid (poly:IC) stimulation. This suggests that during viral infection, the metabolic reprogramming towards glycolysis is also part of the virus’ strategies to inhibit the antiviral response.

Long-Term Impact of COVID-19 Pandemic in Sleep Quality and Lifestyle in Young Adults

Due to the evolution of COVID-19,restrictive measures were implemented. The quarantine resulted in significant changes in the social, economic, and psychological status of the population; however, its long-term effects have not yet been elucidated, especially in young adults. In the present study, people aged 18-25 years were studied, in relation to their sleeping, smoking, eating, and drinking habits and their physical activity before, during, and after the implementation of quarantine. We included 540 respondents (21.2 ± 2.3 years, 62.8% female). During quarantine, from 23 March to 4 May 2020, we observed an increase in sleep hours by 1.17 ± 1.98 h (p < 0.001), time of sleep arrival by 11.90 ± 30.41 min (p < 0.001), and number of daily meals by 0.66 ± 1.4 (p < 0.001). The subjects who consumed alcoholic beverages never or almost never had an upward change of 27.04%, and the time of daily exercise was reduced by 10.16 ± 48.68 min (p < 0.001). After quarantine, cigarettes per day increased by 1.14 ± 3.62 (p < 0.001) and the awakenings during night time increased by 0.37 ± 1.93 (p < 0.001). Our results suggest that the quarantine brought about significant changes in smoking, sleeping habits, physical activity, dietary habits, and the consumption of alcoholic beverages, some of which continue after its termination.

Geriatric Health Care During the COVID-19 Pandemic: Managing the Health Crisis

COVID-19 pandemic significantly threatens the health and well-being of older adults. Aging-related changes, including multimorbidity, weakened immunity and frailty, may make older people more susceptible to severe infection and place them at higher risk of morbidity and mortality from COVID-19. Various quarantine measures have been implemented to control the spread of COVID-19. Nevertheless, such social distancing has disrupted routine health care practices, such as accessibility of medical services and long-term continuous care services. The medical management of older adults with multimorbidity is significantly afflicted by COVID-19. Older persons with frailty or multiple chronic disease may poorly adapt to the altered health care system, having detrimental consequences on their physical and mental health. COVID-19 pandemic has posed great challenges to the health of older adults. We highlighted the difficulties and obstacles of older adults during this unprecedented time. Also, we provided potential strategies and recommendations for actions to mitigate the COVID-19 pandemic threats. Certain strategies like community primary health care, medication delivery and home care support are adopted by many health facilities and caregivers, whereas other services such as internet hospital and virtual medical care are promoted to be accessible in many regions. However, guidelines and policies based on high-quality data are still needed for better health promotion of older groups with increasing resilience during the COVID-19 pandemic.

Effects of Home-Based Nine-Square Step Exercises for Fall Prevention in Thai Community-Dwelling Older Adults during a COVID-19 Lockdown: A Pilot Randomized Controlled Study

The deterioration of muscle strength in aging has been associated with fall risks. During the COVID-19 pandemic, older adults were restricted from doing outdoor activities. This study aimed to investigate the effect of Nine-Square Step Exercises (NSSE) on improving physical performance and balance in older adults at risk of falling. We conducted an open-labelled, assessor-blinded, randomized controlled trial in 46 (aged 65-84 years) community-dwelling older adults. They were randomly assigned to an NSSE group (n = 24) instructed to perform the program for at least 45 days over 8 weeks or a control group (n = 22). The outcomes were measured by the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), the Five-Times-Sit-to-Stand test (FTSS), and hand grip strength during the baseline, 4th and 8th weeks in both groups. A mixed-effect linear regression model analysis was performed to estimate the independent effect of NSSE by the intention-to-treat over the 8-week period. The NSSE group showed significant weekly changes in BBS (β 0.57, 95% CI: 0.30, 0.84), TUG (β -0.44, 95% CI: -0.74, -0.14), and FTSS (β -0.52, 95% CI: -0.78, -0.25), demonstrating beneficial improvements in lower extremity and balance, whereas the control group did not demonstrate significant changes over time in any parameter.

The Effects of High-Intensity Power Training versus Traditional Resistance Training on Exercise Performance

Background: High-intensity interval training (HIIT) features short, repeated bursts of relatively vigorous exercise with intermittent periods of rest or low-intensity exercise. High-intensity power training (HIPT), in combination with HIIT and traditional resistance training (TRT), is characterized as multijoint high-intensity resistance exercises with low interset rest periods. HIPT requires people to finish the exercise as fast as possible, which increases acute physiological demands. The aim of the study was to investigate the differences between eight-week HIPT or TRT on exercise performance. Methods: Twenty-four college students were recruited and randomly assigned to either the HIPT or TRT group in a counterbalanced order. The power of upper and lower limbs (50% 1RM bench press and vertical jump) and anaerobic power were tested before and after the training (weeks 0 and 9). The results were analyzed by two-way analysis of variance (ANOVA) or Friedman’s test with a significance level of α = 0.05 to compare the effects of the intervention on exercise performance. Results: There were significant differences in the explosive force of the upper and lower limbs between the pretest and post-test in both the HIPT and TRT groups (p < 0.05). However, only the HIPT group showed a significant difference in the mean power on the Wingate anaerobic test between the pretest and post-test (p < 0.05). Conclusions: Both HIPT and TRT can improve upper and lower limb explosive force. HIPT is an efficient training protocol, which took less time and produced a better improvement in mean anaerobic power.

Examining the effect of the first wave of the COVID-19 pandemic on home care recipients’ instrumental activities of daily living capacity

Objective

To examine the effect of the pandemic on, and factors associated with, change in home care (HC) recipients’ capacity for instrumental activities of daily living.

Design

Retrospective cohort study.

Setting and participants

HC recipients in Ontario, Canada, between September 1, 2018, and August 31, 2020, who were not totally dependent on others and not severely cognitively impaired at baseline.

Methods

Data were collected with the interRAI Home Care assessment. Outcomes of interest were declines in instrumental activities of daily living. Factors hypothesized to be associated with declining function were entered as independent variables into multivariable generalized estimating equations, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Those significant at P < .01 were retained in the final models.

Results

There were 6786 and 5019 HC recipients in the comparison and pandemic samples, respectively. Between baseline and follow-up for the 2 groups, 34.1% and 42.1% of HC recipients declined in shopping, whereas 25.2% and 30.5% declined in transportation capacity in the comparison and pandemic sample, respectively. For shopping, those with cognitive impairment (OR 0.83, 95% CI 0.76-0.89) and receiving formal care (OR 0.72, 95% CI 0.62-0.85) were less likely to decline, whereas those who were older (OR 1.91, 95% CI 1.69-2.16) and had unstable health (OR 1.31, 95% CI 1.16-1.48) were more likely. For transportation, those receiving informal (OR 0.71, 95% CI 0.61-0.81) or formal care (OR 0.56, 95% CI 0.47-0.67) were less likely to decline, whereas those who were older (OR 1.81, 95% CI 1.58-2.07) and had unstable health (OR 1.35, 95% CI 1.119-1.54) were more likely.

Conclusions and implications

The pandemic was associated with a decline in HC recipients’ capacity for shopping and transportation. HC recipients who are older and have unstable health may benefit from preventive strategies.

Train at home, but not alone: a randomised controlled multicentre trial assessing the effects of live-streamed tele-exercise during COVID-19-related lockdowns

OBJECTIVE

Public life restrictions associated with the COVID-19 pandemic caused reductions in physical activity (PA) and decreases in mental and somatic health. Considering the interplay between these factors, we investigated the effects of digital home exercise (DHE) during government-enforced lockdowns.

METHODS

A multicentre randomised controlled trial was performed allocating healthy individuals from nine countries (N=763; 523 female) to a DHE or an inactive control group. During the 4-week main intervention, DHE members engaged in live-streamed multicomponent home exercise. Subsequently, both groups had access to prerecorded workouts for an additional 4 weeks. Outcomes, assessed weekly, included PA level (Nordic Physical Activity Questionnaire-Short), anxiety (Generalized Anxiety Disorder Scale-7), mental well-being (WHO-5 Questionnaire), sleep quality (Medical Outcome Study Sleep Scale), pain/disability (Chronic Pain Grade Scale) and exercise motivation (Self-Concordance Scale). Mixed models were used for analysis.

RESULTS

Live-streamed DHE consistently increased moderate PA (eg, week 1: 1.65 times more minutes per week, 95% CI 1.40 to 1.94) and vigorous PA (eg, week 1: 1.31 times more minutes per week, 95% CI 1.08 to 1.61), although the effects decreased over time. In addition, exercise motivation, sleep quality and anxiety were slightly improved for DHE in the 4-week live streaming period. The same applied to mental well-being (mean difference at week 4: +0.99, 95% CI 0.13 to 1.86), but an inverted trend was observed after live streaming was substituted by prerecorded exercise.

CONCLUSIONS

Live-streamed DHE represents an efficacious method to enhance PA and selected markers of health during pandemic-related public life restrictions. However, research on implementation is warranted to reduce dropout rates.

TRIAL REGISTRATION NUMBER

DRKS00021273.

Acute Blood Pressure Response to High- and Moderate-Speed Resistance Exercise in Older Adults With Hypertension

An increase in blood pressure (BP) occurs during resistance exercise; attention to this response may be necessary in older individuals with hypertension. We compared the BP responses following high- (HSRE) and moderate-speed resistance exercise (MSRE) (4 × 8 repetitions at 60% one-repetition maximum) and control protocol in 15 older adults with hypertension. HSRE and MSRE increased systolic BP (SBP) by the end of each set compared with preexercise and control protocol. Immediately after the fourth set, a higher SBP was observed in MSRE than HSRE (147 ± 14 vs. 141 ± 12 mmHg; p = .01). Taking an exploratory analysis of the individual response, we observed that MSRE resulted in greater mean changes and number of SBP exposures to values ≥150 mmHg (22-fold) than HSRE (10-fold). Diastolic BP increased (p < .05) with exercise, but only MSRE increased compared with the control condition (p < .05). HSRE may be an alternative for individuals in which SBP peak should be avoided.

Design and Evaluation of an Online Squat Fitness System: Lessons Learned During the Early COVID-19 Pandemic in Japan

COVID-19 has changed our lives and limited our ability to have adequate physical activity (PA). It is necessary to replace outdoor PA with home-based fitness. However, people lack access, skills, and even motivation for home-based fitness. To address these issues, we designed a free access self-monitoring and coaching and music-based interactive online squat fitness system. Body weight squat was utilized for fitness exercise and evaluated based on three indices: knee width, hip depth, and rhythm. An online survey on changes in exercise due to the COVID-19 pandemic and exercise habits was conducted to investigate the effect of the COVID-19 pandemic on PA. We collected data from 557 respondents 5 months after the system first released and analyzed 200 visitors' performance on squat exercise and the other relevant parameters. Visitors were divided into three groups according to their age: younger, middle, and older groups. Results showed that the younger group had better squat performance than the middle and older groups in terms of hip depth and rhythm. We highlighted the lessons learned about the system design, fitness performance evaluation, and social aspects, for future study of the design and development of similar home-based fitness systems. We provided first-hand results on the relation between the COVID-19 pandemic and physical exercise among different age groups in Japan, which was valuable for policy making in the post-COVID-19 era.

Effect of whole-body resistance training at different load intensities on circulating inflammatory biomarkers, body fat, muscular strength, and physical performance in postmenopausal women

The primary purpose of this study was to identify the impact of whole-body resistance training (RT) at different load intensities on adipokines, adhesion molecules, and extracellular heat shock proteins in postmenopausal women. As secondary purpose, we analyzed the impact of RT at different load intensities on body fat, muscular strength, and physical performance. Forty participants were randomized into lower-load intensity RT (LIRT, n = 20, 30-35 repetition maximum in the first set of each exercise) or higher-load intensity RT (HIRT, n = 20, 8-12 repetition maximum in the first set of each exercise). Adipokines (adiponectin and leptin), adhesion molecules (MCP-1 and ICAM-1), extracellular heat shock proteins (HO-1 and eHSP60), body fat, muscular strength (1RM), and physical performance [400-meter walking test (400-M) and 6-minute walking test (6MWT)] were analyzed at baseline and after 12-weeks RT. There was a significant time-by-group interaction for eHSP60 (P = 0.049) and 400-M (P = 0.003), indicating superiority of HIRT (d = 0.47 and 0.55). However, both groups similarly improved adiponectin, ICAM-1, HO-1, body fat, 1RM, and 6MWT (P < 0.05). Our study suggests that load intensity does not seem to determine the RT effect on several obesity-related pro-inflammatory and chemotactic compounds, body fat, 1RM, and 6MWT in postmenopausal women, although a greater improvement has been revealed for eHSP60 and 400-M in HIRT. Novelty: Higher-load intensity resistance training improves eHSP60 and 400-M in postmenopausal women. Resistance training improves the inflammatory profile, body fat, muscle strength, and 6MWT, regardless of load intensity.

Changes in Daily Life during the COVID-19 Pandemic among South Korean Older Adults with Chronic Diseases: A Qualitative Study

Amid the COVID-19 pandemic, older adults are considered a high-risk group and have been advised to stay home or practice social distancing. This qualitative study examined the effects of strong quarantine measures and social distancing on older adults’ lifestyles. The participants in this study were 13 people aged 65 and older with chronic diseases who resided in South Korean communities. Qualitative content analysis was conducted to interpret the data collected from in-depth interviews. Four themes and 13 subthemes were identified. The four themes were “lifestyle changes,” “increased cautiousness in daily life,” “psychological changes,” and “adaptation to life during the COVID-19 pandemic.” The participants followed quarantine rules strictly and noted lifestyle changes, such as increased time spent at home due to social distancing guidelines, a smaller radius of daily activity, and changes in exercise and dietary habits. They also reported increased caution toward other people and objects that other people interacted with due to their fear of COVID-19 infection. They expressed fear about COVID-19 infection and anxiety about COVID-19-related news, and they often felt bored and depressed; however, the participants accepted, endured, and gradually adapted to these lifestyle changes. Non-face-to-face community support is urgently needed for older adults facing reduced levels of physical activity and psychological hardships due to the COVID-19 pandemic.

Effects of Power Training on Physical Activity, Sitting Time, Disability, and Quality of Life in Older Patients With Type 2 Diabetes During the COVID-19 Confinement

BACKGROUND

To evaluate the effectiveness of a multicomponent supervised and unsupervised training program focused on muscle power to counteract the potential changes in sedentary behavior, disability, physical activity (PA), and health-related quality of life (HRQoL) caused by the COVID-19 pandemic domiciliary confinement in prefrail older adults with type 2 diabetes mellitus.

METHODS

Thirty-five older adults with type 2 diabetes mellitus were assigned to 2 groups according to their frailty status: exercise training group (prefrail or frail; n = 21; 74.7 [4.5] y; 33.3% male) and control group (robust; n = 14; 73.1 [3.9] y; 42.9% male). The exercise training group followed a multicomponent training program focusing on muscle power: supervised (5 wk) and unsupervised (6 wk). The primary outcomes, including PA and sitting time, perceived disability, and HRQoL, were assessed at the baseline and after 11 weeks.

RESULTS

At the end of confinement, there were significant decreases in PA in both groups (P < .05). Thus, sitting time increased more in the control group than in the exercise training group (P < .05). The HRQoL measures remained unchanged.

CONCLUSIONS

Muscle power training before and during mandatory COVID-19 self-isolation in type 2 diabetes mellitus older adults (1) attenuates the COVID-19 domiciliary confinement-related increase in sitting time and (2) slightly decreases the self-reported levels of disability and maintains HRQoL.

Effect of COVID-19 Pandemic on the Change in Skeletal Muscle Mass in Older Patients with Type 2 Diabetes: A Retrospective Cohort Study

Background: The aim of this study was to investigate the effect of the coronavirus disease (COVID-19) pandemic restrictions on the change in muscle mass in older patients with type 2 diabetes (T2D), who were not infected with COVID-19. Methods: In this retrospective cohort study, data were obtained from outpatients who underwent bioelectrical impedance analysis at least twice before April 2020 and at least once thereafter. Skeletal muscle mass index (SMI, kg/m²) was calculated as appendicular muscle mass (kg) divided by height squared (m²). Change in SMI (kg/m²/year) was calculated as (follow-up SMI-baseline SMI/follow-up period). The differences between the changes in SMI before and after the start of the COVID-19 pandemic were evaluated using paired t test. Results: This study recruited 56 patients, with a mean (SD) age of 75.2 (7.1) years. SMI changed from 6.7 (0.9) to 6.8 (0.9) kg/m² before the COVID-19 pandemic, whereas SMI changed from 6.8 (0.9) to 6.6 (0.9) kg/m² after the start of the COVID-19 pandemic. SMI decreased after the start of the COVID-19 pandemic compared with before the pandemic (-0.117 (0.240) vs. 0.005 (0.289) kg/m²/year, p = 0.049). This decrease was observed in men (-0.159 (0.257) vs. 0.031 (0.325) kg/m²/year, p = 0.038), patients with poor glycemic control (-0.170 (0.264) vs. 0.031 (0.285) kg/m²/year, p = 0.042), and those with a long diabetes duration (-0.153 (0.229) vs. 0.082 (0.291) kg/m², p = 0.049). Conclusions: The COVID-19 pandemic restrictions caused muscle mass loss in older patents with T2D. Actions, including recommendation of exercise and adequate diet intake, are needed to prevent loss of muscle mass.

Midterm functional sequelae and implications in rehabilitation after COVID-19: a cross-sectional study

BACKGROUND

COVID-19 has been mainly investigated concerning the acute and subacute phase implications and management. Meanwhile, few studies focused on the midterm sequelae, which still remain largely unknown.

AIM

To assess the physical performance of COVID-19 survivors at 3 to 6 months from Hospital discharge.

DESIGN

A cross-sectional study focused on mid-term functional outcomes evaluation in COVID-19 survivors.

SETTING

Outpatients who had been previously hospitalized due to COVID-19 from March to May 2020 at the University Hospital of Novara, Italy.

POPULATION

We enrolled 204 patients, of which 60% were men, with the mean age of 57.9 years.

METHODS

Patients firstly underwent the short physical performance battery test (SPPB), which is composed of a series of physical tests assessing the lower limb function and the functional status of the subjects. Subsequently, based on SPPB results, patients' cardiorespiratory fitness performance was further investigated. Patients with normal SPPB score (SPPB>10) underwent the 2-minute walking test (2MWT) whereas, in order to safely test the cardiorespiratory function, in patients with abnormal SPPB score (SPPB≤10) the 1-minute sit-to-stand test (1MSTST) was performed. It should be noted that the 1MSTST can be safely performed even by subjects with compromised walking ability.

RESULTS

Overall, 66 patients (32% of our sample) showed an impaired physical performance at 3 to 6 months after hospital discharge. In particular, 29 patients presented an SPPB score ≤10, and the 1MSTST confirmed this status in the whole group (100%) compared to the reference values for age and sex. Besides, among patients with a normal SPPB score, 37 showed a lower sex- and age-matched 2MWT score. Finally, a significant association between Intensive Care Unit hospitalization or mechanical ventilation and physical impairment was observed together with a significant association between the walking ability (measured with SPPB and 2MWT) and the number of comorbidities.

CONCLUSIONS

A residual physical and functional impairment was observed in COVID-19 survivors at mid-term evaluation after hospitalization.

CLINICAL REHABILITATION IMPACT

Considering the current COVID-19 epidemiology, we might expect a tremendous burden of disability in the next future. Thus, an appropriate clinical rehabilitation pathway must be implemented.

Home-Based Resistance Training for Older Subjects during the COVID-19 Outbreak in Italy: Preliminary Results of a Six-Months RCT

BACKGROUND

The aim of this study was to evaluate the effect of a six-month home-based resistance-training program on muscle health and physical performance in healthy older subjects during the unique condition of home confinement caused by the COVID-19 pandemic.

METHODS

This was a randomized-controlled study that enrolled older participants that were allocated to either an experimental group performing the six-months exercise prescription (EXE) or a control group (CON). At the beginning (PRE), and after 6 months (POST), participants were assessed for muscle strength, balance, gait assessment and body composition by dual energy X-ray absorptiometry and magnetic resonance imaging. Normality distribution of data was checked with the D'Agostino and Pearson test and changes between PRE and POST were assessed by paired Student's t-test while percentage and absolute changes between groups at POST were tested by unpaired t-test.

RESULTS

Nine participants were included for the final analysis: EXE, n = 5 (age: 66 ± 4; BMI: 27.5 ± 3.7) and CON, n = 4 (age: 71 ± 9; BMI: 24.2 ± 4.1). Significant PRE-to-POST changes were observed in the EXE group only in the chair-stand test (+19.8%, p = 0.048 and ES:1.0, moderate) and in total fat mass (+5.0%, p = 0.035 and ES:1.4, large) with no between-group differences. Moreover, EXE had significantly higher absolute thigh CSA values than CON at POST (14.138 ± 2977 vs. 9039 ± 1015, p = 0.0178, ES = 1.7). No other within- and between-group differences were detected.

CONCLUSIONS

The home-based resistance-training program during the lockdown period, caused by the COVID-19 outbreak, determined only within-group improvement in lower limb muscle strength but not in muscle mass and composition in older subjects. Home confinement may partially explain the increase in total body fat due to a reduced daily PA regime and altered diet pattern.