Physiological effects of regular CrossFit® training and the impact of the COVID-19 pandemic-A systematic review.

CrossFit® is a functional fitness training program known for its day-to-day varying "Workouts of the Day" (WOD). In accordance with the 'CrossFit® Level 1 Training Guide', regular CrossFit® training sessions consist of Warm-up, Mobility, Skill/Power training, WOD, and Cool-down. Despite the fast-growing and widespread popularity, data on the practical implementation of the training program based on scientific evidence are rare. Therefore, the purpose of this study is to systematically review the existing literature on the physiological effects of regular CrossFit® training in full extent instead of stand-alone WODs and to examine the impact of the COVID-19 pandemic on the training behavior of CrossFit® athletes. A systematic search was conducted following the PRISMA guidelines in April 2022 and updated in July 2022 using the following databases: PubMed, SPORTDiscus, Scopus, and Web of Science. Using the keyword "CrossFit", 1,264 records were found. Based on the eligibility criteria, 12 studies are included and separated by topics: acute-short term physiological response (n = 8), and impact of the COVID-19 pandemic (n = 4). The results show that studies of regular training sessions were rarely conducted and contradicted the existing knowledge of the physiological demands [e.g., heart rate (HR)] of CrossFit®. In detail, included studies demonstrate that training sessions last 30-60 min and provide a progressive increase in cardiovascular load up to maximal effort activity (>90% HRmax), differing from stand-alone WODs exclusively at high-intensity. Also, scarce research exists on COVID-19-pandemic-induced effects on training behavior, and studies are of moderate to low quality. There is still a lack of comprehensive analyses on the acute physiological effects of regular training sessions and the consequences of the COVID-19 pandemic in the scientific literature. Moreover, the inconsistent terminology used in CrossFit® research complicates generalized conclusions. Therefore, future research on the training methodology of CrossFit® needs to overcome terminological inequalities and examine scientifically the implementation of the concept by considering regular training sessions under practical settings.

Postoperative rehabilitation of shoulder pain.

Background: Shoulder joint diseases such as rotator cuff tear, adhesive capsulitis, calcific tendinitis, shoulder instability, and glenohumeral osteoarthritis often require surgical treatment. Surgical outcomes can change significantly depending on whether the postoperative rehabilitation was appropriately performed. Current Concepts: The focus of postoperative rehabilitation should be to remove pain and restore functional movement through improving the dynamic stability of the rotator cuff and shoulder muscles. However, rehabilitation should not include activities that aggravate the injury. Therefore, rehabilitation treatment should be carried out with gradual increments in exercise intensity. Postoperative rehabilitation is not only related to exercise but may also include drug administration, such as steroid injection. In particular, many investigations have been performed to identify the clinical risks and benefits of steroid injection after rotator cuff repair. Notably, telemedicine can be used as a solution for the problematic situations that have been caused by coronavirus disease 2019 pandemic. Discussion and Conclusion(s): A thorough understanding and appropriate application of postoperative rehabilitation protocols are essential to improve surgical outcomes.Copyright © Korean Medical Association.

Implementation of pulmonary rehabilitation in postCOVID19 in Latin America: 18 months later

Introduction: The impact caused by the Coronavirus disease (COVID-19) has considerably altered the provision of outpatient rehabilitation services, especially pulmonary rehabilitation (PR). Objective(s): To describe the situation of PR services in Latin America 18 months after the beginning of the COVID-19 pandemic. Method(s): Cross-sectional study in which a survey was sent to professionals from PR centers in Latin America. An online questionnaire was applied from May to September 2021. The following data were included: demographic data of the programs, evaluation strategies, program structure, RP intervention in post-COVID-19 patients, and perception of therapeutic strategies for the care of post-COVID patients. COVID-19. The questionnaire was distributed in Spanish and Portuguese languages. This study was approved by the ethics committee. Result(s): Responses were received from 196 centers from 14 countries;Most of the surveys were answered by physiotherapists/kinesiologists in 65.7%. In the evaluation of exercise tolerance, the 6-minute walk test is the most used. Less than 50% of the institutions evaluate the quality of life, symptoms, and lung function. In the prescription of exercise intensity, there is reduced use of CPET and it is prescribed mainly with subjective scales of symptoms (Borg Scale) (78.1%), and response to exercise with vital signs (71.4%). The programs have, practically, for the most part, physical therapists (90.8%), as well as pulmonologists (60%), psychologists (35%), among other professionals. Conclusion(s): The application of these programs in Latin America is heterogeneous, both in the evaluations and the interventions carried out.

Tolerability and safety of high-intensity continuous and intermittent exercise in COVID-19

Aim: We assessed safety of high-intensity [IV1] constant-load exercise (CLE) and intermittent exercise (HIIT) in 14 post-severe-COVID-19 patients (63+/-13 years;78.6% male;BMI: 28+/-5, without comorbidities) between July 2020 and April 2021 after 55+/-22 days of COVID-induced acute respiratory failure. Method(s): The crossover study balanced exercise intensity between CLE at 70% of peak work rate (WRpeak) to the limit of tolerance (Tlim) and HIIT including 1 min exercise at 100% WRpeak, alternated with 1 min at 40% WRpeak to Tlim. Gas exchange, ventilation, electrocardiography and symptoms were assessed. Result(s): Exercise endurance time and total work output were not different between HITT and CLE (Table 1). At Tlim, none of the ventilatory or cardiovascular responses differed between HITT and CLE and there was no difference in the intensity of symptoms (Table 1). Conclusion(s): Individuals with ongoing symptomatic COVID-19 could safely undertake high intensity exercise performed continuously or intermittently.

Exploring use of a connected Internet-Of-Things system (A4A+) with CE-marked devices to support asthma selfmanagement? A mixed method study

Background: In the COVID pandemic, patients have had to rely on remote consultations to help them to live with their condition. Aim(s): We aimed to explore how a connected system (A4A+) linking smart devices (inhaler/watch/peak flow meter) could support asthma self-management. Method(s): The A4A+ system collected data from smart devices that could be shared with practices in a pdf attached to patients' electronic health records. We recruited 10 patients via social media, observed their usage of the system over a month, and undertook baseline and exit interviews. We also interviewed 3 GPs and an asthma nurse for their views on the report format. Thematic analysis used the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Result(s): 7517 self-management data-points (asthma symptoms, PEFR, inhaler usage, exercise intensity, heart rate, sleeping pattern, body/air temperature) were collected from 10 patients though recording reduced over the month. Most patients chose to monitor their reliever inhaler rather than the preventer. Patients felt 'positive', found it 'easy' to use the system and chose to use devices they thought were "accurate". Monitoring adjustments to medication, having asthma (or COVID) symptoms triggered and motivated them to adopt the system. Clinicians wanted an overall asthma score/status and reliever usage on the report. Conclusion(s): A connected system could enable flexible digital approaches to care by providing on-going selfmanagement data to support remote consultation. However, providing users with confidence in the 'accuracy' of systems is needed to maintain patients' motivation to use the system.

Changes in training activity post COVID-19 infection in recreational runners and cyclists.

Background: Anecdotal evidence suggests that athletes struggle to return to exercise post COVID-19 infection. However, studies evaluating the effect of COVID-19 on athletes' exercise activity are limited. Objectives: The objectives of this study were: (i) to describe the perceptions of recreational runners and cyclists recovering from COVID-19 on their training activity and general well-being, (ii) to compare device-measured training data in runners and cyclists pre- and post COVID-19, with non-infected controls that had a training interruption. Methods: Participants who were recruited via social media completed an online questionnaire (n=61), including demographic, health and COVID-19 descriptive data. In a sub-sample, device-measured training data (heart rate, time, distance and speed, n=27) were obtained from GPS devices for four weeks before infection and on resumption of training. Similar data were collected for the control group (n=9) whose training had been interrupted but by factors excluding COVID-19. Results: Most participants experienced a mild to moderate illness (91%) that was associated with a training interruption time of two-four weeks. Decreases in heart rate, relative exercise intensity, speed, time and distance were observed during the first week of returning to training for both groups, followed by an increase from Week two onwards. Discussion: Results failed to support a 'COVID-19 effect' on exercise activity as reductions in training variables occurred in both the COVID-19 and control groups. A possible explanation for the reductions observed is a deliberate gradual return to training by athletes post-COVID-19. Conclusion: More research is needed using device-measured training data prior to and post COVID-19 infection to better understand the impact of the SARS-CoV-2 virus on the exercise activity of athletes.

The Effect of Exercise Training on Long Covid Patients

PURPOSE/HYPOTHESIS: Individuals with Long COVID experience a variety of symptoms (cardiopulmonary, neurological, musculoskeletal, and psychological) for 12 weeks or more after being infected with COVID-19. Preliminary evidence suggests exercise to be beneficial in alleviating short-term COVID-19 symptoms. The purpose of this investigation is to assess the impact of a progressive therapeutic exercise program on individuals with Long COVID. NUMBER OF SUBJECTS: Ten participants (8 females, 2 males) with Long COVID (age=49 +/- 5 yrs, mass = 89 +/- 6 kg, BMI = 30.2 +/- 1.9 kg/m2) were enrolled in the study. MATERIALS AND METHODS: Before and after the intervention participants were assessed for 6-minute walk distance (6MWD), 5-times sit to stand (5XSTS), gait speed, grip strength, perceived quality of life (SF-12), and general fatigue (visual analog fatigue scale, VAFS). Participants then completed a progressive, individualized exercise program (;8 weeks) designed to improve cardiovascular fitness, muscle strength, and endurance. Modes of exercise used to facilitate improvement in cardiorespiratory fitness included the treadmill, NuStep, semirecumbent bike, semi-recumbent elliptical, and standup elliptical. Heart rate (HR), blood pressure (BP), O2saturation, and rating of perceived exertion (RPE) were regularly monitored during aerobic exercise. Dumbbell exercises targeted at large muscle groups were used to challenge muscular strength and endurance. Progression of exercise intensity and duration was based on symptom response to exercise. Paired t-tests were used to evaluate changes in outcome measures following the intervention. RESULT(S): 6MWD (pre = 469 +/- 19 m, post=529 +/- 18 m, P = .001), 5XSTS (pre=11.4 +/- 1.1 s, post=9.4 +/- 0.9 s, P = .012), gait speed (pre=1.24 +/- 0.05m/s, post=1.35 +/- 0.07m/s, P = .029), and right (pre=69.8 +/- 4.2lbs, post=73.6 +/- 4.4lbs;P = .041) and left (pre=64.7 +/- 3.5lbs, post=68.8 +/- 3.1lbs;P = .041) grip strength improved following the intervention. Similarly, both the physical component (pre=44.4 +/- 3.1, post=50.76 2.4, P = .006) and mental component (pre=43.9 +/- 2.9, post=51.4 +/- 2.0, P = .007) of SF-12 improved, while VAFS (pre54.86 0.5, post52.86 0.6, P5.005) was reduced following the intervention. CONCLUSION(S): A progressive individualized exercise program can be effective at improving physical function and perceived quality of life in Long COVID patients. CLINICAL RELEVANCE: Many physicians are referring patients out to be treated for Physical Therapy, but there is currently limited reference of evidence-based practice to treat these individuals and some concern that exercise may exacerbate symptoms. The majority of APTA clinical guidelines for COVID-19 focus on short-term COVID-19 symptoms and do not address treatment methods for Long COVID symptoms. While functional status has been demonstrated to be negatively impacted in Long COVID patients, little guidance is available for treatment strategies in this population. This investigation provides physical therapists with a generalized strategy to improve physical function and quality of life in Long COVID patients.

Safety, Feasibility, and Appropriateness of Submaximal Exercise Testing in Inpatient Rehabilitation: A Case Series

BACKGROUND AND PURPOSE: Submaximal graded exercise testing (GXTsubmax) is rarely used during inpatient (IP) rehabilitation, and there is little research supporting its use. Lack of exercise testing limits optimal exercise prescription using target heart rate (HR) zones, which are important for high intensity gait training and rehabilitation. The purpose of this study was to help determine whether GXTsubmax was (1) safe, (2) feasible and (3) able to inform a target training HR zone in people with medically complex diagnoses. CASE DESCRIPTION: Nine patients in IP rehabilitation were identified via therapist referral and chart review (7 males;mean age +/- standard deviation 57 +/- 13 years). Diagnoses were stroke (n = 2), COVID rehab (n=4), limb loss (n=2), and oncology (n= 1). All participants were considered medically complex with significant cardiac and pulmonary disease comorbidities. They received medical clearance to participate in the GXTsubmax. We used the total body recumbent stepper submaximal exercise test (TBRS submax) for the exercise test. Oxygen saturation, heart rate, rate of perceived exertion (RPE) and blood pressure were monitored. Termination criteria included reaching one of the following: 85%HR Max, RPE 17, SpO2 drop,90%, patient requests to stop, or end of test. A target HR zone was chosen through comprehensive performance analysis including HR and RPE. HR zones were identified that correlated with Borg RPE zones 11 to 15/20. Once these HR zones were determined, we compared them to calculated target HR zones using Karvonen's Formula (Moderate exercise intensity 40%-60% HRR) and estimated peak VO2. OUTCOME(S): Nine patients completed 1 or 2 tests during their length of stay, resulting in 15 tests analyzed. There were no serious adverse events. Two tests were terminated at the end of the first stage (3 minutes), 7 tests by the end of the second stage (5-6 minutes), 3 tests by the end of the third stage (7-9 minutes), and 3 tests made it to the fourth stage (11-12 minutes). Reasons for termination were: 11 (73%) reached the RPE 17, 1 SpO2 was 89%, 1 reached 85% HR max, and 2 completed the test. The total duration for set up and completion was less than 30 minutes. Physical therapists (n = 3) reported the TBRS submax was feasible, billable, and provided a valuable opportunity for patient education on exercise intensity. Based on RPE and patient performance, therapists suggested a lower initial target power (15 watts vs 30 watts) and reduce the stepwise workload changes to accommodate complex patients. Seven participants required an extrapolated target HR range because of the brevity of their GXTsubmax. Target HR zone identified based on the GXTsubmax was more than 10% below the target HR derived fromKarvonen's Formula for 7 participants. DISCUSSION: This study suggests the TBRS submax is safe and feasible in IP rehabilitation. Our experience suggests a reduction in both initial watts across stages is needed in complex patients. Future studies should determine whether the target heart rate zones through the TBRS submax are appropriate in IP rehabilitation and contribute to prognosis, quality of life, and discharge planning.

Acute effects of different facemasks during High Intensity Interval Training in trained women. A randomized crossover pilot study

The aim of the present investigation was to analyze the acute effect of different facemasks on physiological, perceptual and performance parameters in trained young women during a High Intensity Interval Training (HIIT) on cycle ergometer. Fifteen subjects participated in the study. Heart rate variability, muscle oxygen saturation, lactate concentration and comfort parameters were measured under 3 conditions: no facemask, surgical and FFP2 facemask. The use of facemasks had no effect on any variable related to oxygen saturation, heart rate variability and cycling power during the HIIT protocol. Only lactate concentration revealed significantly lower values in the No mask condition compared to FFP2 3 min after HIIT (p = .038). Regarding the overall perception and comfort, participants reported greater discomfort when wearing the FFP2 mask compared to the No mask condition (p<.05). On the contrary, the analysis of heart rate variability, revealed significant differences (p<.001) in the Pre compared to the Post exercise for all conditions. The use of surgical or FFP2 facemask during HIIT training does not affect performance during strenuous exercise while perceived comfort appears to be lower with FFP2 masks in physically trained women.Alternate : El objetivo de esta investigación fue analizar los efectos agudos de diferentes tipos de mascarillas sobre los parámetros fisiológicos y comodidad en mujeres entrenadas durante un entrenamiento interválico de alta intensidad (HIIT) en cicloergómetro. Quince sujetos fueron examinados, obteniendo la variabilidad de la frecuencia cardíaca, la saturación de oxígeno muscular, la concentración de lactato y los parámetros de confort bajo 3 condiciones: sin mascarilla, mascarilla quirúrgica y mascarilla FFP2. El uso de mascarillas no tuvo efecto sobre la saturación de oxígeno, la variabilidad de la frecuencia cardíaca y la potencia de pedalada durante el ejercicio. Sólo la concentración de lactato reveló valores significativamente más bajos Sin mascarilla que con FFP2 3 min después del HIIT (p = .038). En cuanto a la percepción y comodidad, los participantes identificaron una mayor incomodidad con el uso de FFP2 en comparación con la ausencia de ésta (p<.05). Por el contrario, el análisis de la variabilidad de la frecuencia cardíaca, reveló diferencias significativas (p<.001) en el ejercicio Pre- comparado con el Post- en todas las condiciones. El uso de mascarilla quirúrgica o FFP2 durante el entrenamiento HIIT no afecta al rendimiento, mientras que la comodidad percibida parece ser menor con las mascarillas FFP2 en mujeres entrenadas.

Pilot Trial Triumphs and Tribulations. A Feasibility Study of Supervised Exercise Delivered Via Telehealth for Secondary Stroke Prevention

Background and Aims: Medical management alone is insufficient to reduce secondary stroke risk. Supervised exercise combined with behaviour change support may facilitate increased physical activity and help adequately address stroke recurrence risk. This early analysis of the ENAbLE Pilot Trial aimed to test the feasibility of a supervised aerobic exercise package delivered via telehealth. Method(s): A 4-arm, assessor blinded RCT was piloted during the COVID-19 Pandemic. The remotely delivered trial included people 3 months to 10 years post stroke or TIA. The intervention involved 12 weeks of twice weekly telehealth-supervised aerobic exercise and support sessions. Feasibility data including recruitment, adherence, adverse events and ability to collect clinical outcomes to support a Phase III trial (blood pressure [primary outcome], physical activity, fatigue, and quality of life) was collected and analysed. Result(s): Thirty people participated (exercise intervention n=14, control n=16) between April 2020 and July 2021. Session attendance was 80%. Three participants (10%) withdrew or were lost to follow-up, all in the experimental group. Mean exercise intensity during supervised sessions was in the target range (moderate to vigorous). Mean number of systolic BP measures recorded over 7 days was 27 (SD 2.2) of a maximum of 28, at baseline. One non-serious adverse event occurred during supervised exercise sessions. However, outside exercise sessions adverse events were higher in the experimental group who were more frequently monitored. Conclusion(s): A remotely delivered program of supervised aerobic exercise delivered via telehealth was feasible. Learnings from the remote delivery of an exercise pilot trial will be shared. Acknowledgements: Stroke Foundation Australia.

The Influence of Physical Exercise Frequency and Intensity on Individual Entrepreneurial Behavior: Evidence from China.

Physical exercise can benefit individuals' physical and mental health and also influence individuals' long-term behavioral choices. Doing exercise is particularly important given that physical exercise can impact individuals' cognitive abilities and positive emotional states, which may further impact entrepreneurial behavior. Therefore, understanding the relationship between exercise and entrepreneurial behavior is essential, because it can provide policy suggestions for popularizing athletic activities and boosting entrepreneurship. Consequently, the present study examined whether physical exercise could predict entrepreneurial behavior and the possible psychological mechanisms within this relationship. Based on the 2017 Chinese General Social Survey (CGSS2017), this study tested the hypotheses using the Probit and Tobit models. The results showed that individuals' physical exercise intensity and frequency positively affected their entrepreneurial behavior. In addition, five variables moderated the relationships between physical exercise and individual entrepreneurial behavior: urban-rural differences, education level, marital status, the existence of minor children, and age. Moreover, positive emotions and physical/mental health mediated the influence of physical exercise (exercise frequency and exercise intensity) on individual entrepreneurial behavior. Endogeneity explanations were ruled out by including instrumental variable, copula terms and adopting coarsened exact matching.

Introduction of a physical activity assessment and exercise prescription to the cardiac risk in the young clinic

49 Table 1Exercise Prescription template using the FITT-VP (frequency, intensity, type, time, volume and progress) principle of exercise prescription.Exercise type Frequency (per week) Intensity Time (mins/session) Volume (weekly mins) Progression As always if you develop any concerning symptoms during exercise please stop and seek medical advice 49 Table 2‘How do I estimate exercise intensity?’ patient guide as part of the exercise prescription template and patient information leafletIntensity RPE (Rating of perceived exertion) % of HR max** Talk test 0 Resting 1 2 Very light No noticeable change in breathing or sweating Low 3 Somewhat light <55% Can talk and sing 4 Light Moderate 5 Somewhat moderate 55–74% Can talk, can’t sing Increased breathing and sweating 6 Moderate 7 Somewhat hard Feeling ‘out of breath’ and increased sweating High 8 Very hard 75–90% Can’t talk or sing 9 Extremely hard 10 Maximal exertion **%HR max will not be an accurate measure of exercise intensity if your heart rate is effected by certain medications or conditions 49 Figure 1Levels of self reported physical activity based on the NAPQ-short questionnaire and WHO 2020 physical activity guidelines[Figure omitted. See PDF] 49 Figure 2Variety of patients with a diagnosis of a cardiac condition or a family history of a cardiac condition receiving an exercise prescription. HCM;hypertrophic cardiomyopathy, DCM;dilated cardiomyopathy, ARVC;arrhythmogenic right ventricular cardiomyopathy, LQTS;long QT syndrome, Brugada;brugada Syndrome, CPVT;catecholaminergic polymorphic ventricular tachycardia, SADS;sudden adult death syndrome, Other;Friedreich’s ataxia, ischemic heart disease, supraventricular tachycardia)[Figure omitted. See PDF]ConclusionsCompared to the general adult Irish population, self reported adherence to the WHO PA Guidelines was 6% lower among the CRY Clinic patient cohort (33% vs. 27%). Additionally, reported resistance exercise levels was lower (30%) than aerobic exercise (72%). This is despite resistance exercise being additionally beneficial for many cardiac conditions. During the period of data collection, access to gyms and group exercise was limited due to pandemic government restrictions that likely effected resistance exercise more than aerobic exercise. In fact, a significant increase in recreational walking during covid restrictions was previously reported. Exercise is often discussed during medical consultation but rarely prescribed. In our cohort only 0.5% of patients received an Ex Rx. The reported barriers to Ex Rx are lack of time, perceived lack of patient engagement, complex co-morbidities and clinician education. Attempts were made in the form of education and resource provision to clinicians to challenge perceived barriers. Ex Rx are important in the CRY Clinic not only for the known benefits of PA but as inappropriate exercise can be harmful for some cardiac conditions. The Ex Rx enabled the benefit of PA to be gained by the safe promotion of appropriate exercise to such patients (figure 2). The introduction of this PA assessment and Ex Rx was a successful call to action to incorporate exercise as medicine to the CRY Clinic. ‘Walking is a (wo)mans best medicine’ (Hippocrates 460BC).

Vascular Response to a Cardiac Rehabilitation Program Adapted for COVID-19

Background: Cardiac Rehabilitation (CR) is a supervised exercise and risk factor modification program for patients with cardiac conditions. Endothelial dysfunction is often present and is associated with worsening cardiac prognosis, and several studies have indicated that standard onsite CR has improved endothelial function in heart disease patients. However, during the COVID-19 pandemic, many CR programs transitioned to a virtual or hybrid model of care to increase safety of CR programs. Objective(s): The objective of this study was to determine vascular function of patients with coronary artery disease (CAD) measured before and after 4 months of outpatient CR using a virtual model of care. Method(s): Virtual CR included 1 virtual group session/week by videoconferencing and hybrid CR included 1 session/week (4 on-site and 12 virtual group sessions) for a total of 16 weeks. CAD patients (6 females, 4 males) mean age 68.1+/-7.5 years rested in a supine position to measure 1) brachial artery flow-mediated dilation (FMD), 2) microvascular function, and 3) augmentation index (AI) using ultrasound sonography (n=8) and an EndoPAT 2000 (n=9). Two patients completed virtual CR and the rest underwent hybrid CR. These measurements were obtained concurrently using an ultrasound transducer at the brachial artery proximal to a blood pressure cuff on the forearm with EndoPAT cuffs on the index fingers during 5-minute intervals of baseline, occlusion, and recovery. FMD results were analyzed using automated Cardiovascular Suite software. AI and Reactive Hyperemia Index (LnRHI) were determined using automatic analysis via the EndoPAT 2000. Anthropometrics, blood pressure, and food intake were recorded at each visit. Patients were advised to refrain from strenuous exercise, alcohol, caffeine, and highly saturated foods at least 12 hours prior to the study appointment. One tailed paired t-tests were conducted between baseline and completion. Result(s): Adherence to CR averaged 10.3+/-3.2 out of 16 sessions. FMD improved from (2.75+/-1.71% to 5.63+/-4.37%, p=0.048) while there was no improvement in AI (14.2+/-18.8 to 13.2+/-19.6, p=0.45) or LnRHI (0.56+/-0.12 to 0.52+/-0.20, p=0.24). Conclusion(s): While there was no improvement in LnRHI or AI after CR, FMD improved in CAD patients after 4 months of adapted CR. Our results indicate that while virtual and hybrid models of CR may not be sufficient for improving microvascular function and aortic stiffness in CAD, there is an improvement of endothelial function. Future studies should examine the effects of adherence, duration and exercise intensity within these alternative models of CR on aortic and microvascular improvements.

The Relationship between Self-Concept and Negative Emotion: A Moderated Mediation Model.

Background: Emotional problems such as depression and anxiety are very serious among college students, especially during the COVID-2019 pandemic. The present study aimed to explore the mediating role of resilience in the relationship between self-concept and negative emotion, and the moderating role of exercise intensity in the direct and indirect effect of self-concept on negative emotion among college students. Methods: A total of 739 Chinese college students aged between 18 and 25 years (M = 20.13; SD = 1.67) were selected to complete the Tennessee Self-Concept Scale (TSCS), the Depression Anxiety Stress Self Rating Scale, the Adolescent Psychological Resilience Scale, and the Physical Exercise Scale (PARS-3) to assess self-concept, negative emotions, psychological resilience, and exercise intensity, respectively. Hayes' PROCESS macro for SPSS was used to test the relationships among these variables. Results: Self-concept was negatively correlated with negative emotions; psychological resilience partially mediated the association between self-concept and negative emotions; exercise intensity moderated the effect of self-concept on negative emotions, and college students with low intensity physical activity would strengthening the association between self-concept and psychological resilience, psychological resilience, and negative emotions. Conclusions: Psychological resilience is a critical mediating mechanism through which self-concept is associated with negative emotions among college students, and exercise intensity plays a role as a moderating variable in the direct and indirect influence of self-concept on negative emotions. Implications for preventing or reducing negative emotions are discussed.

Effects of Yogurt Intake on Cardiovascular Strain during Outdoor Interval Walking Training by Older People in Midsummer: A Randomized Controlled Study.

We examined whether post-exercise yogurt intake reduced cardiovascular strain during outdoor interval walking training (IWT) in older people during midsummer. The IWT is a training regimen repeating slow and fast walking at ~40% and ≥70% peak aerobic capacity, respectively, for 3 min each per set, ≥5 sets per day, and ≥4 days/wk. We randomly divided 28 male and 75 female older people (~73 yr), who had performed IWT ≥12 months, into a carbohydrate group (CHO-G) consuming jelly (45 g CHO, 180 kcal) and a yogurt group (YGT-G) consuming a yogurt drink (9.3 g protein, 39 g CHO, 192 kcal) immediately after daily IWT for 56 days while monitoring exercise intensity and heart rate (HR) with portable devices. We analyzed the results in 39 subjects for the CHO-G and 37 subjects for the YGT-G who performed IWT ≥ 4 days/wk, ≥60 min total fast walking/wk, and ≥4 sets of each walk/day. We found that the mean HR for fast walking decreased significantly from the baseline after the 30th day in the YGT-G (p < 0.03), but not in the CHO-G (p = 1.00). There were no significant differences in training achievements between the groups. Thus, post-exercise yogurt intake might reduce cardiovascular strain during outdoor walking training in older people.

Physical Exercise Ameliorates Anxiety, Depression and Sleep Quality in College Students: Experimental Evidence from Exercise Intensity and Frequency.

BACKGROUND: The main purpose of this study was to investigate the effects of exercise intensity and exercise frequency on anxiety, depression and sleep quality in college students. METHODS: All participants came from a university in northeastern China. All participants were tested for Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and were diagnosed with anxiety disorders. The research subjects were divided into six groups, namely the low-intensity and low-frequency group (group 1), low-intensity and moderate-frequency group (group 2), low-intensity and high-frequency group (group 3), high-intensity and low-frequency group (group 4), and high-intensity and moderate-frequency group (group 5) and high-intensity and high-frequency group (group 6). The duration of each physical exercise for each group was 1 h. Participants' exercise intensity was monitored using Polar H10 HR sensors and the Borg RPE scale. The experiment was carried out for a total of 6 weeks. The researchers conducted pre- and post-test scores on the subjects' anxiety, depression and sleep quality through questionnaires. RESULTS: Exercise intensity improved anxiety and decreased symptoms of depression better than exercise frequency; sleep quality was more closely related to exercise intensity. CONCLUSION: Exercise intensity and exercise frequency have different effects on anxiety, depression and sleep quality improvement, indicating that exercise intensity and exercise frequency have different effects on anxiety, depression and sleep quality of college students.

Does wearing a mask while exercising amid COVID-19 pandemic affect hemodynamic and hematologic function among healthy individuals? Implications of mask modality, sex, and exercise intensity.

OBJECTIVES: We investigated how wearing a mask - and its modality (surgical vs. N95) - affect hemodynamic and hematologic function in males and females across two exercise intensities (submaximal (SUB) and maximal (MAX)). METHODS: 144 individuals participated in the present study and were randomly allocated to three mask groups of 48 (N95, SURGICAL, and NO MASK) with two exercise subgroups for each mask group (MAX, n = 24; SUB, n = 24) for both sexes. Participants in each experimental group (N95SUB, N95MAX; SURSUB, SURMAX; SUB, MAX) were assessed for their hemodynamic and hematologic function at baseline and during recovery after exercise. RESULTS: No significant differences were noted for either hemodynamic or hematologic function at post-exercise as compared to baseline with regard to mask modality (P > 0.05). Heart rate (HR) for maximal intensity were significantly greater at 1 min post-exercise in N95 as compared to SURGICAL (P < 0.05). No differences were noted for hemodynamic and hematologic function with N95 and SURGICAL compared to NOMASK for either intensity (P > 0.05). Females showed significantly greater HR values at 1 min post-exercise in N95 as compared to NO MASK, but no significant differences were noted for hematological function between sexes (P > 0.05). CONCLUSION: Our findings show that wearing a face mask (N95/surgical) while exercising has no detrimental effects on hemodynamic/hematologic function in both males and females, and suggest that wearing a mask, particularly a surgical mask, while exercising during the ongoing pandemic is safe and poses no risk to individual's health. Future studies examining physiological responses to chronic exercise with masks are warranted.