Effects of a concurrent training, respiratory muscle exercise, and self-management recommendations on recovery from post-COVID-19 conditions: the RECOVE trial.

The aim of this study was to determine the effectiveness of physical exercise, respiratory muscle training, and the self-management World Health Organization (WHO) recommendations leaflet on the recovery of physical fitness, quality of life, and symptom status in people with post-COVID-19 conditions. Eighty nonhospitalized adults with a post-COVID-19 condition were randomly assigned to one of four 8-wk parallel intervention groups: 1) multicomponent exercise program based on concurrent training (CT, number of subjects (n) = 20; 3 resistance and endurance supervised sessions per week at low-moderate intensity); 2) inspiratory muscle training (RM, n = 17; 2 standardized daily sessions); 3) a combination of both of the above (CTRM, n = 23); and 4) control group (CON, n = 20; following the WHO guidelines for post-COVID-19-related illness rehabilitation). No significant differences between groups were detected at baseline. Although no significant differences between interventions were detected in the V̇o2max, significant individual improvements were identified in the CT (7.5%; effect size, ES = 0.28) and CTRM (7.8%; ES = 0.36) groups. Lower body muscle strength significantly improved in the CT and CTRM (14.5%-32.6%; ES = 0.27-1.13) groups compared with RM and CON (-0.3% to 11.3%; ES = 0.10-0.19). The CT and CTRM groups improved significantly for dyspnea and fatigue, as did the health status. In addition, significant differences between interventions were described in fatigue and depression scales favoring CT and CTRM interventions. An individualized and supervised concurrent training with or without inspiratory muscle training was safe and more effective than self-care recommendations and inspiratory muscle training alone, to regain cardiovascular and muscular fitness, improve symptom severity, and health status in outpatients with post-COVID-19 conditions.NEW & NOTEWORTHY Eight weeks of concurrent training, with or without inspiratory muscle exercise, was better than WHO "Support for Rehabilitation: Self-Management after COVID-19-Related Illness" recommendations or inspiratory muscle training alone to improve cardiopulmonary fitness, strength, and symptom severity, in a safe and effective manner. The RECOVE trial proved the benefits and utility of a supervised exercise program in people with post-COVID-19 conditions after mild COVID-19 in an ambulatory setting.

Rehabilitation for post-COVID-19 condition through a supervised exercise intervention: A randomized controlled trial.

PURPOSE: The aim of the study was to compare the outcomes of patients with post-COVID-19 condition undergoing supervised therapeutic exercise intervention or following the self-management WHO (World Health Organization) rehabilitation leaflet. METHODS: A randomized controlled trial was carried out that included 39 participants with post-COVID-19 condition who had a chronic symptomatic phase lasting >12 weeks. Comprehensive medical screening, patient-reported symptoms, and cardiorespiratory fitness and muscular strength were assessed. Patients were randomly assigned to a tailored multicomponent exercise program based on concurrent training for 8 weeks (two supervised sessions per week comprised resistance training combined with aerobic training [moderate intensity variable training], plus a third day of monitored light intensity continuous training), or to a control group which followed the WHO guidelines for rehabilitation after COVID-19. RESULTS: After follow-up, there were changes in physical outcomes in both groups, however, the magnitude of the change pre-post intervention favored the exercise group in cardiovascular and strength markers: VO2 max +5.7%, sit-to-stand -22.7% and load-velocity profiles in bench press +6.3%, and half squat +16.9%, (p < 0.05). In addition, exercise intervention resulted in a significantly better quality of life, less fatigue, less depression, and improved functional status, as well as in superior cardiovascular fitness and muscle strength compared to controls (p < 0.05). No adverse events were observed during the training sessions. CONCLUSION: Compared to current WHO recommendations, a supervised, tailored concurrent training at low and moderate intensity for both resistance and endurance training is a more effective, safe, and well-tolerated intervention in post-COVID-19 conditions.

Relationship between the severity of persistent symptoms, physical fitness, and cardiopulmonary function in post-COVID-19 condition. A population-based analysis.

The aim of this study was to determine the relationship between physical fitness, cardiopulmonary function and patient-reported severity of symptoms in people with post-COVID-19 condition. We examined ambulatory patients (n = 72) with post-COVID-19 condition who had a chronic symptomatic phase lasting > 12 weeks from the onset of symptoms, but had not been hospitalized for acute COVID-19. A comprehensive medical screening was conducted, including clinical history, symptomatology, comorbidities, body composition and physical activity levels. We then identified the relationship between physical fitness (cardiorespiratory fitness and muscular strength), cardiopulmonary function (echocardiographic and spirometry parameters) and patient-reported severity of symptoms (fatigue, dyspnea, health-related quality of life, anxiety, and depression). Age, body mass index, sex, number of comorbidities and duration of symptoms were included as potential confounders. Results showed that greater physical fitness and cardiopulmonary function were associated with lower severity of symptoms in people with post-COVID-19 condition. Cardiorespiratory fitness, lower-limb muscle strength, maximal voluntary ventilation and left ventricular ejection fraction account for reducing fatigue and dyspnea. Greater physical activity levels were associated with fewer symptoms and less-severe fatigue and dyspnea. In conclusion, preserving better cardiopulmonary health and physical condition during the course of the disease-even in mild cases-was related to a lower intensity of symptoms in non-hospitalized people with post-COVID-19 condition. It is probable that exercise and physical conditioning are valuable pre- and post-COVID-19 countermeasures that could help decrease the severity, not only of acute infection, but of post-COVID-19 persistent symptoms and prognosis.

Impact of COVID-19 lockdown on match activity and physical performance in professional football referees.

To investigate the effect of COVID-19 lockdown on match-play metrics in professional football referees during official matches of the Spanish professional leagues. Forty-two professional football referees from the First (n = 20) and Second Division (n = 22) were monitored during 564 official games using Global Positioning System (GPS) technology. Data of matches before lockdown were compared to matches after resumption of the competition. Compared to pre-lockdown, in the referees of the First Division there was a decrease in the total running distance and the distance covered at all speed thresholds > 6 km · h-1 after lockdown (P < .05). In the Second Division referees, the post-lockdown measurement only showed a decrease in the running distance at 21-24 km · h-1 (P < .05), with no changes in the other speed thresholds. The post-lockdown measurement showed an increased distance covered at < 6 km · h-1 and the number of accelerations for both First and Second Division referees (P < .05). Referees' match activity was reduced due to the COVID-19 lockdown, while the effect on running parameters was more pronounced in First Division referees.

Long-Term Effect of Exercise on Irisin Blood Levels-Systematic Review and Meta-Analysis.

Physical exercise may activate a number of important biochemical processes in the human body. The aim of this systematic review and meta-analysis was to identify the long-term effect of physical activity on irisin blood levels. We searched PubMed, Scopus, and Web of Science for articles addressing the long-term effect of physical exercise on irisin blood levels. Fifty-nine articles were included in the final qualitative and quantitative syntheses. A statistically significant within-group effect of exercise on irisin blood levels was in 33 studies; out of them, the irisin level increased 23× and decreased 10×. The significant positive between-groups effect was found 11×. Furthermore, the meta-analysis indicated that physical exercise had a significant positive effect on irisin blood levels (SMD = 0.39 (95% CI 0.27-0.52)). Nevertheless, considerably high heterogeneity was found in all the analyses. This systematic review and meta-analysis indicate that physical exercise might increase irisin blood levels; however, the results of individual studies were considerably inconsistent, which questions the methodological detection of irisin by ELISA kits.

Chronotropic Incompetence in Non-Hospitalized Patients with Post-COVID-19 Syndrome.

Patients recovering from COVID-19 commonly report persistence of dyspnea, exertional fatigue, and difficulties in carrying out their daily activities. However, the nature of these symptoms is still unknown. The purpose of the study was to identify limiting causes of cardiopulmonary origin for the performance of physical exercise in post-COVID-19 condition that could explain the symptomatic persistence of dyspnea or fatigue-related symptoms. Thirty-two non-hospitalized patients with post-COVID-19 condition (i.e., still presenting a chronic symptomatic phase lasting >90 days since debut of symptoms that lasted for at least 2 months and cannot be explained by an alternative diagnosis) completed a clinical examination including echocardiography, submaximal and maximal cardiorespiratory fitness tests (Ekblom-Bak and Bruce's protocols), and a battery of validated questionnaires about fatigue and exercise intolerance. Four participants (12.5%) reported an abnormal cardiac response to exercise during the submaximal test, which aroused suspicion of the presence of chronotropic incompetence. All of them were confirmed with a positive diagnosis maximal exercise test after cardiology screening, even with a comprehensive clinical examination, resting ECG, and echocardiogram, without other findings. No statistical differences were found in any physiological variables or questionnaire values, between patients with positive and negative diagnoses. Chronotropic incompetence and other autonomic disorders may appear in patients with mild forms of COVID-19 presentation and may persist in the long term, being responsible for exercise intolerance after resolution of acute infection. Clinicians should be aware that chronotropic incompetence and other autonomic disorders may be a complication of COVID-19 and should consider appropriate diagnostic and therapeutic interventions in these patients, especially when early exercise-related fatigability is reported.

Impact of Tailored Multicomponent Exercise for Preventing Weakness and Falls on Nursing Home Residents' Functional Capacity.

OBJECTIVES: We aimed to determine whether the benefits of long (24 weeks) and short (4 weeks) training programs persisted after short (6 weeks) and long (14 weeks) periods of inactivity in older adult nursing home residents with sarcopenia. DESIGN: Multicenter randomized trial. INTERVENTION: The Vivifrail tailored, multicomponent exercise program (http://vivifrail.com) was conducted to individually prescribe exercise for frail older adults, depending on their functional capacity. The training included 4 levels combining strength and power, balance, flexibility, and cardiovascular endurance exercises. SETTING AND PARTICIPANTS: Twenty-four institutionalized older adults (87.1 ± 7.1 years, 58.3% women) diagnosed with sarcopenia were allocated into 2 groups: the Long Training-Short Detraining (LT-SD) group completed 24 weeks of supervised Vivifrail training followed by 6 weeks of detraining; the Short Training-Long Detraining (ST-LD) group completed 4 weeks of training and 14 weeks of detraining. MEASURES: Changes in functional capacity and strength were evaluated at baseline, and after short and long training and detraining periods. RESULTS: Benefits after short and long exercise interventions persisted when compared with baseline. Vivifrail training was highly effective in the short term (4 weeks) in increasing functional and strength performance (effect size = 0.32-1.44, P < .044) with the exception of handgrip strength. Continued training during 24 weeks produced 10% to 20% additional improvements (P < .036). Frailty status was reversed in 36% of participants, with 59% achieving high self-autonomy. Detraining resulted in a 10% to 25% loss of strength and functional capacity even after 24 weeks of training (effects size = 0.24-0.92, P < .039). CONCLUSIONS AND IMPLICATIONS: Intermittent strategies such as 4 weeks of supervised exercise 3 times yearly with no more than 14 weeks of inactivity between exercise periods appears as an efficient solution to the global challenge of maintaining functional capacity and can even reverse frailty in vulnerable institutionalized older adults.

Post-COVID-19 Syndrome and the Potential Benefits of Exercise.

The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, is leading to unknown and unusual health conditions that are challenging to manage. Post-COVID-19 syndrome is one of those challenges, having become increasingly common as the pandemic evolves. The latest estimates suggest that 10 to 20% of the SARS-CoV-2 patients who undergo an acute symptomatic phase are experiencing effects of the disease beyond 12 weeks after diagnosis. Although research is beginning to examine this new condition, there are still serious concerns about the diagnostic identification, which limits the best therapeutic approach. Exercise programs and physical activity levels are well-known modulators of the clinical manifestations and prognosis in many chronic diseases. This narrative review summarizes the up-to-date evidence on post-COVID-19 syndrome to contribute to a better knowledge of the disease and explains how regular exercise may improve many of these symptoms and could reduce the long-term effects of COVID-19.

Training Load and Performance Impairments in Professional Cyclists During COVID-19 Lockdown.

PURPOSE: The COVID-19 outbreak has challenged professional athletes' training and competition routines in a way not seen before. This report aims to inform about the changes in training volume and intensity distribution and their effects on functional performance due to a 7-week home-confinement period in professional road cyclists from a Union Cycliste Internationale Pro Team. METHODS: A total of 18 male professional cyclists (mean [SD] age = 24.9 [2.8] y, body mass = 66.5 [5.6] kg, maximal aerobic power = 449 [39] W; 6.8 [0.6] W/kg) were monitored during the 10 weeks before the lockdown (outdoor cycling) and the 7-week lockdown (indoor cycling turbo trainer). Data from the mean maximal power output (in watts per kilogram) produced during the best 5-minute and best 20-minute records and the training intensity distributions (weekly volumes at power-based training zones) were collected from WKO5 software. RESULTS: Total training volume decreased 33.9% during the lockdown (P < .01). Weekly volumes by standardized zones (Z1 to Z6) declined between 25.8% and 52.2% (effect size from 0.83 to 1.57), except for Z2 (P = .38). There were large reductions in best 5-minute and best 20-minute performance (effect size > 1.36; P < .001) with losses between 1% and 19% in all the cyclists. CONCLUSIONS: Total indoor volumes of 12 hours per week, with 6 hours per week at low intensity (Z1 and Z2) and 2 hours per week at high intensity over the threshold (Z5 and Z6), were insufficient to maintain performance in elite road cyclists during the COVID-19 lockdown. Such performance declines should be considered to enable a safe and effective return to competition.