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Zheng C, Chen JJ, Dai ZH, Wan KW, Sun FH, Huang JH, Chen XK. Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis. J Exerc Sci Fit 2024; 22:341-349. [PMID: 39022666 PMCID: PMC11252993 DOI: 10.1016/j.jesf.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/21/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
Objective This study aims to systematically assess physical exercise-related symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC or long COVID) in coronavirus disease 2019 (COVID-19) survivors. Methods Eight databases were systematically searched on March 03, 2024. Original studies that compared physical exercise-related parameters measured by exercise testing between COVID-19 survivors who recovered from SARS-CoV-2 infection over 3 months and non-COVID-19 controls were included. A random-effects model was utilized to determine the mean differences (MDs) or standardized MDs in the meta-analysis. Results A total of 40 studies with 6241 COVID-19 survivors were included. The 6-min walk test, maximal oxygen consumption (VO2max), and anaerobic threshold were impaired in COVID-19 survivors 3 months post-infection compared with non-COVID-19 controls in exercise testing, while VO2 were comparable between the two groups at rest. In contrast, no differences were observed in SpO2, heart rate, blood pressure, fatigue, and dyspnea between COVID-19 survivors and non-COVID-19 controls in exercise testing. Conclusion The findings suggest an underestimation of the manifestations of PASC. COVID-19 survivors also harbor physical exercise-related symptoms of PASC that can be determined by the exercise testing and are distinct from those observed at rest. Exercise testing should be included while evaluating the symptoms of PASC in COVID-19 survivors.
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Affiliation(s)
- Chen Zheng
- Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Ting Kok, Hong Kong, China
| | - Jun-Jie Chen
- Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Ting Kok, Hong Kong, China
| | - Zi-Han Dai
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Ke-Wen Wan
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - Feng-Hua Sun
- Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Ting Kok, Hong Kong, China
| | - Jun-Hao Huang
- Guangdong Provincial Key Laboratory of Physical Activity and Health Promotion, Scientific Research Center, Guangzhou Sport University, Tian He, Guangzhou, China
| | - Xiang-Ke Chen
- Division of Life Science, School of Science, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China
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Neal L, McCarthy M, Dempsey P, Zaccardi F, Berrington R, Brady EM, Edwardson CL, Game F, Hall A, Henson J, Khunti K, Turner B, Webb D, Davies MJ, Rowlands AV, Yates T. Capturing How the Accelerometer Measured Physical Activity Profile Differs in People with Diabetic Foot Ulceration. SENSORS (BASEL, SWITZERLAND) 2024; 24:4875. [PMID: 39123923 PMCID: PMC11314688 DOI: 10.3390/s24154875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/11/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024]
Abstract
Diabetic Foot Ulcers (DFUs) are a major complication of diabetes, with treatment requiring offloading. This study aimed to capture how the accelerometer-assessed physical activity profile differs in those with DFUs compared to those with diabetes but without ulceration (non-DFU). Participants were requested to wear an accelerometer on their non-dominant wrist for up to 8days. Physical activity outcomes included average acceleration (volume), intensity gradient (intensity distribution), the intensity of the most active sustained (continuous) 5-120 min of activity (MXCONT), and accumulated 5-120 min of activity (MXACC). A total of 595 participants (non-DFU = 561, DFU = 34) were included in the analysis. Average acceleration was lower in DFU participants compared to non-DFU participants (21.9 mg [95%CI:21.2, 22.7] vs. 16.9 mg [15.3, 18.8], p < 0.001). DFU participants also had a lower intensity gradient, indicating proportionally less time spent in higher-intensity activities. The relative difference between DFU and non-DFU participants was greater for sustained activity (MXCONT) than for accumulated (MXACC) activity. In conclusion, physical activity, particularly the intensity of sustained activity, is lower in those with DFUs compared to non-DFUs. This highlights the need for safe, offloaded modes of activity that contribute to an active lifestyle for people with DFUs.
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Affiliation(s)
- Liam Neal
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Applied Research Collaboration East Midlands (ARC EM), University of Leicester, Leicester LE1 7RH, UK
| | - Matthew McCarthy
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Paddy Dempsey
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- School of Exercise & Nutrition Sciences, Deakin University, Burwood 3125, Australia
| | - Francesco Zaccardi
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
| | | | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Charlotte L. Edwardson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Frances Game
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
| | - Andrew Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Joseph Henson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Applied Research Collaboration East Midlands (ARC EM), University of Leicester, Leicester LE1 7RH, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Applied Research Collaboration East Midlands (ARC EM), University of Leicester, Leicester LE1 7RH, UK
| | - Bethany Turner
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
| | - David Webb
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
- University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK
| | - Alex V. Rowlands
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Tom Yates
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; (L.N.)
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
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Zheng C, Huang WYJ, Sun FH, Wong MCS, Siu PMF, Chen XK, Wong SHS. Association of Sedentary Lifestyle with Risk of Acute and Post-Acute COVID-19 Sequelae: A Retrospective Cohort Study. Am J Med 2023:S0002-9343(23)00757-X. [PMID: 38110069 DOI: 10.1016/j.amjmed.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Evidence suggests that coronavirus disease 2019 (COVID-19) survivors could experience COVID-19 sequelae. Although various risk factors for COVID-19 sequelae have been identified, little is known about whether a sedentary lifestyle is an independent risk factor. METHODS In this retrospective cohort study, 4850 participants self-reported their COVID-19 sequelae symptoms between June and August 2022. A sedentary lifestyle included physical inactivity (<150 min/week of moderate-to-vigorous intensity physical activity) and prolonged sedentary behavior (≥10 h/day) before the fifth COVID-19 wave was recorded. Logistic regression analysis was performed to determine the relationships between sedentary lifestyle and risk of acute and post-acute (lasting ≥2 months) COVID-19 sequelae. RESULTS A total of 1443 COVID-19 survivors and 2962 non-COVID-19 controls were included. Of the COVID-19 survivors, >80% and >40% self-reported acute and post-acute COVID-19 sequelae, respectively. In the post-acute phase, COVID-19 survivors who were physically inactive had a 37% lower risk of insomnia, whereas those with prolonged sedentary behavior had 25%, 67%, and 117% higher risks of at least one symptom, dizziness, and "pins and needles" sensation, respectively. For the acute phase, prolonged sedentary behavior was associated with a higher risk of fatigue, "brain fog," dyspnea, muscle pain, joint pain, dizziness, and "pins and needles" sensation. Notably, sedentary behavior, rather than physical inactivity, was correlated with a higher risk of severe post-COVID-19 sequelae in both acute and post-acute phases. CONCLUSIONS Prolonged sedentary behavior was independently associated with a higher risk of both acute and post-acute COVID-19 sequelae, whereas physical inactivity played contradictory roles in COVID-19 sequelae.
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Affiliation(s)
- Chen Zheng
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China; Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Tai Po, Hong Kong, China
| | - Wendy Ya-Jun Huang
- Department of Sport, Physical Education and Health, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China
| | - Feng-Hua Sun
- Department of Health and Physical Education, Faculty of Liberal Arts and Social Sciences, The Education University of Hong Kong, Tai Po, Hong Kong, China
| | - Martin Chi-Sang Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Parco Ming-Fai Siu
- Division of Kinesiology, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Xiang-Ke Chen
- Division of Life Science, School of Science, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China.
| | - Stephen Heung-Sang Wong
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
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Sánchez-García JC, Reinoso-Cobo A, Piqueras-Sola B, Cortés-Martín J, Menor-Rodríguez MJ, Alabau-Dasi R, Rodríguez-Blanque R. Long COVID and Physical Therapy: A Systematic Review. Diseases 2023; 11:163. [PMID: 37987274 PMCID: PMC10660729 DOI: 10.3390/diseases11040163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
Prolonged COVID is a persistent condition following the initial COVID-19 infection, which is characterized by a variety of symptoms that may include fatigue, muscle pain, sleep disturbances, "brain fog", respiratory, cardiovascular, digestive, neurological and dermatological symptoms. Physical therapy has been identified as a crucial aspect of the management of patients with long COVID, as it can help improve symptoms and overall physical function. The investigation of long COVID poses significant challenges due to the diversity and variability of symptoms, lack of clear diagnostic criteria, and limited understanding of the underlying mechanisms. The aim of this study is to conduct a systematic review of studies conducted in patients with long COVID in conjunction with interventions targeting respiratory function, particularly involving physical activity. To this end, we conducted a systematic review to analyze studies conducted on treatment programs for long COVID based on some form of physical activity. The protocol of the review was registered in the PROSPERO website, and the databases PubMed, Scopus, CINAHL and WOS were searched. Of the 62 initial articles, six were included in the review. The results obtained have positive implications for the advancement of physical activity as a therapeutic intervention for individuals with long COVID-19 and the conceptualization of evidence-based treatment protocols. Statistically significant results have been observed in studies of at least 6 weeks duration, in which inspiratory muscle training exercises are proposed. Further research is needed to better understand long COVID and develop effective treatment strategies.
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Affiliation(s)
- Juan Carlos Sánchez-García
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Ampliación de Campus de Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (A.R.-C.); (R.A.-D.)
| | - Beatriz Piqueras-Sola
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Virgen de las Nieves University Hospital, 18014 Granada, Spain
| | - Jonathan Cortés-Martín
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - María José Menor-Rodríguez
- Área Sanitaria Santiago de Compostela-Barbanza, Subdirección de Humanización y Atención a la Ciudadanía, 15706 Santiago de Compostela, Spain;
| | - Raquel Alabau-Dasi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Ampliación de Campus de Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (A.R.-C.); (R.A.-D.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS-1068, Andalusia Research Plan, Junta de Andalucía, 18014 Granada, Spain; (J.C.S.-G.); (B.P.-S.); (R.R.-B.)
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- San Cecilio University Hospital, 18071 Granada, Spain
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