Isometric thumb extension exercise as part of a multimodal intervention for de Quervain's syndrome: A randomised feasibility trial

Introduction: de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Method(s): This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Result(s): Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusion(s): Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.Copyright © The Author(s) 2023.

Effects of training and protein/carbohydrate supplementation by food on strength, body composition and bone metabolism in postmenopausal women

Background: Menopause is associated with impairments of health, e.g. cardiovascular disease, changes in body composition, decrease in bone density. Physical activity and nutrition strategies have been demonstrated to counteract some of these disabilities. Aim of the present study was to analyze the impact of 3 months of strength and endurance training combined with protein/carbohydrate supplementation on strength, body composition and bone metabolism in postmenopausal women. Method(s): 62 postmenopausal women were recruited. Measurements: Body composition by BIA. Strength of leg, chest and handgrip. delta44Ca/42Ca in blood and urine as proxies for bone metabolism, samples were analyzed by mass spectrometry. Participants completed 2/week endurance training (walking) for 60 minutes (60-75% km/h of 4mmol threshold) and a whole-body strength training 1/week for 60 minutes (online). In addition, the intervention group (IG) received 100g of sour milk cheese and 76g of white bread (35.3 g carbohydrate, 36.1 g protein, 3.5 g fat, 321 kcal) after each training. Result(s): Training results in an anabolic effect on bone metabolism, here protein/carbohydrate supplementation does not show additive effects. Training resulted in an increase of leg and hand grip strength. For hand grip strength an additive effect could be demonstrated after protein/carbohydrate supplementation. Both groups increased muscle mass and reduced fat mass, although the results were not significant. Discussion(s): Training was effective, showing an increase in strength. Additive effects of the nutritional intervention could be only observed for hand grip strength. This may be due to a weak compliance of the protein/carbohydrate supplementation by a meal while corona pandemic. Also, because of the endurance parts, the training was not specifically designed to increase strength. Nevertheless, even this mild training has a remarkably strong impact on bone metabolism. Conclusion(s): Even if the effects are faint, the data of this study provide evidence that protein/carbohydrate supplementation, also by food, supports the events of training on strength. Training has a strong impact on bone metabolism in postmenopausal women. The subjects respond very individually to training and nutrition interventions. Training consequentially is to be personalized.Copyright © 2023

Different reversibility of skeletal muscle mass and strength in elderly Japanese women after the first wave of COVID-19

BackgroundRestrictions on outdoor movements due to the coronavirus disease (COVID-19) pandemic have led to a decreased physical activity;this can lead to sarcopenia and frailty in older adults. Our recent study has demonstrated a significant decrease in the trunk muscle mass immediately after the pandemic's first wave (April–May 2020) among Japanese community-dwelling older women. In the present study, we further examined whether muscle mass recovery or deterioration occurs after 1 year of the pandemic's first wave by comparing physical measurements among the following assessment periods: before the first wave, immediately after the first wave, and at 1-year follow-up thereafter.MethodsThis study included 77 women (78.0 ± 5.7 years) who underwent physical measurements for muscle mass, grip strength, one-leg stand-up ability (3 s), and oral motor skills and answered questionnaires on sociality (social network, participation, and support) in the three assessment periods.ResultsThe frequency of going out and the subjective vitality were significantly decreased immediately after the first wave;these recovered at the 1-year follow-up (P < 0.001). When comparing muscular measures, the trunk muscle mass index preferentially decreased immediately after the first wave but recovered significantly at the 1-year follow-up (P < 0.001). Conversely, the appendicular skeletal muscle mass index (ASMI) and grip strength continued to decrease until the 1-year follow-up (P < 0.001 and P = 0.03, respectively). The ability to perform a one-leg stand-up for 3 s and the oral motor skills did not change significantly across the assessment periods. The prevalence of pre-sarcopenia and sarcopenia tended to increase during these periods (P = 0.068). The reduction and subsequent recovery patterns for sociality were similar to those observed for the trunk muscle mass.ConclusionsOur findings demonstrated differences in the reversibility of skeletal muscle mass and strength at 1 year after the first wave of the COVID-19 pandemic: the trunk muscle mass declined acutely and recovered rapidly, whereas the ASMI and grip strength declined continuously. These differences in the skeletal muscle recovery and deterioration might help formulate short-term or long-term strategies for COVID-19-related sarcopenia prevention in community-dwelling older adults.

Effect of Tai Chi versus Aerobic Training on Improving Hand Grip Strength, Fatigue, and Functional Performance in Older Adults Post-COVID-19: a randomized controlled trial

Background: The recent pandemic of COVID-19 has left a wide range of after-effects on the health of older adults. The effects of the pandemic have been particularly felt in the areas of physical strength, fatigue, and functional performance. Material(s) and Method(s): Fifty-four participants were allocated into three groups: Tai Chi (TC) attended 4 sessions of 60-min TC training per week for consecutive 12 weeks, Aerobic Training (AT) attended 4 sessions of 60-min aerobic training per week for 12 weeks, and Control (CON) instructed to maintain a daily routine. Hand grip strength (HGS) and Fatigue Severity Scale (FSS) were used to evaluate the participants. Functional performance outcomes were determined The functional performance outcome was determined by The 30-second Chair Stand Test (CST), The 30-second Arm Curl Test (ACT), The 8-feet Up-and-Go test (TUG), and The 2 min steps. Pre-post comparisons of all outcomes in each group and comparisons between groups were analyzed using the ANOVA test with SPSS software. Result(s): After the intervention, TC and AT groups both experienced significant improvements in HGS, fatigue levels, CST, ACT, TUG, and 2-minute steps compared to baseline (all P < 0.001). The Tai Chi group also experienced significantly improved hand grip strength (p =0.0435, mean difference of-2.5), and ACT (p =0.0235, mean difference of 1) compared to the AT group. Conclusion(s): Tai Chi is an integrated rehabilitation program that had a positive effect on hand grip strength, fatigue levels, and functional performance compared to aerobic training in the elderly post-COVID-19.Copyright © 2023, Codon Publications. All rights reserved.

Transverse myelitis 48 hours after the administration of an mRNA COVID 19 vaccine

Background Vaccinations against SARS-CoV-2 have been a topic of political, social, and medical intrigue since the declaration of the COVID-19 pandemic in early 2020. The vaccine side effects have been relatively mild to date, with few observed systemic effects. Case presentation A 69-year-old previously healthy female presented with symptoms of asymmetric bilateral lower and upper extremity weakness 2 days after vaccination with the Pfizer-BioNTech mRNA vaccine. MRI of the cervical spine revealed a non-compressive myelitis extending from C3-4 to T2-3. Common known causes of transverse myelitis were ruled out by diagnostic techniques. Conclusions Transverse myelitis is a rare autoimmune disorder that has been shown to have a temporal association with vaccination in the past. With a progressively partisan societal view on vaccinations, it is important for clinicians to remain vigilant on documenting potential associations without encouraging fear of causation.Copyright © 2021 The Author(s)

Handgrip Strength Test and Bioelectrical Impedance Analysis in SARS-CoV-2 Patients Admitted to Sub-Intensive Unit.

Hospitalized patients with respiratory failure due to SARS-CoV-2 pneumonia are at increased risk of malnutrition and related mortality. The predictive value of the Mini-Nutritional Assessment short form (MNA-sf®), hand-grip strength (HGS), and bioelectrical impedance analysis (BIA) was determined with respect to in-hospital mortality or endotracheal intubation. The study included 101 patients admitted to a sub-intensive care unit from November 2021 to April 2022. The discriminative capacity of MNA-sf, HGS, and body composition parameters (skeletal mass index and phase angle) was assessed computing the area under the receiver operating characteristic curves (AUC). Analyses were stratified by age groups (<70/70+ years). The MNA-sf alone or in combination with HGS or BIA was not able to reliably predict our outcome. In younger participants, HGS showed a sensitivity of 0.87 and a specificity of 0.54 (AUC: 0.77). In older participants, phase angle (AUC: 0.72) was the best predictor and MNA-sf in combination with HGS had an AUC of 0.66. In our sample, MNA- sf alone, or in combination with HGS and BIA was not useful to predict our outcome in patients with COVID-19 pneumonia. Phase angle and HGS may be useful tools to predict worse outcomes in older and younger patients, respectively.

Respiratory muscle strength in patients post infection by COVID-19

The persistence of symptoms in post-COVID patients, such as dyspnea and fatigue, has been common. Our objective was to determine the prevalence of respiratory and palmar muscles weakness in patients post-COVID-19 infection and compare with those without weakness. Method(s): A prospective study carried out with individuals of post-COVID-19 outpatient clinic of the Pulmonology Department of Hospital Sao Paulo/Brazil. Assessment of maximal respiratory pressures and maximal handgrip strength (HGS) were performed in the first assessment after hospital discharge (60+/-20 days after the onset of symptoms). Individuals with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) lower than 80% of predicted were considered respiratory muscle weakness. Result(s): 269 patients were evaluated, most were male (55%), 55+/-14 years, BMI 30+/-7 Kg/m , average length of stay for hospital 14+/-10 days, of which 138 (51%) were referred to the ICU (11+/-9 days) and 49 (87%) required invasive mechanical ventilation. Inspiratory and expiratory muscle weakness was verified in 85 (32%) and 72 (27%) patients, respectively. Patients with inspiratory muscle weakness had MIP of 67+/-22 vs 110+/-26 cmH2O (p<0.001), MIP 2 %predicted 65+/-13 vs 108+/-18 cmH2O (p<0.001), sustained MIP of 60+/-21 vs 110+/-26 cmH2O (p<0.001), MEP of 73+/-32 vs 104+/-34 cmH2O (p<0.001), MEP%predicted of 72+/-23 vs 94+/-25 cmH2O (p<0.001). The HGS of patients with inspiratory muscle weakness was 17+/-10 vs 22+/-12 KgF (p<0.05). Conclusion(s): After hospital discharge for COVID-19, 32% of patients had inspiratory muscle weakness and 27% had expiratory muscle weakness. Patients with inspiratory muscle weakness had lower maximal HGS when compared to patients without inspiratory muscle weakness.

Inspiratory muscle capacity in Long Covid

Persistent symptoms beyond three months are common following acute infection with Covid 19 and termed Long Covid. There are a broad range of symptoms including breathlessness, fatigue, reduced exercise tolerance, chest pains, sleep disturbance and palpitations. The pathophysiology of Long Covid is poorly understood limiting treatment options. We hypothesised that diaphragm muscle weakness would be common in Long Covid and may in part be responsible for a number of the reported symptoms thereby providing a therapeutic option via inspiratory muscle training. We examined lung function, hand grip strength, Chester step test and symptom scores;mMRC (modified Medical Research Council), HADS (Hospital Anxiety And Depression), SF36 quality of life, Chalder Fatigue, in patients attending the Beacon Hospital Long Covid Clinic. Ethical approval was granted by our institutional review board. 101 patients were aged 40 +/- 14 years (Mean +/- SD). 63% were female. 75% had their acute illness managed at home. mMRC was 0 (16%), 1 (39%), 2 (34%), 3 (9%), 4 (2%). Predicted spirometry was normal however DLCO (diffusing capacity for carbon monoxide) was reduced at 86 +/- 14 % predicted as was MIP (Mean Inspiratory Pressure) at 70 +/- 25 % predicted. DLCO was significantly different when analysed by mMRC scores (ANOVA p<0.005). DLCO was correlated with MIP (R2= 0.22, p<0.0005). We propose implementing inspiratory muscle training as part of the therapeutic response to Long Covid to ascertain the role of diaphragm weakness in the pathophysiology of this syndrome and evaluate its effect on a range of presenting symptoms.

Pulmonary Rehabilitation in Post-COVID-19 Patients Improves Lung Function and Mechanics and Skeletal Muscle, and Immune Response

COVID-19 let sequelae beyond the respiratory system, including in skeletal muscle and in immune response. We evaluated the effects of 12 weeks of pulmonary rehabilitation (PR), 3x/week, constituted by aerobic and resistance training on 28 moderate and severe post-COVID-19 patients. The results demonstrated that PR improved lung function, FVC (p<0.02), FEV1 (p<0.02), FEV1/FVC (p<0.01), MEF25% (p<0.006), MEF50% (p<0.03), and MEF75% (p<0.02). PR improved lung mechanics, respiratory impedance (Z5hz, p<0.03);respiratory reactance (X5Hz, p<0.01), resistance of the whole respiratory systems (R5Hz, p<0.03), central airway resistance (RCentral, p<0.03), and peripheral airway resistance (RPeripheral, p<0.02). PR improved peripheral muscle strength, increasing right (p<0.02) and left (p<0.01) hand grip strength and respiratory muscle strength, increasing maximum inspiratory (p<0.02) and expiratory (p<0.03) pressure. Of note, PR reduced pulmonary inflammation (breath condensate), reducing the levels of pro-inflammatory cytokine IL-1beta (p<0.0001) and IL-6 (p<0.0001), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0004) and IL-10 (p<0.003), beyond to increase the levels of IFN-gamma (p<0.0002) and IFN-beta (p<0.008). PR reduced the serum levels of pro-inflammatory IL-1beta (p<0.006) and IL-6 (p<0.01), while increased the levels of anti-inflammatory cytokine IL-1RA (p<0.0001) and IL-10 (p<0.0001), increasing the levels of IFN-gamma (p<0.02) and IFN-beta (p<0.001). PR reveals to be beneficial for post-COVID-19 patients, mitigating the sequelae observed in the respiratory system, skeletal muscle and in the immune response.

The effect of pulmonary rehabilitation on respiratory and peripheral muscle weakness following SARS-CoV-2 infection: an interim analysis

Background: COVID-19 ICU patients present respiratory and peripheral muscle weakness both during hospitalisation and following discharge. However, few studies have evaluated muscle strength in non-ICU hospitalised patients. Aim(s): To report the incidence of muscle weakness in non-ICU hospitalised patients and investigate the effect of pulmonary rehabilitation (PR) on respiratory and peripheral muscle strength. Method(s): Maximum static inspiratory (MIP) and expiratory (MEP) muscle pressures, quadriceps muscle force (QF), and handgrip strength were assessed in 21 patients (age: 56+/-12 yrs.) previously hospitalised with COVID-19, 94+/-32 days following discharge. Fifteen out of 21 patients were re-assessed three months later (10 following a PR program and 5 who declined PR and recovered at home (UC)). Result(s): 12/21 patients (57%) had reduced MIP and 18/21 patients (86%) reduced MEP (both <80% pred) (Wilson et al., Thorax 1984;39:535-538). Eleven patients (52%) had reduced QF and handgrip strength (both <80% pred). Data from the 3-month follow up period are presented in table 1. Conclusion(s): A number of patients hospitalised with COVID-19 presented with respiratory and peripheral muscle weakness 3 months following discharge. PR programme improved respiratory and peripheral muscle strength in these patients.

Poor nutritional status and dynapenia are highly prevalent in post-acute COVID-19

Malnutrition estimates range between 5 and 69% in acute Coronavirus disease 2019 (COVID-19) patients. With respect to body composition (BC) and muscle function, low values of phase angle (PhA) and handgrip strength (HGS) have been related to poor disease outcomes. Little evidence is available in post-acute patients. We aimed to combine the evaluation of nutritional status, BC, and muscle strength in a real-life cross-sectional cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. The study population included 144 patients (M=95;mean age 64.8yrs), of which 37% bedridden (M=60%). Nutritional status was evaluated with the Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT) scores. Fat-free mass (FFM), skeletal muscle (SM), and raw variables, i.e. PhA, were estimated with bioelectrical impedance analysis. HGS was measured with a digital handle dynamometer for both dominant and non-dominant body sides. Dynapenia was identified according to the 2019 EWGSOP criteria. According to MNA, 18% of patients were malnourished and 62% at risk of malnutrition. As for CONUT, 21% of patients had moderate-severe malnutrition, while 58%light malnutrition. Overall, malnutrition was highly prevalent in older patients with more comorbidities. Marked abnormalities of PhAand HGSwere more frequent in bedridden or malnourished patients, and when FFM or SM were low. Dynapenic patients were 65% males and 47% females. Malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients. Future studies will help to tailor screening algorithms for full nutritional status assessment to appropriate care processes and rehabilitation strategies.

One-year physical recovery in patients admitted to ICU and ward for COVID-19

Data are emerging on persistent symptoms 12 months after hospitalization for COVID-19. However, objective and longitudinal physical recovery comparing patients admitted to ICU and ward are lacking. To compare recovery in aerobic capacity and muscle strength between patients admitted to ICU and ward for COVID-19 up to 1-year follow-up. In this multicenter prospective cohort study we evaluated aerobic capacity (6-minute walk distance [6MWD]) and muscle strength (max handgrip strength [HGS]) at 3, 6, 12 months after hospital discharge. Physical recovery was assessed using absolute and relative outcomes (% of norm values). 582 patients (>=18 years) were included: 237 (41%) in ICU (age 59+/-11 y, 76% male;length of stay (LOS) ICU 16 [9- 30] days, LOS hospital 30 [18-46] days) and 345 (59%) in ward (age 60+/-11 y, 64% male, LOS hospital 6 [4-11] days). At 3 months, ICU patients had more impairment (84% of norm) in HGS than ward patients (95% of norm) (p<0.001), but not in 6MWD (ICU 85.6% of norm, ward 87.7% of norm;p=0.5). ICU patients showed more improvement in HGS and 6MWD (p<=0.01) (Figure) and % of norm in HGS and 6MWD did not differ from ward patients at 12 months. Overall, patients reached 91% of norm 6MWD and 107% of norm HGS at 12 months. Physical function improved well after hospitalization for COVID-19. ICU patients started off worse, needed time to catch up with less severe ward patients, but reached equal levels at 12 months.

Pulmonary function, muscular strength and quality of life according to mechanical ventilation use in post-Covid patients

Introduction: Mechanical ventilation (MV) is a known risk to impact in respiratory and functional capacity postCOVID-19 infection. Objective(s): Assess pulmonary function, muscular strength and quality of life in post-COVID-19 patients submitted or not to MV. Method(s): During March of 2020 and July 2021 we had 983 hospitalized COVID-19 patients and 527 patients were discharged and invited to be followed at the multidisciplinary assistance. From the total, 116 patients [57% male, 59(52-67) years] were evaluated 60 days after first symptoms appearance through pulmonary function testing, manovacuometry, handgrip test and Saint George's Respiratory Questionnaire (SGRQ). There were no vaccinated subjects. Result(s): 34% of the patients needed intensive care (n=39), of which, 51% needed MV (n=20). MV group showed statistically significant weaker handgrip strength [27(18-35) kgf vs 35(26-45) kgf;p=0,025] and maximum inspiratory pressure predicted percentile reduction (86+/-23,5% vs 101+/-27,6%;p=0,043) when compared to non-MV group. We did not observe SGRQ differences between the groups. However, females showed statistically significant higher impact in quality of life in all SGRQ domains compared to males. There were no differences in pulmonary function. Conclusion(s): MV submitted patients presented worsened respiratory and peripheral muscular strengths without difference in pulmonary function and quality of life. Women showed higher impact in quality of life regardless of MV use.

Short-term impact of COVID-19 on health-related physical fitness in hospitalized and home-treated patients

Assessment of health-related physical fitness (PF) and body composition (BC) may yield relevant information on body function in patients who have been affected by Coronavirus disease-2019 (COVID-19). Aim of our study was to evaluate the short-term effects of COVID-19 on physical fitness in a real-life cohort of outpatients including hospitalized and home-treated patients. Sixty-four patients (M=36;mean age 56+/-13.5 yrs) previously affected by COVID-19 (25 hospitalized vs. 39 hometreated) in the 3-6 months preceding the study measurements were enrolled. PF was evaluated with the following tests: handgrip strength (HGS), gait speed (GAIT), sit-to-stand (STS), timed up and go (TUG) and Short physical performance battery (SPPB). Phase angle (PhA) was measured by bioelectrical impedance analysis (BIA) as a proxy marker of fat-free mass composition in terms of body cell mass and cell integrity. Poor PF performance was observed in 38% of subjects for HGS, 55% for GAIT, 30% for STS, 38% for TUG, and 70% for SPPB, while low values of PA were observed in 42% of the study sample in comparison with international cut-offs. The presence of 3-5 impaired values out of five was observed in 38% of patients. All PF tests (and even more the number of abnormal PF tests) consistently correlated with PhA. No differences were reported between hospitalized and home-treated patients. In the short-run, COVID-19 causes a worsening of physical fitness regardless of baseline disease severity. More research is required to systematically measure the extent of functional impairments in COVID-19 and to address whether and how rehabilitation can promote post-infection recovery.

Association between Handgrip Strength, Skinfold Thickness, and Trunk Strength among University Students.

OBJECTIVES: The main goal was to explore the relationship between hand grip strength (HGS), the thickness of the skinfold at multiple sites, and the trunk flexor (TF) and extensor (TE) muscle strength among healthy participants. METHODS: We employed a cross-sectional design and randomly recruited 40 participants. Ultimately, only 39 participants were included. First, measurements for demographic and anthropometric variables were carried out. After that, the evaluation of hand grip strength and skinfold was performed. DATA ANALYSIS: Descriptive statistics were used to explore the amount of interaction between the smoking and nonsmoking groups, and a repeated measures analysis of variance was employed. Furthermore, associations between dependent and independent variables were discovered through a multiple linear regression model. RESULTS: The participants had a mean age of 21.59 ± 1.19 years. The results of the repeated measures analysis of variance validated an acceptable interaction between the trunk and hand grip strength at a significance level of p < 0.01, further emphasized by their moderate association (p < 0.05). Multiple regressions between TE, TF, the independent variables T score, height, and age were also significant (p < 0.05). CONCLUSIONS: The trunk muscle strength can be used as a health indicator for comprehensive evaluation. The present study also found a moderate relationship between hand grip strength, trunk strength, and T score.

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.

Low muscle strength and low phase angle predicts greater risk to mortality than severity scales (APACHE, SOFA, and CURB-65) in adults hospitalized for SARS-CoV-2 pneumonia.

Introduction: The acute physiology and chronic health evaluation (APACHE), sepsis-related organ failure assessment (SOFA), score for pneumonia severity (CURB-65) scales, a low phase angle (PA) and low muscle strength (MS) have demonstrated their prognostic risk for mortality in hospitalized adults. However, no study has compared the prognostic risk between these scales and changes in body composition in a single study in adults with SARS-CoV-2 pneumonia. The great inflammation and complications that this disease presents promotes immobility and altered nutritional status, therefore a low PA and low MS could have a higher prognostic risk for mortality than the scales. The aim of the present study was to evaluate the prognostic risk for mortality of PA, MS, APACHE, SOFA, and CURB-65 in adults hospitalized with SARS-CoV-2 pneumonia. Methodology: This was a longitudinal study that included n = 104 SARS-CoV-2-positive adults hospitalized at General Hospital Penjamo, Guanajuato, Mexico, the PA was assessed using bioelectrical impedance and MS was measured with manual dynamometry. The following disease severity scales were applied as well: CURB-65, APACHE, and SOFA. Other variables analyzed were: sex, age, CO-RADS index, fat mass index, body mass index (BMI), and appendicular muscle mass index. A descriptive analysis of the study variables and a comparison between the group that did not survive and survived were performed, as well as a Cox regression to assess the predictive risk to mortality. Results: Mean age was 62.79 ± 15.02 years (31-96). Comparative results showed a mean PA of 5.43 ± 1.53 in the group that survived vs. 4.81 ± 1.72 in the group that died, p = 0.030. The mean MS was 16.61 ± 10.39 kg vs. 9.33 ± 9.82 in the group that died, p = 0.001. The cut-off points for low PA was determined at 3.66° and ≤ 5.0 kg/force for low grip strength. In the Cox multiple regression, a low PA [heart rate (HR) = 2.571 0.726, 95% CI = 1.217-5.430] and a low MS (HR = 4.519, 95% CI = 1.992-10.252) were associated with mortality. Conclusion: Phase angle and MS were higher risk predictors of mortality than APACHE, SOFA, and CURB-65 in patients hospitalized for COVID-19. It is important to include the assessment of these indicators in patients positive for SARS-CoV-2 and to be able to implement interventions to improve them.

Correlation Between Respiratory Muscles Power, Hand Grip Strength and Their Impact on Quality of Life in Post COVID-19 Patients

Background:After being released from the hospital, COVID-19 cases frequently report experiencing tiredness, dyspnea, muscle weakness, and mental agony. Method(s): The study involved 100 participants (both sexes, 30 to 50 years old) who had been COVID-19 for three to six months ago. A respiratory pressure meter was used to measure the highest possible inspiratory and expiratory pressures. A hand dynamometer was used to measure hand grip strength, while the Medical Outcomes Study Questionnaire Short Form 36 Health Survey was used to measure the quality of life (SF-36). Result(s): The results of Pearson correlation coefficients in post-Covid-19 cases showed a strong correlation between respiratory muscle strength and hand grip muscles. Additionally, respiratory muscle strength and hand grip strength had a significant impact on the quality of life of post-Covid-19 cases. (p <0.05). Conclusion(s): There was a correlation between the gripping power of the hands and the respiratory muscle strength in individuals who had undergone COVID-19 that in turn had effect on quality of life. This might aid in the efficient recovery of these patients. Copyright © 2022, Anka Publishers. All rights reserved.

A Booster Dose of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Induced C7-C8 Radiculitis Leading to Hand Dysfunction: A Case Report

Case Diagnosis: A 71-year-old female developed C7-C8 radiculitis with left hand weakness 4 days after receiving her booster dose of SARS-CoV-2 vaccine. Case Description or Program Description: Patient with a significant past medical history of cervical fusion and bilateral carpal tunnel releases over 20 years ago presented to outpatient office because of decreased hand grip strength 4 days after receiving her booster dose of Pfizer-BioNTech SARS-CoV-2 vaccine. Her left hand weakness was spontaneous in onset, making her unable to flex her index finger and type. No pain or paresthesia. No trauma, swelling, color or temperature change in her left hand. Nerve conduction study and electromyography performed 19 days after the onset of her symptoms revealed acute greater than chronic changes mainly in distal muscles innervated by C7-C8 nerve roots, compatible with left C7-8 radiculopathy. MRI findings were chronic and compatible with her history of cervical fusion. Her clinical presentation was thought to be an inflammatory rather than mechanical etiology associated with the booster. Patient was referred to outpatient occupational therapy to help her restore hand function. Setting(s): Outpatient office of acute rehabilitation hospital Assessment/Results: Patient underwent occupational therapy and reported mild improvement in hand strength and function after 3 months of therapy. Discussion (relevance): The clinical course of this patient suggested an association between her symptoms and the booster dose of SARS-Cov-2 vaccine. It is possible that some component of the booster might have triggered an immune response and cross-reacted to the peripheral nerve system, leading to acute neuritis and the weakness of her hand. Conclusion(s): Neurologic complications after SARSCov- 2 vaccination is usually mild and self-limiting. We present a rare case of acute radiculitis that was associated with SARS-Cov-2 vaccination with residual impairment in function. Although the causality cannot be confirmed due to the lack of a biological marker, this case may help guide further research into a potential pathogenic mechanism.

Implementation of a Nationwide Online Exercise Program in Hemodialysis Patients

Background: Physical inactivity of HD patients was aggravated during the COVID-19 pandemic due to the imposed lockdown and suspension of ongoing intradialytic exercise program (IDE). To address this, we have developed an online exercise program (OLEP). The aim of this study was to analyze its implementation over a 12-weeks period. Method(s): Implementation study based on retrospective analysis using the REAIM framework (reach, effectiveness, adoption, implementation, maintenance). OLEP was proposed to 24 HD units previously offering IDE and included live online exercise sessions (3 times/week) led by 2 exercise physiologists via Zoom. For each RE-AIM dimension specific implementation outcomes were adapted to OLEP. Effectiveness measures included safety (adverse events during exercise sessions) and in-clinic physical function tests (sit-to-stand 5 and 30, 8-foot up and go (8UG), handgrip strength and single leg stance) performed at baseline and 12 weeks in a group of OLEP participants and a group of patients who refused to participate. Result(s): OLEP was adopted by 16 units (66.7%). Among 2063 patients of these units, 313 (15.2%) were eligible. Of those, 84 accepted to participate in OLEP (4.1% reach of all patients). Compared to refusals, OLEP participants had higher female proportion (p=0.009), higher education level (p<0.001), lower lean tissue index and handgrip strength (both p<0.001), and completed less steps/day (p=0.008). Maintenance in OLEP over the 12 weeks was 59.5%, i.e., 40.5% drop-out - of which 65% were voluntary. Implementation fidelity (patient's adherence to exercise sessions) was 73.1+/-18.8%, and implementation dose was 2.2+/-0.6 exercise sessions/week. Effectiveness: OLEP participants improved performance in all physical function measures (p<0.05), except in 8UG (p=0.677), whilst refusals did not (p>0.05);no severe adverse events were reported. Conclusion(s): Our data suggests that an OLEP is realistic, safe and may improve physical function. Therefore, its applicability may subsist beyond the pandemic and be used to complement IDE. However, strategies to increase proficiency to use mobile health technology may be needed to reach more patients.