Comparing the Effectiveness of Mindfulness and Aerobic Exercise on Psychological Factors and Sleep Quality Following Recovery from COVID-19.

Background and purpose: The COVID-19 pandemic have led to some psychological disorders and sleep problems that should be taken into account after recovery. After recovering from COVID-19 people are at risk of sleep disorders, depression, and low quality of life and there is paucity of information about this issue. The present study aimed to compare the effectiveness of mindfulness and aerobic exercise on depressive symptoms, perceived stress, and sleep quality in recovered COVID-19 patients. Material(s) and Method(s): An intervention field research was performed in 60 male and female patients (mean age: 39.52+/-5.82) recovered from COVID-19 in Kermanshah, Iran. Participants were randomly divided into four groups (n=15): 1) attending mindfulness-based stress reduction (MBSR) program, 2) aerobic exercise, 3) combination of MBSR and aerobic exercise, and 4) control group. The study was carried out at four stages: pretest, interventions, post-test, and follow-up test. Dependent variables included depressive symptoms, perceived stress, and sleep quality. Bonferroni Post hoc test in 4*3 mixed ANOVA was used for data analysis. Result(s): In this study, depression and perceived stress reduced in all experimental groups compared to the control group (P= 0.001). Also, sleep quality improved in these groups compared to the control group (P= 0.001). Post hoc tests showed the superiority of combination of MBSR and aerobic exercise compared to other interventions. Conclusion(s): According to current study, combination of MBSR and physical activity shows to be more helpful than mindfulness training and physical activity alone in improving psychological problems and sleep quality after recovering from COVID-19.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Frail Scale as Predictor of 30-Day Postoperative Outcomes in Geriatric Surgical Patients at a Tertiary Hospital in the Philippines from June 2020 to June 2021

Introduction: The geriatric population is a growing subset of surgical patients. Specialized surgical risk management is important since physiologic changes are only loosely associated with age. Searching for better risk assessment tools, we come across the 5-point FRAIL scale, a validated measure of weakness and physiologic malfunction resulting to vulnerability to stressors like surgery. Method(s): Our objective was to assess the effectiveness of FRAIL scale in predicting 30-day complications in geriatric surgical patients. We conducted this research at a tertiary hospital in the Philippines from June 2020 to June 2021. Patients were classified preoperatively as frail or robust, and they were monitored 30 days post-surgery for adverse outcomes. Result(s): Out of 100 patients, fifty-seven were frail. Postoperatively, 20% had complications, while 18% expired, with 76% of all adverse outcomes belonging to frail group. FRAIL scale had a significantly better predictive value as compared with Charlson comorbidity index and ACS surgical risk calculator in cases of mortality, but there was no significant difference in predicting morbidity for the three assessment tools. The increase in adverse outcomes compared with previous years was attributed to (1) the proportion of colorectal procedures, and (2) patients were probably in a more advanced stage of illness due to the delays in treatment caused by the COVID-19 pandemic. Conclusion(s): In conclusion, FRAIL scale is an easy-to-use and effective risk assessment tool for geriatric surgical patients. Since most frail patients admit of weakness, resistance training and aerobic exercises may be an appropriate strategy to improve surgical outcomes.

Comparing the Effectiveness of Mindfulness and Aerobic Exercise on Psychological Factors and Sleep Quality Following Recovery from COVID-19

Background and purpose: The COVID-19 pandemic have led to some psychological disorders and sleep problems that should be taken into account after recovery. After recovering from COVID-19 people are at risk of sleep disorders, depression, and low quality of life and there is paucity of information about this issue. The present study aimed to compare the effectiveness of mindfulness and aerobic exercise on depressive symptoms, perceived stress, and sleep quality in recovered COVID-19 patients. Material(s) and Method(s): An intervention field research was performed in 60 male and female patients (mean age: 39.52+/-5.82) recovered from COVID-19 in Kermanshah, Iran. Participants were randomly divided into four groups (n=15): 1) attending mindfulness-based stress reduction (MBSR) program, 2) aerobic exercise, 3) combination of MBSR and aerobic exercise, and 4) control group. The study was carried out at four stages: pretest, interventions, post-test, and follow-up test. Dependent variables included depressive symptoms, perceived stress, and sleep quality. Bonferroni Post hoc test in 4*3 mixed ANOVA was used for data analysis. Result(s): In this study, depression and perceived stress reduced in all experimental groups compared to the control group (P= 0.001). Also, sleep quality improved in these groups compared to the control group (P= 0.001). Post hoc tests showed the superiority of combination of MBSR and aerobic exercise compared to other interventions. Conclusion(s): According to current study, combination of MBSR and physical activity shows to be more helpful than mindfulness training and physical activity alone in improving psychological problems and sleep quality after recovering from COVID-19.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Effect of telehealth-based versus in-person nutritional and exercise intervention on type II diabetes mellitus improvement and efficiency of human resources utilization in patients with obesity

Aims: Telehealth became a patient necessity during the COVID pandemic and evolved into a patient preference in the post-COVID era. This study compared the % total body weight loss (%TBWL), HbA1c reduction, and resource utilization among patients with obesity and diabetes who participated in lifestyle interventions with or without telehealth. Method(s): A total of 150 patients with obesity and diabetes who were followed every 4-6 weeks either in-person (n = 83) or via telehealth (n = 67), were included. All patients were provided with an individualized nutritional plan that included a weight-based daily protein intake from protein supplements and food, an activity/sleep schedule-based meal times, and an aerobic exercise goal of a 2000-calorie burn/week, customized to patient's preferences, physical abilities, and comorbidities. The goal was to lose 10%TBWL. Telehealth-based follow-up required transmission via texting of weekly body composition measurements and any blood glucose levels below 100 mg/dl for medication adjustments. Weight, BMI, %TBWL, HbA1c (%), and medication effect score (MES) were compared. Patient no-show rates, number of visits, program duration, and drop-out rate were used to assess resource utilization based on cumulative staff and provider time spent (CSPTS), provider lost time (PLT) and patient spent time (PST). Result(s): Mean age was 47.2 +/- 10.6 years and 74.6% were women. Mean Body Mass Index (BMI) decreased from 44.1 +/- 7.7-39.7 +/- 6.7 kg/m2 (p < 0.0001). Mean program duration was 189.4 +/- 169.3 days. An HbA1c% unit decline of 1.3 +/- 1.5 was achieved with a 10.1 +/- 5.1%TBWL. Diabetes was cured in 16% (24/150) of patients. %TBWL was similar in regards to telehealth or in-person appointments (10.6% +/- 5.1 vs. 9.6% +/- 4.9, p = 0.14). Age, initial BMI, MES, %TBWL, and baseline HbA1c had a significant independent effect on HbA1c reduction (p < 0.0001). Program duration was longer for in-person follow-up (213.8 +/- 194 vs. 159.3 +/- 127, p = 0.019). The mean annual telehealth and in-person no-show rates were 2.7% and 11.2%, respectively (p < 0.0001). Mean number of visits (5.7 +/- 3.0 vs. 8.6 +/- 5.1) and drop-out rates (16.49% vs. 25.83%) were lower in telehealth group (p < 0.0001). The CSPTS (440.4 +/- 267.5 min vs. 200.6 +/- 110.8 min), PLT (28.9 +/- 17.5 min vs. 3.1 +/- 1.6 min), and PST (1033 +/- 628 min vs. 113.7 +/- 61.4 min) were significantly longer (p < 0.0001) for the in-person group. Conclusion(s): Telehealth offered comparable %TBWL and HbA1c decline as in-person follow-up, but with a shorter follow-up, fewer appointments, and no-shows. If improved resource utilization is validated by other studies, telehealth should become the standard of care for the management of obesity and diabetes.Copyright © 2023 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.

Comparing the Effects of Aerobic Exercise and Yoga on Stress Levels in College Students

Purpose of Study: College for many is a time of transition. This transition from adolescence to young adulthood can be very stressful. During the COVID-19 pandemic, rates of suicide, depression and anxiety increased in adolescents and young adults. Recently, Wang and colleagues (2020) found that among 2,031 students in a large US university, 48% reported having moderate-to-severe depression, 38% had moderate-to-severe anxiety, and 18% had thoughts of suicide. Effective strategies to help emerging adults cope with stress is critically needed to decrease these alarming data. The primary aim of this study was to compare the effects of aerobic exercise and yoga on college students' perceived levels of stress. A secondary aim of the study was to examine whether athlete status would moderate the effectiveness of either intervention. Methods Used: A sample of 55 college students were recruited via email during the spring of 2022. Students were randomly assigned to complete a single, 20-minute session of either yoga or aerobic exercise. Participant's current and chronic stress levels were recorded both before and after exercise. Chronic stress was measured using Cohen's Perceived Stress Scale and current stress was measured using a modified version of the same scale. To support the second research aim, participants were asked to report if they were a member of a college-affiliated athletic team during the 2021-2022 academic year. Demographic characteristics including age, gender, and ethnicity were also collected. Summary of Results: A 2 (Time) X 2 (Condition) x 2 (Athlete Status) mixed factorial ANOVA was conducted. Results indicated that both aerobic exercise and yoga led to a significant decrease in chronic stress (p=.03), although there were no meaningful differences between the two conditions (p=.075). This pattern of results held for current stress as well, with both groups experiencing an equivalent decrease in current stress (p<.001). Athlete-status did not significantly predict changes in current or chronic stress, nor did it moderate the efficacy of either intervention. Conclusion(s): Taken together, these findings indicate that a small bout of exercise, regardless of type, can help decrease reported stress for college students. They also provide preliminary evidence about the efficacy of exercise as stress reduction for college athletes. Our findings provide further support for using exercise as a practical strategy for coping with stress. (Table Presented).

2023 Western Medical Research Conference

The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.

Physical Therapy Management of Postacute Sequelae of COVID-19 in Outpatient Settings: A Scoping Review

Purpose:The devasting effects of the coronavirus disease 2019 (COVID-19) pandemic have warranted the rapid development of evidence surrounding the physical therapy (PT) management of the disease within inpatient settings. However, the medical community is still working to define the long-term effects of COVID-19, referred to as Postacute Sequalae of SARS-CoV-2 (PASC), and ways for physical therapists to manage them in outpatient settings. The primary objective of this review was to summarize the available evidence related to the PT management of PASC in outpatient settings. Method(s):A systematic search in PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane CENTRAL, Academic Search Complete, and MedLine yielded systematic and scoping reviews and randomized controlled trials, among others. Data extraction was performed independently by 2 reviewers with 8 studies included. Result(s):Only 3 publications were specific to the outpatient setting area, with 5 more studies that focused on outpatient practice as part of a multisetting study, or the postacute setting. Although the limited number and quality of publications creates challenges applying the interventions provided across a population, each were specific to PASC. Conclusion(s):This review supports the need for further research focused on the PT management of patients who are experiencing PASC in outpatient settings.Copyright © Cardiovascular and Pulmonary Section, APTA.

Physical activity and coronavirus disease 2019 (COVID-19): specific recommendations for home-based physical training

The novel coronavirus disease 2019 (COVID-19) seems to be having a major impact on physical activity behaviours globally. The pandemic has forced many people around the world to stay at home and self-isolate for a period of time. WHO recommends 60 min/day of moderate-to-vigorous physical activity for 6–17-yr-olds, and 75 min/wk of vigorous or 150 min/wk of moderate physical activity for adults and elderly, including 3 and 2 days/wk, respectively, with muscle and bone strengthening. Practical recommendations for staying active at home, with aerobic exercise training on a bike or rowing ergometer, bodyweight training, dance and active video gaming, can aid to counteract the detrimental physical and mental side-effects of the COVID-19 protective lifestyle regulations. This commentary provides useful information on home-based physical activity for sedentary people across the lifespan, including children and adolescence, that can be undertaken during the present pandemic or other outbreaks of infectious disease.

Moderate Aerobic Exercise Reduces the Detrimental Effects of Hypoxia on Cardiac Autonomic Control in Healthy Volunteers.

Physical inactivity increases cardiometabolic risk through a variety of mechanisms, among which alterations of immunological, metabolic, and autonomic control systems may play a pivotal role. Physical inactivity is frequently associated with other factors that may further worsen prognosis. The association between physical inactivity and hypoxia is particularly interesting and characterizes several conditions-whether physiological (e.g., residing or trekking at high altitude and space flights) or pathological (e.g., chronic cardiopulmonary diseases and COVID-19). In this randomized intervention study, we investigated the combined effects of physical inactivity and hypoxia on autonomic control in eleven healthy and physically active male volunteers, both at baseline (ambulatory) conditions and, in a randomized order, hypoxic ambulatory, hypoxic bedrest, and normoxic bedrest (i.e., a simple experimental model of physical inactivity). Autoregressive spectral analysis of cardiovascular variabilities was employed to assess cardiac autonomic control. Notably, we found hypoxia to be associated with an impairment of cardiac autonomic control, especially when combined with bedrest. In particular, we observed an impairment of indices of baroreflex control, a reduction in the marker of prevalent vagal control to the SA node, and an increase in the marker of sympathetic control to vasculature.

Impaired Neuromuscular Efficiency and Symptom-Limited Aerobic Exercise Capacity 4 Weeks After Recovery From COVID-19 Appear to Be Associated With Disease Severity at Onset.

OBJECTIVE: The objectives of this study were to evaluate neuromuscular recruitment and efficiency in participants who recovered from COVID-19 and assess the association between neuromuscular efficiency and symptom-limited aerobic exercise capacity. METHODS: Participants who recovered from mild (n = 31) and severe (n = 17) COVID-19 were evaluated and compared with a reference group (n = 15). Participants underwent symptom-limited ergometer exercise testing with simultaneous electromyography evaluation after a 4-week recovery period. Activation of muscle fiber types IIa and IIb and neuromuscular efficiency (watts/percentage of root-mean-square obtained at the maximum effort) were determined from electromyography of the right vastus lateralis. RESULTS: Participants who had recovered from severe COVID-19 had lower power output and higher neuromuscular activity than the reference group and those who had recovered from mild COVID-19. Type IIa and IIb fibers were activated at a lower power output in participants who had recovered from severe COVID-19 than in the reference group and those who had recovered from mild COVID-19, with large effect sizes (0.40 for type IIa and 0.48 for type IIb). Neuromuscular efficiency was lower in participants who had recovered from severe COVID-19 than in the reference group and those who had recovered from mild COVID-19, with a large effect size (0.45). Neuromuscular efficiency showed a correlation with symptom-limited aerobic exercise capacity (r = 0.83). No differences were observed between participants who had recovered from mild COVID-19 and the reference group for any variables. CONCLUSION: This physiological observational study supports the notion that more severe COVID-19 symptoms at disease onset appear to correspondingly impair neuromuscular efficiency in survivors over a short time frame of 4 weeks after recovery, potentially contributing to reduced cardiorespiratory capacity. Further studies are needed to replicate and extend these findings with respect to their clinical implications for assessment/evaluation and interventions. IMPACT: After 4 weeks of recovery, neuromuscular impairment is particularly evident in severe cases; this problem may contribute to reduced cardiopulmonary exercise capacity.

Feasibility, Safety and Efficacy of a Combined Supervised Physical Exercise and Nutritional Program in a Selected Population of Luminal Metastatic Breast Cancer Patients: Oncare01 Pilot Study

Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.

The effects of COVID-19 infection on respiratory muscle strength and trunk muscle endurance in healthy individuals

The study aims to evaluate the relationship between the endurance of the trunk muscles and the strength of the respiratory muscles among Novel Coronavirus Disease (COVID-19) survivors. The study included 20 participants divided into Experimental Group (10 COVID-19 survivors) and Control Group (10 healthy volunteers). Respiratory muscle strength, functional exercise capacity, core endurance, quality of life were assessed with The Micro Medikal Micro Respiratory Pressure Meter, Six-Minute Walking Test, McGill Core Endurance Test, and Short Form-36, respectively. Experimental Group had statistically lower scores in respiratory muscle strength, functional exercise capacity, core endurance and quality of life (p<0.05). In the light of current study, the physiotherapy and rehabilitation programs may include respiratory muscle training, aerobic exercises, and core training for COVID-19 survivors.

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.

Personalized individual-based exercise prescriptions are effective in treating depressive symptoms of college students during the COVID-19: A randomized controlled trial in China.

Background: The COVID-19 pandemic has seriously increased depression prevalence among the public, including Chinese college students. However, many exercise cannot be performed as usual under the stay-at-home order. This study was a 12-week three-arm randomized controlled trial using the intention-to-treat principle, aiming to explore and compare the feasibility and effect of individual-based personalized aerobic-exercise and resistance-training prescriptions on depressive symptoms in college students, and conclude with some recommendations for individual-based exercise prescriptions. Methods: Eighty-six college students with depressive symptoms were randomized into aerobic-exercise (AE), resistance-training (RT), and wait-list control (WLC) groups. Participants in two experimental groups received 12-week personalized AE and RT prescriptions on their individual situations, respectively. No intervention was implemented on participants in the WLC group. Depressive symptoms and physical activity (PA) were measured by Zung Self-Rating Depression Scale (SDS) and International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. All data were collected at the baseline, 4, 8, and 12 weeks, and 4-week post-intervention. Results: At 12 weeks, 72.09% of depressive participants improved to "normal." Participants exhibited a statistical reduction in SDS in all 3 groups (p < 0.05) at 12 weeks compared to baseline. Follow-up assessments showed no significant increase in SDS at 4-week post-intervention compared to 12 weeks (p > 0.05). The independent t-test revealed significantly lower SDS in AE and RT group than in WLC group (p AE < 0.001 and p RT < 0.05) at 4, 8, and 12 weeks, and 4-week post-intervention. Furthermore, the PA of participants (including total PA and intensities) in both experimental groups represented a significant improvement at 4-week post-intervention compared to baseline (p < 0.05), while no differences were observed in the PA of participants in the WLC group (p > 0.05). Conclusion: Personalized exercise prescriptions have good feasibility as they can increase adherence to intervention and reduce serious adverse events. Besides, individual-based personalized aerobic-exercise and resistance-training prescriptions result in a similar effect in relieving depressive symptoms and improving physical activity in college students. The individual-based exercise programs performed in 45- to 60- min with progressive moderate-to-vigorous intensity, 3 times/week for at least 12 weeks, may reduce depressive symptoms in college students during the COVID-19.

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.

Functional Improvements Observed in Long-Covid Patients Following Participation in Pulmonary Rehabilitation

PURPOSE/HYPOTHESIS: Some patients with COVID-19 have physical impairments that last well beyond the acute infection, termed long-COVID. An increasing number of patients experiencing ongoing symptoms are being referred to outpatient Pulmonary Rehabilitation (PR) with a growing understanding of their key limitations and the benefits of PR. Patients with long- COVID often present with significant inspiratory muscle weakness and functional limitations even months after infection and benefit from PR and IMT. The purpose of this study was to examine the impact of PR on inspiratory muscle performance (IMP) and several functional performance measures (FPM), as well as COPD Assessment Tool (CAT), quality of life (QOL) and depression (D) screening. NUMBER OF SUBJECTS: Eight patients (3 male and 5 female, age 51 +/- 15, BMI 32 +/- 6) diagnosed with long- COVID-19. MATERIALS AND METHODS: Twenty-two patients with long-COVID entered PR but only 8 patients successfully completed the program. The PR program included aerobic exercise, strength training, IMT, and education. Of the 22 patients who started PR, 64% dropped out due to a variety of reasons. IMP was examined via the PrO2 from residual volume providing the maximal inspiratory pressure (MIP) at 1 to 2 seconds of inspiration and the sustained maximal inspiratory pressure (SMIP) from MIP to total lung capacity. The 6-minute walk test (6MWT), timed-up-and-go (TUG), BERG balance test (BERG), 5x-sit-to-stand (5xSS), Patient Health Questionnaire (PHQ9), Ferrans & Powers QOL, and CAT were measured using standardized methods. Wilcoxon Signed Rank Tests were computed before and after PR with statistical significance set at P< 05. RESULT(S): No significant difference in any outcome measure was found when comparing completers to non-completers of PR. Significant (P< 05) improvements in the SMIP (198.1 +/- 61.5-286.8 +/- 130.7 PTU), 6MWT (313 +/- 103-451 +/- 101 m), TUG (7.7 +/- 2.3-6.2 +/- 1.1 s), 5xSS (13.0 +/- 3.2-10.5 +/- 1.5 s) and QOL (21.2 +/- 3.6-24.8 +/- 2.4) were observed, while non-significant changes were observed in PHQ9 (7.3 +/- 5.6-6.5 +/- 5.1), BERG (52.7 +/- 6.7-55.8 +/- 0.4), MIP (69.9 +/- 17.2-84.8 +/- 27.7 cmH2O), and CAT (22.2 +/- 7.7-19.8 +/- 7.9) following PR. At baseline, SMIP but not MIP was significantly (P< 05) lower than predicted values (41 +/- 11% and 76 +/- 20%) but following PR the difference from predicted was no longer significant. CONCLUSION(S): Only 36% of patients with long-COVID who were referred to and initiated PR successfully completed the program. Following PR, patients demonstrated significant improvements in inspiratory muscle endurance, functional performance, and self-reported QOL, with non-significant improvements in balance and self-reported symptoms, confidence with activity, and depression. CLINICAL RELEVANCE: IMP and FPM are significantly impaired in patients with long-COVID. PR has been shown to significantly improve many respiratory, functional performance, and psychosocial outcome measures and should be considered as part of the plan of care for these patients. Furthermore, methods to improve adherence to PR in patients with long-COVID are needed.

Eating Disorders during the pandemic COVID-2019

Introduction: Concerns about health and fitness during lockdown may serve as a trigger for eating disorders in vulnerable individuals. Other risk factors may also include increased use of social networks and comparison with beauty ideals. Isolation, loneliness and problems with emotional regulation may lead people to reduce food intake by giving them a greater sense of control. Objective(s): Emphasise the relevance of the increase in the incidence of Eating Disorders (ED) cases during the pandemic. Method(s): Review of the scientific literature based on a relevant clinical case. Result(s): 14-year-old female, residing with her mother. She reports that from the beginning of COVID-19 confinement she became obsessed with leading a healthier life, starting to restrict food, limiting fats and carbohydrates, and having also started compulsive physical activity (approximately 4 hours of aerobic exercise per day), without associated purging behaviours. She also acknowledges eating small amounts (although she minimises this aspect) and controlling all calories, stating that food and practices aimed at "staying healthy" now dominate her life. Her previous BMI was 18, with a current BMI of 11.7. Conclusion(s): Patients suffering from ED, who often have poor knowledge of their illness and find social-emotional communication difficult, may delay seeking help. Studies suggest the relevance of identifying specific vulnerability factors among ED patients in confinement in order to develop preventive strategies and personalised treatment approaches.

Effects of Aerobic Training in Patients with Subacute COVID-19: A Randomized Controlled Feasibility Trial.

Many clinical practice recommendations indicate rehabilitation as essential for patients with sequelae of severe or critical COVID-19 and suggest the prompt initiation of a multicomponent rehabilitation program focused on aerobic and endurance training. However, randomized controlled trials (RCTs) regarding aerobic exercise are lacking. Therefore, we aimed to assess the feasibility and effectiveness of the addition of aerobic training to standard rehabilitation in subjects with subacute COVID-19. Participants were 32/214 patients with the sequelae of severe or critical COVID-19 in the acute phase who were eligible and agreed to participate in the study (eligibility = 15%, recruitment = 100%). After randomization and assessment with functional and strength tests, all the participants underwent an inpatient-tailored rehabilitation program (50 min/day, 5 days/week, 10 sessions); in addition, the experimental group performed a low- to moderate-intensity aerobic exercise (30 min/day, 10 sessions). No dropouts or severe adverse events were reported, with an attendance rate of 95.6%. Most of the secondary outcomes significantly improved in both groups, but the improvement in the Functional Independence Measure and Cumulated Ambulation Score-Italian version was significantly greater in the experimental group (at least, p < 0.05). This RCT showed that aerobic exercise is feasible and safe in subacute COVID-19. Moreover, it appears to be beneficial and useful in improving patients' independence and mobility.

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 Potential of Exerkines in Women's COVID-19: A New Idea for a Better and More Accurate Understanding of the Mechanisms behind Physical Exercise.

The benefits of physical exercise are well-known, but there are still many questions regarding COVID-19. Chow et al.'s 2022 study, titled Exerkines and Disease, showed that a special focus on exerkines can help to better understand the underlying mechanisms of physical exercise and disease. Exerkines are a group of promising molecules that may underlie the beneficial effects of physical exercise in diseases. The idea of exerkines is to understand the effects of physical exercise on diseases better. Exerkines have a high potential for the treatment of diseases and, considering that, there is still no study of the importance of exerkines on the most dangerous disease in the world in recent years, COVID-19. This raises the fundamental question of whether exerkines have the potential to manage COVID-19. Most of the studies focused on the general changes in physical exercise in patients with COVID-19, both during the illness and after discharge from the hospital, and did not investigate the basic differences. A unique look at the management of COVID-19 by exerkines, especially in obese and overweight women who experience high severity of COVID-19 and whose recovery period is long after discharge from the hospital, can help to understand the basic mechanisms. In this review, we explore the potential of exerkines in COVID-19 by practicing physical exercise to provide compelling practice recommendations with new insights.