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.

Keeping breast cancer survivors exercising with the “movement and health beyond care” (MOVIS) clinical trial in the age of COVID-19: Amelioration of heart rate variability and cardiorespiratory fitness

Background: MoviS: 'Movement and health beyond care' is an ongoing randomized controlled trial aiming to educate breast cancer (BC) survivors on the benefits of exercise and proper nutrition habits. Methods: The study included thirty women (17.4% of the total planned cohort of 172 patients) with stage 0-III non-metastatic BC (age: 53.5±7.6 yrs;BMI: 25.3±4.9 kg/ m2) randomly allocated to the Intervention Arm (IA;supervised exercise training: “MoviS Training”) or control arm. The MoviS Training consists of 12 weeks of aerobic exercise (2 d/week of supervised and 1 d/week of unsupervised exercise) which intensity and duration gradually increased from 40 to 70% of heart rate reserve and from 20 to 60min, respectively. Both arms received nutritional and lifestyle counselling based on WCRF 2018 guidelines through the DIANA-Web platform and motivational interviewing. As the planned protocol was changed due to nationwide lockdown to contain the spread of COVID-19, IA performed home-based exercise sessions, which were remotely supervised using heart rate monitors. Heart rate variability (HRV;by 24-Holter monitoring), cardiac function indexes (by echocardiography with speckle tracking imaging), and cardiorespiratory fitness (by estimated maximal oxygen uptake [VO2max]) were evaluated at baseline and after the intervention period. Results: There were no adverse events during training. Baseline evaluation revealed no systolic disfunction (mean LVEF 60.4±4.5%) and a mild reduction (values 3 -18%) in global longitudinal strain in 26% of patients. HRV improved in both time and frequency domains: ASDNN/5min (50.6±14.4 to 55.2±16.7 msec, p=0.033);very low frequency (VLF) (1597±967 to 1881±963 msec, p=0.04);low frequency (LF) (613±404 to 731±542 msec, p=0.004);total power (2627±1393 to 3034±1669 msec, p=0.034). HRV parameters tended to improve to a greater extent in IA group (Coefficient of Variation: ASDNN/5min 13.7% vs 4.6%, LF 27% vs 10%, total power 26.5% vs 5.1%). Cardiorespiratory fitness level increased significantly in both groups (VO2max from 30.7±5.7 to 33.9±6.6mL/kg/min, p<0.001). Conclusion: During COVID-19 lockdown, short-term remotely supervised exercise training and recommendations on a healthy lifestyle lead to a significant improvement in HRV parameters and cardiorespiratory fitness in BC survivors.

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.

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.