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Journal of Science and Medicine in Sport ; JOUR:S69, 25(Supplement 2).
Article in English | EMBASE | ID: covidwho-2095700


Introduction: In Australia, it is estimated that 45% of adults meet the aerobic training recommendations (i.e., 150-300 minutes of MVPA) and only 9-30% meet the resistance training (RT) guidelines (i.e., minimum 2 sessions/week). Given the lack of 'scalable' physical activity community-based interventions promoting RT, the aim of this effectiveness trial (based on the published ecofit efficacy trial) was to determine the effects of an innovative community-based multicomponent physical activity intervention promoting resistance and aerobic-based physical activity using outdoor gym equipment, smartphone technology, and social support. Method(s): The ecofit effectiveness trial was evaluated using a two-arm (intervention versus wait-list control) randomised controlled design, with assessments at baseline, 3 (primary time-point) and 9-months (follow-up). Participants were recruited from the Newcastle and Lake Macquarie local government areas, NSW. Eligible participants were aged 18-80 years, had access to a smartphone, did not meet the aerobic and/or resistance-based physical activity guidelines, and passed the Adult Pre-Exercise Screening Tool. The intervention components included (i) smartphone technology (i.e., purpose-built application that included standardised workouts using local outdoor gym equipment across 11 locations), (ii) social support (i.e., option to enrol as a group and join the ecofit Facebook group), and (iii) a 90-minute introductory session. Linear mixed models were conducted with an adjusted alpha (p<.025) to account for the two primary outcomes of upper (i.e., push-up test) and lower (sit-to-stand test) body strength. Result(s): Participants (N=245;mean age 53.44 (SD=13.9);72% women) were recruited. There were no statistically significant (p<.025) group-by-time effects for the primary outcomes (i.e., upper and lower body muscular fitness) at 3-months. At 9-months, however, there were significant improvements in both upper (1.42 repetitions, 95%CI=0.25, 2.59) and lower body (2.6 repetitions, 95%CI=0.41, 4.82) muscular fitness, compared to controls. Among the secondary outcomes at 3-months, mean differences in visceral adipose tissue (-59.52 grams, 95%CI=-122.17, 3.12), and total fat (-494.30 grams, 95%CI=-1012.39, 23.79) approached statistical significance (p's=0.06). Discussion/Conclusion: To our knowledge this is the first community-based RT intervention that has employed a scalable approach targeting the general population. Despite the mixed findings, it was encouraging to see beneficial effects on the primary outcomes, particularly in light of the disruption to the trial caused by the COVID-19 pandemic. The positive findings presented warrant further examination of this scalable intervention mode for its dissemination to other local government areas. Impact and application to the field: * The ecofit program is promising with significant statistical and clinical effects and could be considered to be scaled-up in other Local Government Districts across Australia and abroad. This study was funded by NHMRC grant (APP1134914, 2017), registered with the Australian and NZ Clinical Trial Registry (ACTRN12619000868189) and received Human Ethics approval from the University of Newcastle (H-2018-0060). Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this . Copyright © 2022

Rheumatology (United Kingdom) ; 60(SUPPL 1):i14-i15, 2021.
Article in English | EMBASE | ID: covidwho-1266141


Background/AimsThe novel infectious disease COVID-19 is associated with a widespectrum of clinical severity amongst the general population. Patientswith autoimmune rheumatic diseases (ARD) are more likely toexperience serious COVID-19 related events, although risk factorsfor such outcomes have yet to be established. In particular, the riskprofiles of specific ARD therapies are unknown.MethodsA Scottish wide registry was rapidly developed in March 2020. Clinicalcharacteristics and outcomes of infected cases were collated acrossall Scottish health boards, leveraging the Scottish Systemic VasculitisNetwork and Scottish Society for Rheumatology. Eligible patientsincluded any adult ARD patients with a confirmed (clinically or PCR)diagnosis of COVID-19. Simple descriptive statistics were employed toevaluate associations between ARD therapies and a serious COVID-19disease outcome, as defined by a requirement of invasive or noninvasive ventilation, and/or death.ResultsA total of 69 patients (59% female;mean age 65.6, SD15.5) wererecruited to the registry , 92% of which required hospitalisation. Caseswere most commonly diagnosed with rheumatoid arthritis (n = 32, 46.4%) followed by spondyloarthritis (n = 19, 27.5%) and systemicvasculitis (n = 9, 13.0%). Anti-TNF therapy (n = 8, 11.6%) andmethotrexate (n = 31, 44.9%) were the commonest biologic andconventional disease modifying drug (bDMARD and csDMARD) usedrespectively. N = 20 (29%) received background corticosteroid therapy (15.9% prednisolone >5mg, 13% prednisolone 5mg). A severeoutcome was observed in n = 25(31.9%);n = 11 required assistedventilation and n = 19 died. With the exception of Leflunomide, conventional and biologic DMARDs did not appear to confer ahigher risk for severe outcome (table 1). Of note, anti-TNF therapywas associated with a non-serious outcome (p = 0.04) and prednisolone>5mg with a serious outcome (p = 0.08). ConclusionPreliminary data from this Scotland-wide ARD COVID-19 registryevidences variation in the impact of standard ARD therapies on theseverity of COVID-19 outcome. In general, background csDMARD andbDMARD use does not appear to be a risk factor for severe outcomes.However, anti-TNF therapy may confer a favourable outcome, whileleflunomide and corticosteroids may have the opposite effect.Rheumatologists should be aware of these possible risk factors andcontinue to contribute to registries to help establish whether theseputative signals are clinically relevant.

ASAIO Journal ; 66(SUPPL 3):15, 2020.
Article in English | EMBASE | ID: covidwho-984837


Due to the inherent thrombotic risk associated with the ECMO circuit, therapeutic anticoagulation is recommended. While unfractionated heparin is commonly used due to wide availability, the use of bivalirudin, a direct thrombin inhibitor, is gaining popularity. The benefits of bivalirudin over heparin include: Relatively organ-independent metabolism, inhibition of fibrin-bound and freely circulating thrombin, rapid clearance, and less resistance. Early reports in the COVID-19 pandemic suggest a hypercoagulable state. Particular attention should be paid to adequate anticoagulation in the high-risk patients with SARs-CoV-2 on ECMO support. To date, there are few reports discussing the use of bivalirudin in COVID ECMO patients. Bivalirudin is the anticoagulation of choice for the maintenance of patients on ECMO at our institution. We conducted a retrospective analysis of the first 20 patients with COVID that required ECMO support. Data was collected on outcomes related to hemostasis. Standard protocol for ECMO patients includes screening duplex ultrasound at regular intervals following decannulation to evaluate for thromboembolism. Three patients did not receive screening due to terminal weans. Of the remaining 17 patients, 7 had confirmed acute venous thromboembolism. Four patients had hemorrhage requiring intervention;two cases of epistaxis, one intra-abdominal bleeding, and one cannulation site bleeding. One patient developed nonfatal intracranial hemorrhage that did not require intervention. Only two patients developed renal failure requiring temporary renal replacement therapy. This is in comparison to the 24% rate noted in the ELSO COVID-19 database. Our findings suggest bivalirudin is an alternative to heparin for appropriate COVID ECMO patients.