Effect of COVID-19 isolation measures on physical activity of children and their parents, and role of the family environment: a cross-sectional study.

Background: The rigorous isolation measures due to the COVID-19 pandemic seriously impacted children's lifestyles. A descriptive cross-sectional study was carried out to collect and analyze information about physical activity habits of children and their parents during the social distancing period resulting from the COVID-19 pandemic. Methods: An online questionnaire was administered to 363 families (507 children aged 5-13) recruited by convenience sampling, asking for physical activity type and frequency before, during, and after the lockdown period (9th March - May 3rd 2020), education, outdoor spaces, and children's weight gain perception. Results: Results show a remarkable decrease in children's physical activity during lockdown (88.9 vs 39.8% active children) associated with older age and low availability of outdoor spaces (p<0.001). Parents' physical activity was related to educational level, and a slight but significant correlation between parents' education and children's physical activity was found, especially with father's university degree (p<0.05). Active mothers significantly influenced children's physical activity during the lockdown, especially if not engaged in smart working. The return to an active lifestyle by children did not reach previous levels (75.9% active children) and was directly related to parent's physical activity. Finally, the risk of weight gain was lower in active children during the lockdown (OR = 0.46; p<0.001). Conclusions: This work highlights the importance of physical activity during a pandemic event to prevent the risk of gaining weight, and underlines the relevance of the entire family system as a source of promotion of healthy behaviors in children.

Physical activity, sedentary behaviour and screen time among youths with Down syndrome during the COVID-19 pandemic.

BACKGROUND: The COVID-19-related restrictions hampered habitual physical activity (PA), particularly affecting the more vulnerable, such as people with Down syndrome (DS). The study aimed to investigate changes in PA, sedentary behaviour (SB) and screen time (ST) of youths with DS, before, during and after the restrictions, also in relation to parental PA levels. METHODS: A cross-sectional design with a retrospective assessment of variables for the before and during restrictions periods was adopted. Parents of youths with DS completed an online questionnaire. Sociodemographic aspects, weekly PA levels and youths' daily SB and ST were investigated, referring to three time-points: before the pandemic, during the restrictions and the restrictions-easing phase. RESULTS: A total of 57 parents voluntarily participated in the study, proxy-reporting on their child (male = 41, female = 16, age = 21.4 ± 7.7 years). A repeated measures multivariate analysis of variance showed negative effects of restrictions (P < 0.05) on PA levels, SB and ST, independently from sociodemographic characteristics. In the restrictions-easing phase, PA levels did not return to before the pandemic values (P < 0.05). A positive correlation between parents and their child's PA was detected before the pandemic (r = 0.38; P < 0.01), no longer reported in the restrictions-easing phase. CONCLUSIONS: The findings showed the negative impact of restrictions on youths with DS lifestyle. Moreover, the importance of addressing the needs of the disabled community including the whole family is highlighted.

Health-related quality of life, heart rate variability and physical fitness in breast cancer patients during the COVID-19 lockdown: The impact of a lifestyle program ('MoviS Project, movement and health beyond the care' (CESU approval n. 21/10.07.2019)

Background: Breast cancer (BC) is the most common invasive cancer in women and evidence has shown that exercise can significantly improve the outcomes of BC survivors. MoviS: 'Movement and Health Beyond Care' is a randomized controlled trial, which aims to educate cancer patients after adjuvant therapy on the benefits of exercise and proper nutritional plan. Material (patients) and methods: Thirty women with stage 0-III non-metastatic BC recruited 12-month postsurgery (age: 53.5±7.6;BMI: 25.3±4.9) were randomized in two groups: intervention arm received 3-month aerobic training (40-70% of the heart rate reserve;20 to 60 min 3-day/week);control arm with usual care recommendations. Patients enrolled in January 2020 were monitored for diet habits by DianaWeb platform, they carried out the exercise training across the COVID-19 pandemic shifting from the gym to a home-based exercise program. The objective was to investigate the effects of lifestyle program on quality of life by EORTC QLQ-C30 and health-related QoL parameters such as cardiac function indexes;heart rate variability (HRV) (by repeated Holter 24h) and cardiorespiratory fitness by estimated maximal oxygen uptake (VO2max). Results: There were no adverse events and a high attendance was registered considering the challenges to be overcome in shifting to a home-based exercise program. Statistical analysis revealed a significant improvement in both arms in QLQ scale score: in global health status (from 64.7±17 to 15.9±13;coefficient of variation (CV) 15.9%;p=0.0015);physical functioning (from 54.4±12.3 to 6±6.6;CV 13.9%;p=0.0005);fatigue (from 26.3±23.4 to 11.9±14.3;CV -54.9%;p=0.0008) and showed a general improvement over time even on the social functioning (from 47.2 ± 22.8 to 66.7±00;CV 41.2%;p=0.0001). Both groups had a significant improvement in HRV parameters in both time and frequency domain: average SDNN/5min and VLF increased (from 50.6±14.4 to 55.2±16.7msec, p=0.033 and form 1597±967 to 1881±963 msec, p=0.04, respectively);mean heart rate decreased (from 76.6 ±7.8 to 73.7±8.3 bpm after training, p=0.009) and both arms improved the cardiorespiratory fitness level (VO2max from 30.7±5.7 to 33.9±6.64 mL/kg/min;CV 10.3%;p<0.001). Conclusions: Despite the challenges faced during the pandemic, a change in lifestyle integrating exercises, nutrition and educational counseling provides benefit to BC patients when delivered in a clinic-based setting group including the exercise specialists.

Transfer Factor as an Option for Managing the COVID-19 Pandemic

Abbreviations: CMI - cell-mediated immunity, CMV - cytomegalovirus, CFS - chronic fatigue syndrome, DTH - delayed type hypersensitivity, EBV - Epstein-Barr virus, HIV - human immunodeficiency virus, HSV - herpes simplex virus, MW - molecular weight, NPC - nasopharyngeal carcinoma, SAIDS - simian AIDS, SARS - severe acute respiratory syndrome, SIV - simian immunodeficiency virus, TF - transfer factor, VZV - varicella zoster virus, WHO - World Health Organisation. According to the CDC (Centers for Disease Control and Prevention in the USA) estimates, asymptomatic infections represent 40 % of the total number. Cardiomyopathies and lung lesions are also observed in asymptomatic patients, whereas cases of Kawasaki's disease have been described in children (Gattinoni et al., 2020;Harahsheh et al., 2020;Lauer et al., 2020;Meng et al., 2020;Zheng et al., 2020). [...]certain patients, months after having recovered from the infection, present symptoms reminiscent of those of the chronic fatigue syndrome (CFS), whose aetiopathology is not totally understood, although certain herpes viruses, viz. Be that as it may, as long as an effective vaccine is not available, the world will be exposed to successive outbreaks of Covid-19;its fading out by protective 'herd immunity' requires acquisition of immunity by 70 % of the population, far from the 25 % observed today in the worst infected areas. [...]even if the rate of new infections may periodically seem declining in various areas, as long as the virus continues to circulate and a vaccine is not available to be used worldwide, the present pandemic may persist, with possible successive waves or ripples of new infections occurring episodically, as in the case of the seasonal flu and as it has been observed in the USA.

Beneficial effects of exercise in oncology - MoviS: ‘Movement and Health Beyond Care’

Background: MoviS: ‘Movement and Health Beyond Care’ is a 3-year randomized controlled trial aiming to educate cancer patients after adjuvant therapy on the benefits of personalized physical activity (PA) and a proper nutritional plan. Methods: In this project, breast cancer (BC) patients who consent to participate will be randomized to Interventional Arm (A), consisting of 3-months of Movis Training, or Control Arm (B), consisting of standard care with no supervised PA. The Movis Training consists of 3-months of aerobic training (2 d/week of supervised training and 1 d/week of unsupervised exercise) with an increase in exercise intensity (40-70% Heart Rate Reserve) and duration (20-60 min). Ad interim analyses every 3-months up to 1-year will be included. The first cohort of eligible BC survivors were enrolled in January 2020 and carried out the Movis Training even during the COVID-19 pandemic. The primary outcome is improvement of Quality of Life (QoL) assessed by European Organization for Research and Treatment of Cancer QoL (EORTC QLQ-C30). The secondary outcomes are improvement of health-related QoL parameters such as: PA level (International Physical Activity Questionnaire;SenseWear Armband), fitness (VO2max), flexibility, strength, psychological well-being (Psychological distress Inventory;Profile of Mood States and diet habit (DianaWeb, MEDIET modified and recall 24h);Anthropometric measurement, Body mass (kg);BMI (kg/m2);body composition. Results: The expected improvement (mean ± SD) of the QoL in Arm A at 3-months is 15.1 ± 17.7, while in Arm B is 6.1 ± 17.1 (Cohen d effect size=0.51, medium effect). Using a t test for independent samples, with 0.05 alpha and 0.80 1-beta will require 60 subjects per group. Considering an expected drop-out of 30%, a total of 172 patients will be recruited. Conclusions: The targeted exercise oncology through multidisciplinary team would like to provide a coordinated program of cancer care to improve health care quality, improve prognosis, increase survival times and QoL and reduce the risk of BC recurrence. Legal entity responsible for the study: Elena Barbieri. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Swimming Pool safety and prevention at the time of Covid-19: a consensus document from GSMS-SItI.

Public health measures to cope with the Covid-19 pandemic, imposed also a shutdown of sports facilities and swimming pools. Safety issues related to recreational waters were emerging during the lockdown, rising concerns on how and when reopening pools and on how improve their management while SARS-CoV-2 is circulating in the population. The GSMS-SItI, Working Group on Movement Sciences for Health of the Italian Society of Hygiene Preventive Medicine and Public Health, discussed and summarized some indications for a suitable preventive approach. Several measures are highlighted, including social distancing, optimized water management, airflow and microclimatic parameters in the pool as well in the annexed rooms, verification of sanitation procedures. The GSMS-SItI underlines that prevention should be based on monitoring of the local epidemiological situation and on the constant collaboration with the local health authority and the national health service.