Pulse oximetry and decision making

Introduction: The disease caused by COVID-19 constitutes a global health problem. The early identification of clinical manifestations and respiratory compromise is vital to minimize the complications of the disease;in this sense, the use of the pulse oximeter constitutes an interesting alternative. Objective: To describe the advantages provided by the use of the pulse oximeter in the decision-making of patients to go in a timely manner to request medical attention. Methodology: Basic research, descriptive and retrospective design. Universe made up of 348 patients diagnosed with COVID-19 and the sample of 184 cases. The frequency of complications and the influence of the use of pulse oximeter in decision making were determined. Non-parametric Odd Ratio and Fisher's exact tests were used to identify the range of occurrence. Results: average age of 54.47 years with a predominance of female patients (60.33%) and with associated comorbidities (66.85%). 25.00% of the patients presented respiratory involvement as a complication of OVID-19. 47.83% of the patients with complications used a pulse oximeter, although only 27.27% attended the consultation early, but in 90.91% the decision to attend the emergency service was influenced by the use of the oximeter point and its results. Conclusions: Pulse oximetry helped patients make the decision to seek medical attention. Oxygen saturation monitoring can be considered as a positive action around the clinical suspicion of severe respiratory disease.

Examining Effects of a Physical Activity Intervention on Exercise Capacity and Cardiovascular Function Among Patients With Lymphoma and Breast Cancer Undergoing Treatment

Introduction. Patients receiving serial outpatient infusion treatment for lymphoma or breast cancer (BC) with potentially cardio-toxic chemotherapeutic regimens may experience declines in left ventricular ejection fraction (LVEF) and exercise capacity. This study sought to determine if a physical activity intervention (PAI) administered during cancer treatment could attenuate deterioration of exercise capacity and LVEF. Methods. Across two NCI funded cancer centers, we randomized (2:1) 34 participants to a homebased PAI or healthy living education intervention (HLI) within 6 weeks of initiating curative therapies for stage I-IV Hodgkin's, non-Hodgkin's lymphoma, or stage I-III BC (NCT01719562). Training programs were tailored by treatment and functional status and adapted for remote delivery during COVID-19. Exercise capacity was determined via cardiopulmonary exercise test (peak VO2 [ml/kg/min]) and LVEF (%) was determined by magnetic resonance imaging at baseline, 3, and 6 months. Separate linear mixed-effects regression models controlling for baseline values examined changes in peak VO and LVEF by time and treatment group. Results. Demographics were similar between the two arms (PAI vs. HLI, 52.4 [16.3] vs. 56.8 [12.7] years of age [SD];69% vs. 75% white;and 57.7% vs. 50% female). Peak VO 2increased at 3 (+1.15 ml/kg/min [CI: -1.46 - 3.77]) and 6 months (+3.88 ml/kg/min [CI: 0.79 - 6.96]) in the PAI arm, while the HLI arm increased slightly at 3- (+0.67 ml/kg/min [CI: -5.14 - 6.48]) but not 6 months (-0.83 ml/kg/min [CI: -5.99 - 4.33]). LVEF declined slightly at 3 months in the PAI (-2.29% [CI: -4.83 - 0.25]) but not HLI arm (3.05.% [CI: -2.49 - 8.60]), while at 6 months, the PAI arm had returned to baseline LVEF (-0.58% [CI: -4.30 - 3.14]) and the HLI arm declined slightly (-1.76% [CI: -7.23 - 3.71]). Conclusions. This pilot RCT suggests the importance and utility of home-based physical activity during cancer treatment in protecting against expected declines in exercise capacity and LVEF. These results highlight the need for larger randomized trials that examine the effects of lifestyle interventions administered during treatment to improve quality of life and to support long term cardiovascular health in cancer survivors.

Aprv Avoids Ecmo in Severe Ards Patients Referred for Ecls

INTRODUCTION: Severe ARDS has mortality rates exceeding 45% particularly when meeting criteria for ECMO. APRV has been used for over 4 decades to improve oxygenation when failing conventional MV strategies and may reduce the need for ECMO rescue if implemented early. METHOD(S): Retrospective study of all adult patients referred for V-V ECMO evaluation at UF-Jacksonville for ARDS from 7/17 - 8/2021 including COVID-19 illness that were managed on APRV without ECMO. The EMR was used to search for the datapoints: survival to discharge, P/F ratio at time of referral and then at 1, 6, and 24 hours after initiating APRV when ECMO was not implemented, paralytic and vasopressor usage prior to and 6 hours after initiating APRV, and lactate levels at time 0, 6 hours and 24 hours after initiating APRV. RESULT(S): There were 65 consults for V-V ECMO due to ARDS that were managed on APRV without ECMO. The mean age was 40.1 years;59% men and 41% women;category of ARDS was medical in 72%, trauma in 26%, and surgical in 2%. All patients were on ARDsnet ventilation strategy when referred. The survival to discharge was 79.3% with 50% going home, 39% to rehab, and 11% to an LTAC. The mean P/F ratio at time of evaluation was 77.1;1 hour after initiating APRV it was 122.7;6 hours after initiating it was 163.8;24 hours after initiating it was 211.8 and the mean FiO2 at 24 hours was 59.2%. At time of evaluation 50.8% of patients were on paralytic infusions and 33.3% were on vasopressors while 6 hours after initiating APRV it was 0% for the former and 14.5% for the latter. Mean serum lactate was 3.1 mmol/L at time 0, then 2.6 mmol/L 6 hours after APRV was initiated, and 2.3 mmol/L 24 hours after initiating APRV. CONCLUSION(S): We had excellent success using APRV to improve severe hypoxia in patients failing on standard ventilation using ARDSnet strategy, with a survival rate without ECMO of nearly 80%. The reduction in paralytic use and vasopressor requirements likely contributed to improved pulmonary and cardiovascular function allowing the vast majority of survivors to go home directly or home after shortterm rehab stay. APRV should be considered in severe ARDS and may avoid the need for ECMO in some patients if applied before the patient is in extremis.

Copeptin and Cardiovascular Function Correlation in Children with Multisystem Inflammation Syndrome

INTRODUCTION: Children exposed to COVID-19 can develop Multisystem Inflammation Syndrome in Children (MIS-C). Literature has shown that 80% of affected children have cardiovascular involvement. Copeptin, a provasopressin protein, has been shown to correlate with myocardial injury and failure. Copeptin is a stable biomarker with minimal variation in a healthy population. We hypothesize that copeptin levels will correlate with troponin and Brain Natriuretic Peptide (BNP) levels and echocardiogram findings of left ventricular dysfunction in MIS-C. METHOD(S): We conducted a prospective study with subjects admitted to the Pediatric Intensive Care Unit who met WHO criteria for MIS-C between 2021-2022. Within 24 hours of initiating therapy, consent and a whole blood sample was obtained. The plasma was evaluated by enzyme-linked immunosorbent assay for a copeptin level. Troponin and BNP were drawn as standard of care. Echocardiograms obtained within 24 hours of the copeptin sample were evaluated for dysfunction. Comparisons between copeptin and troponin, BNP, and Ejection Fraction (EF) were evaluated using Wilcoxon Signed Rank Test. Comparisons of copeptin across echocardiogram markers of diastolic dysfunction (EE' ratio, EA ratio) and diastolic dimensions (LV diastolic dimeter index (LVDd), septal diastolic diameter index (LVSDd), and posterior wall diastolic diameter index (LVPWDd)) were evaluated using Friedman's Test. Kruskal-Wallis test was used to compare copeptin levels in patients on vasopressor support. RESULT(S): Ten patients with a clinical diagnosis of MIS-C were recruited. While copeptin levels (normal range 4-45pg/ ml, subjects range 19.5-963pg/ml) were not significantly different between patients who received vasopressors (p=0.088), LVSDd (p=< 0.001) and LVPWDd (< 0.001) did differ. Significant differences were found between copeptin and EA ratio (p=0.006) but not with EE' ratio (p=0.495). Differences between copeptin and EF were statistically significant (p=0.007). Comparisons of copeptin with troponin (p=0.007) and BNP (p=0.005) were also significant. CONCLUSION(S): Copeptin is a biomarker that has the potential to indicate cardiac dysfunction in the MIS-C population. Elevated copeptin levels correlated with echocardiogram findings of systolic dysfunction and diastolic dysfunction in children with MIS-C.

Integrated yoga and naturopathy on cardiovascular functions and mental health in a patient with COVID-19: A case report.

A 43-year-old-married male diagnosed with coronavirus disease 2019 (COVID-19) in July 2020. His symptoms as described by him began with cough and sore throat, breathlessness, generalized body weakness, irritability, stress, and mood swing for a period of one week. He was admitted in our District COVID Care Center (DCCC) located in Tamil Nadu, India. He underwent Integrated Yoga and Naturopathy (IYN) [i.e., Conventional medicine + yoga and naturopathy] for two weeks. The results showed negative Reverse Transcription Polymerase Chain Reaction (RT-PCR) test for COVID-19, improvement in cardiovascular functions (i.e., a reduction in systolic and diastolic blood pressures, pulse rate, mean arterial pressure, rate pressure product, and double product) and mental health (i.e., a reduction in depression, anxiety, and stress levels). The results suggest that IYN might improve cardiovascular and mental health of patients with COVID-19 in addition to positive to negative conversion of RT-PCR. However, further studies are required to warrant these results.

Use of peripheral perfusion index (PI) as a predictor of cardiovascular complications in hospitalised Covid 19 patients-A pilot study

Introduction and Aim: Cardiovascular complications have been associated with fatality in Covid-19 patients. Reduced peripheral perfusion is a marker for cardiovascular dysfunction. Peripheral Perfusion Index (PI) is a non-invasive measure of microvascular perfusion with regards to pulsatile arterial blood flow. The study was aimed at finding the utility of PI as a hemodynamic marker in Covid-19. Material(s) and Method(s): Observational study done on 58 hospitalised adult Covid-19 patients over a span of 6 days. Each day the hemodynamic parameters such as pulse rate, SpO2 and Peripheral Perfusion Index (PI) were measured using a finger pulse oximeter. Peripheral Blood pressure was measured using automated BP apparatus. Mean Arterial Pressure (MAP) and pulse pressure (PP) was calculated. Result(s): Correlation between PI and other parameters checked using Pearson's test. There was significant positive correlation between PI and PP in day wise analysis during first 2 days with linear regression showing PP can be predicted as a dependant function from PI. This shows the association between PI and systemic cardiovascular function. Conclusion(s): PI is a useful measure of peripheral microvascular perfusion and relates to systemic PP. It can be predicted from the results that PI can act as a reliable guide to predict the cardiovascular condition of the patient. As PI is measured from finger pulse oximeter, it is a non-invasive and easy-to-record method, which can be used by untrained personnel in Covid-19 patients. Copyright © 2022, Indian Association of Biomedical Scientists. All rights reserved.

Return to play after SARS-COV-2 infection: Safe sport for children and adolescents

Background and Aim: With the progressive spread of the coronavi-rus among the youngest and the need for a safe resumption of physical activity, several protocols have been proposed for healed athletes. The aim of the present study is to evaluate the presence of cardio-respiratory complications in the pediatric population after mild or asymptomatic SARS-CoV-2 infection. Method(s): From January 2021 the protocols of the Italian Sports Medical Federation were applied to all the children and adoles-cents who came to our observation for return-to-play after covid infection. The protocols take into account the severity of the infection. In case of mild or asymptomatic infection echocardiogram, electrocardiogram, treadmill ECG test and pul-monary function tests were performed. Result(s): From January 2021 to November 2021, 169 children and adolescents (mean age 14+3 ys;male = 92) with previous SARS-CoV-2 infection were evaluated according to the protocols in force after an average time of 48 + 13 days from SARS-CoV-2 swab negativity. 60,3% of the subjects (N = 102) reported an asymptomatic infection;39,7 % reported a mild symptomatic infection. Results of lung function test have exceeded the limit of 80% of the theoretical value in all patients. No subject presented evidence of cardiovascular function impairment. Conclusion(s): The data obtained showed that, in the pediatric pop-ulation, mild coronavirus infection does not cause cardiorespira-tory complications in the short and medium term. This reinforce the evidence from preliminary studies that return to play after Coronavirus infection seems to be safe and must be strongly recommended. It will therefore be possible to assess the possibility of lightening or even suspending these evaluations in the cases of mild coronavirus infection in the pediatric age groups.

DESIGNING A COST-EFFECTIVE, PATIENT-FACING DIGITAL STETHOSCOPE FOR TELEMEDICAL CARDIAC AUSCULTATION

Introduction: The COVID-19 pandemic catalyzed growth of virtual medicine, challenging providers to adapt their standard protocols for telehealth. During this time, cardiologists were unable to gather numerical/graphical heart data to guide therapy. Many examination technologies exist in-person to obtain this data, but they are not engineered for patient use during virtual visits. Objective: The team sought to develop an inexpensive diagnostic point-of-care device designed to work with telehealth applications and provide patients with the ability to transmit data on cardiovascular function to physicians in real time. Methods: The AusculBand used clinician and patient input for final design format. The AusculBand is shaped like a wristband and encapsulates a custom bell, microphone, and novel circuitry to facilitate self-auscultation for live transmission to a virtual physician. Frequency response testing was designed to verify the AusculBand’s captured cardiac sound frequency range. A comparative study was designed to test audio quality against and the Eko Duo’s, a leading competitor. Repeated cardiac auscultation signals at different points and background noise using both devices were obtained to quantify signal-to-noise ratio (SNR) on one user. Results: During frequency response analysis, the AusculBand captured frequencies up to 1997Hz in response to a signal that swept through a range of 0-3kHz. These results were within 0.2% of the 2kHz upper-limit of the cardiac range. SNR testing showed 27.29dB for the AusculBand and 24.02dB for the Eko Duo. The AusculBand is nearly twice as loud as the Eko Duo, and maintains a projected price of $80 (Eko Duo $320). Conclusions: The AusculBand is an inexpensive, patient-oriented digital stethoscope that beats industry standards in SNR and is compatible with existing telehealth platforms. Future modifications will add a single-lead ECG to promote the device as an all-in-one telemedicine tool for virtual cardiac analysis. [Formula presented] [Formula presented]

Design of a Simulator for Ventricular Assistance Devices

Recent research shows that the number of patients with heart disease is still bigger than Covid 19 disease. Some indicators in Brazil indicate about 400,000 deaths per year. Because of heart disease, heart failure is responsible for the main cause of hospitalization of patients over 65 years of age. Part of these patients eventually developed one or more severe disease because of heart disease, leaving as clinical alternatives, treatments, and more aggressive procedures such as heart transplantation. The current scenario for patients waiting for a heart transplantation is actually aggravated each day by the pandemic. Other problem is the organ rejection that is 15% of mortality rate. Then a clinical alternative that can provide support and improve the life quality of patients with heart failure is the mechanical circulatory assistance devices. This kind of device is aiding and/or substitutes in cardiovascular function and it is recognized by the medicine showing satisfactory results over the years. However, the homologation of this kind of device to clinical use is hard and these devices need to be submitted to exhaustive tests, in distinct phases. “In Vitro” validations are applied, a test performed in simulators, whether they physical, computational or hybrid and “In Vivo”, a test that is performed on animals. After these validations, clinical evaluations are started for equipment approval. In this context, the objective of this work is to present the design, construction and functioning of a physical fluid dynamic simulator, which allows testing in ventricular assist devices, with the ability to reproduce the variations of systolic and diastolic blood pressure, as well as the other phenomena related to the functioning of the cardiovascular system. For the project, we used a review of the historical line of the simulators, concepts of hydraulics, anatomy of the human cardiovascular system, heart diseases and PID control algorithms from the theoretical basis. The construction of the physical plant is finished and some tests are made presenting excellent results. The simulator is equipped with two tanks, one proportional control valves, recirculation systems, two level control sensors, blood flow meters, an Microcontroller with a PID control algorithm and a man machine interface developed in android platform. The tests demonstrated the full functioning of the simulator, with the automatic stabilization of the levels, pressure and flow. The tests were made based on the patient body conditions and the variation parameters were observed of the ventricular assist device response. Then the some heart disease were simulated with the modulation of the valve and the monitoring of the ventricular assist device flow as a function of the setpoint change, all these parameters inserted and monitored through a cellular application. (Figure Presented).

SY02-3 Expectations of home-based exercise research for enhancing cancer survivorship care

Exercise guidelines for cancer survivors issued by multiple international organizations (Campbell KL et al, 2019) updated the recommendations that aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes (eg, anxiety, depression, fatigue, physical function, and health-related quality of life). Despite these guidelines, the majority of cancer survivors are not regularly physically active. A lack of awareness regarding available effective program to help facilitate exercise in cancer survivors was suggested to be a one of barriers to clinicians referring them to exercise. Furthermore, given that the COVID-19 pandemic has made getting sufficient exercise difficult, there is an urgent need for developing a home-based exercise program and its effectiveness among cancer survivors. Systematic review revealed that high-intensity interval training (HIIT) is a time-efficient method for increasing cardiovascular function in breast cancer survivors (Tsuji K et al, 2021), while all previous HIIT studies were lab-based supervised intervention. Recently, we originally developed 12-week home-based smartphone-supported HIIT program (habit-B program) and examined its effect on cardiorespiratory fitness among breast cancer survivors in Japan. Our single-blind single-center randomized controlled trial involved 50 sedentary women with stage I-IIa breast cancer. The results showed that home-based HIIT intervention can lead to improve cardiorespiratory fitness and muscle strength (Ochi E et al, 2021). Based on the pilot study, we are proceeding a multi-center RCT in stage I-III breast cancer survivors. Mobile health such as habit-B might become a solution, but we need more collaboration and care coordination with appropriate professionals as well as change in the behaviors of clinicians, cancer survivors, and those who deliver the rehabilitation and exercise program.

Adapted physical activity in subjects and athletes recovering from covid-19: a position statement of the Società Italiana Scienze Motorie e Sportive.

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic illness that is impacting the cardiovascular, pulmonary, musculoskeletal, and cognitive function of a large spectrum of the worldwide population. The available pharmacological countermeasures of these long-term effects of COVID-19 are minimal, while myriads of non-specific non-pharmacological treatments are emerging in the literature. In this complicated scenario, particular emphasis should be dedicated to specific exercise interventions tailored for subjects and athletes recovering from COVID-19. Specific guidelines on adapted physical activity in this critical population are unavailable so far, therefore, in this position statement of the Società Italiana di Scienze Motorie e Sportive (SISMeS) the members of the steering committee of the research group Attività Motoria Adattata, Alimentazione, Salute e Fitness have indicated the adapted physical activity approaches to counteract the long-term effects of the COVID-19, both in good health people and athletes.

49th Rostock Talks on Cardiovascular Function and Hypertension

The proceedings contain 5 papers. The topics discussed include: neurogenic control of venous smooth muscle: a functional component analysis;a rare cause of treatment-resistant hypertension;ionized magnesium in elderly hypertensives;magnesium and COVID-19 - cardiovascular implications;and the 'structured kidney': simply explain complex issues to students.

Forest Bathing Is Better than Walking in Urban Park: Comparison of Cardiac and Vascular Function between Urban and Forest Parks.

Forest bathing is beneficial for human health. To investigate whether walking in forest or urban parks affects cardiovascular functions (CVFs), the present study was conducted in five forest trails in the Xitou Experimental Forest and in five urban parks in Taipei city. We recruited 25 adult volunteers for an observational pilot study in forest parks (n = 14) and urban parks (n = 11). CVFs were assessed by measuring the arterial pressure waveform using an oscillometric blood pressure (BP) device. The baseline and paired differences of systolic BP (SBP), central end SBP, heart rate, left ventricle (LV) dP/dt max and cardiac output in participants were lower before and after walking in a forest park than those in an urban park. In addition, the systemic vascular compliance and brachial artery compliance of those who walked in a forest park were significantly higher compared with those in an urban park. Linear mixed models demonstrated lower levels of SBP by 5.22 mmHg, heart rate by 2.46 beats/min, and cardiac output by 0.52 L/min, and LV dP/dt max by 146.91 mmHg/s among those who walked in forest compared to those in an urban park after controlling covariates. This study provides evidence of the potential beneficial effects of walking exercise in forest parks on CVFs.

POS-252 THE DIFFERENTIAL IMPACT OF TWO NOVEL INTRAVENOUS IRON AGENTS ON FIBROBLAST GROWTH FACTOR 23, PHOSPHATE AND OTHER CLINICAL AND FUNCTIONAL MARKERS: METHODOLOGY AND BASELINE DATA

Introduction: Third generation intravenous (IV) iron preparations are increasingly used in the treatment of non-dialysis dependent chronic kidney disease (CKD) associated iron deficiency. Such compounds allow rapid delivery of large concentrations of iron safely at a single sitting. Evidence suggests that their use may lead to improved cardiovascular outcomes. Nonetheless, concerns exist regarding the potential induction of hypophosphatemia via fibroblast-growth-factor 23 (FGF-23) following the use of certain compounds. Raised FGF-23 has been associated with mineral bone and cardiac disorders, alongside prognostic implications. No prior study has provided a head-to-head comparison between iron preparations in CKD. This pilot study is designed to primarily investigate the differential impact of two different IV iron compounds on FGF-23 and phosphate in patients with CKD;secondarily we examine the impact of these compounds on bone markers and functional status, quality of life and cardiovascular function. Methods: This is a randomized controlled double-blinded pilot study recruiting patients with CKD stage 3a – 5 (non-dialysis) and iron deficiency +/- anemia. Patients are randomized to receive either ferric carboxymaltose or ferric derisomaltose over two infusions (one-month apart) to achieve full repletion. The initial dose administered is 1000 mg for both medications, with 500 mg or 1000 mg reserved for the second dose depending on weight and hematinics. Follow up is over a period of three months following the first infusion with measurements of intact FGF-23, phosphate, phosphaturia, vitamin D, parathyroid hormone, bone metabolism markers, functional status and quality of life and cardiac markers (figure 1). [Formula presented] Results: 168 patients were referred to the specialist renal anemia services for pre-screening. Ninety-nine were contacted for interest to participate, with 64 individuals declining to join. The commonest reason for not participating, was the COVID-19 pandemic (43.3%) with patients not keen to travel. Thirty-five patients were screened, and 27 patients enrolled in the study, of which 26 were randomized to receive iron (figure 2). One patient withdrew from the study, as they were unable to attend appointments following successful screening. In our baseline cohort the median age was 67.9 (12.4) and 17 participants were male. Mean hemoglobin was 100.3 (13.5) and hematinic markers consistent were consistent with iron deficiency. Median eGFR was 18.0 (11.3) ml/min/1.73 m2;the population as expected had a raised intact FGF-23 (212.1 (116.4) pg/ml). Serum calcium and phosphate were within normal parameters, while parathyroid hormone and 1,25 (OH)2 Vitamin D were deranged (Table 1). [Formula presented] [Formula presented] Conclusions: ExplorIRON-CKD, like a number of trials, experienced significant disruption in recruitment due to COVID-19. This study will provide further insight to the potential induction of FGF-23 following administration of specific intravenous iron compounds, and identify whether such a differential effect exists in patients with CKD. The effect of such induction in terms of phosphate and other markers of bone metabolism, functional status and cardiac functioning will be observed. The results will aid in hypothesis generation for further studies to identify the potential long-term impact of iatrogenic FGF-23 increase in patients with CKD. Conflict of interest Potential conflict of interest: This study received funding support from Pharmacosmos A/S and the Kidney Research Yorkshire Charity Fund. The funders had no role in the study design, data collection and analysis, and decision to publish or preparation of the . I have no potential conflicts of interest to disclose.

Effects of a remote exercise intervention on aerobic endurance in individuals with down syndrome

PURPOSE/HYPOTHESIS: Down syndrome (Ds) or Trisomy 21 is a common genetic birth condition, and those with Ds typically display decreased cardiorespiratory fitness compared to those without Ds, potentially leading to an increased risk for cardiovascular conditions and mortality. Low cardiorespiratory fitness is partially caused by low physical activity levels in this population. The COVID-19 pandemic caused community-based activity programs to shut down, as individuals with Ds are at increased risk for COVID-19 hospitalization and death. Thus, it was vital to explore alternatives of in-person exercise during the pandemic. The purpose of this study was to investigate the effects of a remote 12-week exercise intervention on aerobic endurance in individuals with Ds. NUMBER OF SUBJECTS: Twenty individuals with a medical diagnosis of Down syndrome were recruited and consented to participate. One participant dropped out for reasons unrelated to this study. Data was collected on 19 participants (5 females, 14 males;age: 25.4 ± 4.8 years;height: 156.9 ± 10.5 cm;weight: 72.5 ± 14.6 kg). The participants needed to be generally healthy and sedentary to be included in this study. MATERIALS AND METHODS: Nineteen individuals with Ds completed a structured physical therapist-led 12-week exercise intervention via remote video platform, which consisted of cardiovascular activity, foundational strength exercises targeting core/postural activation and endurance, hip strengthening exercises, and visual-vestibular coordination activities. Using the same platform, aerobic endurance was assessed using the 2 Minute Step Test (2MST). To investigate learning effects of the 2MST, it was performed twice in both the pre- and post-intervention testing sessions. BlandAltman plots were used to assess learning effects and a paired sample t-test was used to assess the effect of the intervention on cardiorespiratory fitness. RESULTS: The Bland-Altman plots showed an increase in the number of steps between first and second execution of 2MST in both pre-intervention (mean difference: -8.9 ± 3.9 = 95% CI [-12.8, -5.04]) and post-intervention testing (mean difference: -5.7 ± 4.5 = 95% CI [-10.2,-1.2]) which suggests a learning effect. Therefore, the second execution of the 2MST was used for pre-post intervention comparisons. A paired sample t-test showed a statistically significant improvement of the 2MST between the pre-intervention (67.6 ± 23.6 steps) and post-intervention (79.4 ± 21.8 steps) measurements (P < 0.01). CONCLUSIONS: This research shows a significant learning effect between the first and second 2MST executions. There was also a significant improvement of cardiorespiratory fitness following the exercise intervention. CLINICAL RELEVANCE: This study shows virtual platforms are an effective mode to deliver an exercise intervention to increase aerobic endurance in those with Ds. The results also support the 2MST as a useful tool to assess aerobic endurance in this population via a virtual platform. It is important to have the participant perform at least 2 trials to account for the learning effect with this test.

From heart to muscle: pathophysiological mechanisms underlying long-term physical sequelae from SARS-CoV-2 infection.

The long-term sequelae of the coronavirus disease 2019 (COVID-19) are multifaceted and, besides the lungs, impact other organs and tissues, even in cases of mild infection. Along with commonly reported symptoms such as fatigue and dyspnea, a significant proportion of those with prior COVID-19 infection also exhibit signs of cardiac damage, muscle weakness, and ultimately, poor exercise tolerance. This review provides an overview of evidence indicating cardiac impairments and persistent endothelial dysfunction in the peripheral vasculature of those previously infected with COVID-19, irrespective of the severity of the acute phase of illness. In addition, V̇o2peak appears to be lower in convalescent patients, which may stem, in part, from alterations in O2 transport such as impaired diffusional O2 conductance. Together, the persistent multi-organ dysfunction induced by COVID-19 may set previously healthy individuals on a trajectory towards frailty and disease. Given the large proportion of individuals recovering from COVID-19, it is critically important to better understand the physical sequelae of COVID-19, the underlying biological mechanisms contributing to these outcomes, and the long-term effects on future disease risk. This review highlights relevant literature on the pathophysiology post-COVID-19 infection, gaps in the literature, and emphasizes the need for the development of evidence-based rehabilitation guidelines.

Direct cardiotropic effects of sars-cov-2 and its clinical correlation

Coronavirus disease 2019 (CO-VID-19) is a clinical entity caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which has become a pandemic in the first half of 2020, dominating the global epidemiological panorama. Although the main affected focus is the respiratory tract, injury of other organs is not infrequent, including the kidneys, the gastrointestinal tract, and the cardiovascular system. In particular, the relationship between cardiovascular disorders and COVID-19 is bidirectional, as the preexistence of cardiovascular disease increases de risk of infection and complications. On the other hand, the infection has also been shown to generate cardiovascular injury via various mechanisms. The increased risk of various cardiovascular events has been documented in patients with COVID-19. Thus, considering cardiovascular function has been recommended in the management of patients with COVID-19, chiefly those with comorbidities. The objective of this review is to evaluate the mechanisms and theories explaining the cardiovascular effects of the SARS-CoV-2 infection, and to recognize its clinical implications.

Harnessing Neuroplasticity to Promote Brain Health in Aging Adults: Protocol for the MOVE-Cog Intervention Study.

BACKGROUND: Extensive evidence supports a link between aerobic exercise and cognitive improvements in aging adults. A major limitation with existing research is the high variability in cognitive response to exercise. Our incomplete understanding of the mechanisms that influence this variability and the low adherence to exercise are critical knowledge gaps and major barriers for the systematic implementation of exercise for promoting cognitive health in aging. OBJECTIVE: We aimed to provide an in-person and remotely delivered intervention study protocol with the main goal of informing the knowledge gap on the mechanistic action of exercise on the brain by characterizing important mechanisms of neuroplasticity, cardiorespiratory fitness response, and genetics proposed to underlie cognitive response to exercise. METHODS: This is an open-label, 2-month, interventional study protocol in neurologically healthy sedentary adults. This study was delivered fully in-person and in remote options. Participants underwent a total of 30 sessions, including the screening session, 3 pretest (baseline) assessments, 24 moderate-to-vigorous aerobic exercise sessions, and 3 posttest assessments. We recruited participants aged 55 years and above, sedentary, and cognitively healthy. Primary outcomes were neuroplasticity, cognitive function, and cardiorespiratory fitness. Secondary outcomes included genetic factors, endothelium function, functional mobility and postural control, exercise questionnaires, depression, and sleep. We also explored study feasibility, exercise adherence, technology adaptability, and compliance of both in-person and remote protocols. RESULTS: The recruitment phase and data collection of this study have concluded. Results are expected to be published by the end of 2021 or in early 2022. CONCLUSIONS: The data generated in these studies will introduce tangible parameters to guide the development of personalized exercise prescription models for maximal cognitive benefit in aging adults. Successful completion of the specific aims will enable researchers to acquire the appropriate expertise to design and conduct studies by testing personalized exercise interventions in person and remotely delivered, likely to be more effective at promoting cognitive health in aging adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT03804528; http://clinicaltrials.gov/ct2/show/NCT03804528. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/33589.