Mental Stress in Medical Students during the Pandemic and Their Relation to Digital and Hybrid Semester-Cross-Sectional Data from Three Recruitment Waves in Germany.

BACKGROUND: Because of the COVID-19 pandemic, students had to interrupt their regular studies, and universities changed their teaching formats. The aim of this study was to analyze medical students' stress perception, wellbeing, life and work satisfaction, and cool down reactions, and to compare the survey data of online and hybrid semesters with pre-pandemic education formats in-person. METHODS: Cross-sectional surveys at three time points enrolling 1061 medical students (58% women; 24.4 ± 3.4 years); 30.8% from pre-pandemic formats in-person, 22.8% from pandemic online semesters, and 46.1% from pandemic hybrid semesters. RESULTS: Both students' stress perception and psychological wellbeing decreased during the pandemic semesters. Their satisfaction with the university support was at its lowest during the hybrid semesters. Regression analyses indicated that students' stress perception can be explained only to some extent by their general dissatisfaction with their medical studies or teaching formats. CONCLUSIONS: The lockdowns affected students in more ways than simply their teaching formats. Students require individual support to adjust to difficult situations, and particularly medical students in their preclinical phase compared to students in their clinical phases. These are challenges for the medical education system, which must find ways to be prepared for future times of crisis and insecurity.

INNOVATIVE TELEMONITORED MODEL OF PHYSICAL EXERCISE PRESCRIPTION IN SECONDARY PREVENTION DURING THE QUARANTINE

Introduction: COVID-19 pandemic induced the emanation of extraordinary measures like quarantine, that can be considered a risk factor for both physical and mental health in the population. In particular, gym's closure and the need to stay home didn't allow people to perform physical activity easily, with a consequent worsening of cardiovascular risk factors. During quarantine some general recommendations have been disseminated, but little is known about specific guidelines for home-based exercise prescription in patients with cardiovascular disease. Therefore, the purpose of this study is to develop home-based physical exercise programs for cardiac patients referred to the Center for Exercise Science and Sports of University of Ferrara. Methods: On the basis of exercise capacity obtained from the last functional evaluation, performed in presence before the closure, three structured workouts were realized following the guidelines. They are composed as follows: warm-up, strenght and balance exercises alternate to indoor walking, cool-down. Patients received an explicative iconographic via e-mail or smartphone. Some domiciliary sessions were supervised by an operator through video connection. Results: All patients showed excellent compliance with the proposed program. Adherence has been verified through biweekly recalls. No adverse events occurred. Conclusions: Telemonitored exercise prescription in cardiac outpatients was effective and safe, helping to prevent negative consequences of the abrupt cessation of physical activity due to COVID-19 pandemic. These evidence could be useful even after the end of pandemic, for all those patients that are less likely to participate in traditional cardiovascular rehabilitation programs because of difficulties in reaching facilities or leaving home.

Return to exercise after covid-19 disease

Objectives: Physical activity is one of most important parts of a healthy life style. After COVID-19 we have to consider alterations needed in prescribing exercise. Methods: A comprehensive review. Results: The guidelines for returning to exercise should consider elite athletes as well as the general population in two different categories. We may also classify the patients to these categories: 1. Those who were not affected by COVID-19 or were completely asymptomatic and were home-quarantined;this group will suffer from deconditioning. They have to begin milder physical activity and reduced duration compared to the previous active days before quarantine. The increase in volume and severity of exercises are based on the general condition and the patient's tolerance. All major changes should be monitored by a medical profession expert. 2. Those who were affected by mild to moderate COVID-19 and were not hospitalized;this group will suffer from decreased cardio-respiratory fitness as well as deconditioning. They have to begin with semi-monitored activities. Oxygen saturation should be monitored during physical activity and supplemental oxygen may improve tolerance and safety. 3. Those who were affected by severe COVID-19 and were hospitalized;this group will suffer from severe generalized muscle wasting and decreased cardiorespiratory fitness. They have to begin with in-patient rehabilitation. All participants have to pay attention to social/physical distancing and good hygienic measures, proper warm-up/cool down, adequate hydration, and appropriate dietary regimen. Many affected patients may need protein supplements to counteract severe muscle wasting;anti-oxidant and vitaminmineral supplements may be helpful because of long term decreased intake during hospitalization (low appetite, intensive care measures, and gastrointestinal symptoms). Psychological consultation to manage posttraumatic stress disorder, anxiety, depression, obsessive symptoms should not be neglected.

Pilot study of a ‘Dance Fitness Group’ for children referred to physiotherapy

Keywords: Dance;Compliance;Group Purpose: Deconditioned, hypermobile, and symptomatic musculoskeletal pain in children can cause a reduced level of physical activity leading to weakened muscles and poor tolerance to exercise. Dance and music have been shown to positively affect mood and mental health in individuals, helping to increase compliance of physical activity. Group settings provide evidence for increasing compliance through improving patient's sense of belonging, self-confidence and social engagement. This pilot looks at combining the enjoyment of dance to music in a group setting with physiotherapy strengthening and core exercises to increase engagement, We aim to evaluate the outcome measures to direct the formation of a larger scale study. Methods: The pilot study included children aged 8–16 years old referred by Southampton Paediatric Physiotherapy team with a diagnosis of hypermobility, poor postural fitness and deconditioning with an interest in dance. Children were excluded if they were 7 years old or younger and if they would be unable to follow a group session. The group comprised of a four week (once weekly) group for 45 min consisting of group exercise with warm up, 15 min dance cardio fitness including balance, strengthening, core stability, and cool down sections. A questionnaire assessing patients perceived fitness, pain and overall enjoyment was the outcome measure completed at the beginning and end of the group. Results: Two patients attended the group between November 2020 and December 2020. The post group questionnaire showed both patients found the group very useful or extremely useful. The questionnaire also showed an improvement in sporting activity post group. Both patients also stated an interest in repeating the group and found that it was a positive experience for young people of their age to do fitness in a safe environment. The Coronavirus Pandemic impacted on the sample size of this pilot. Conclusion(s): The results of this small sample pilot have shown very positive outcomes. The pilot highlights the success of using dance as a positive motivator to increase physical activity in those deconditioned and hypermobile patients. The use of music and dance movements helped to engage patients to strengthen weakened muscles and improve compliance to exercise. Future Dance fitness groups could include patients with back pain with the outcome measure Rowland Morris to be used. Limitations of COVID-19 restrictions meant a small sample, however future groups should be repeated on a large scale with up to 6 children in a group. Impact: This was a small scale pilot study which has shown positive evaluation to transform the way we run our groups. With future larger scale quantitative and qualitative results we will further evaluate the impact on our physiotherapy practice. We aim to reduce 1:1 out-patient appointments due to positive outcomes of group treatment using a holistic and innovative approach to improve engagement and compliance to physical activity. Funding acknowledgements: This pilot study was not funded.

Development of endurance training program for patient diagnosed with post-COVID syndrome: A case report

BACKGROUND AND PURPOSE: Post-Covid Syndrome is the chronic phase after COVID-19 when a person no longer has a positive polymerase chain reaction (PCR) test, however continues to display symptoms. Symptoms include fatigue, post-exertional malaise, cognitive dysfunction, shortness of breath and transient or long-term orthostatic intolerances such as Postural Orthostatic Tachycardia Syndrome (POTS). There is limited evidence on exercise guidelines for Post-Covid Syndrome. The purpose of this case study is to describe the physical therapy (PT) plan of care for patient with Post-Covid Syndrome. CASE DESCRIPTION: A 51-year-old female with diagnosed COVID-19 with a nonremarkable recovery at home. Her past medical history was significant for depression, anxiety and migraines. She was active, engaging in hiking and recreational sports. She developed Post-Covid Syndrome and POTS five months later, with medical testing negative for brain MRI, echocardiogram, EKG, pulmonary function test, and bloodwork. Positive tests indicative of POTS, included the cardiac stress test and active stand test. PT started four months later to address fatigue and muscle weakness. She presented with mild cognitive impairment, impaired cardiovascular endurance and standing balance, left upper and lower extremity weakness. She was unable to walk more than 0.5 miles, required rest breaks during activity of daily living, and was unable to return to work. Based on exercise guidelines by De Wandele et al. for POTS, an exercise program was developed. Vitals (BP, HR, oxygen saturation and BORG Rating of Perceived Exertion) were monitored each session. The program was implemented at a frequency of 2 times/week for 10 visits and 1 time/week at home. The mode of exercise was endurance training using recumbent ergometer at 75% of max HR or Borg RPE of 13-15. Total intervention time was 30 minutes including 10 minutes for warm-up and cool-down. Patient was assessed at evaluation and progress report, 10 visits later with the 6- minute walk test (6MWT) to assess endurance, the Modified Fatigue Impact Scale (MFIS) to assess perceived fatigue severity and its impact on function, subjective activity diary of post-exertional malaise, and the EURO-Quality of Life (EUROQOL-5) to determine overall health. OUTCOMES: The patient completed supervised sessions without adverse reactions. She maintained the target HR and demonstrated improved 6MWT by 87 m, MFIS by 18 points and EUROQOL-5 by 8 points after 10 visits. She also had reduced post-exertional malaise episodes from twice a day to twice a week. DISCUSSION: This cardiovascular endurance training program is correlated with positive improvements in endurance, fatigue severity, and quality of life in a person with PostCovid Syndrome. Post-Covid Syndrome is a developing diagnosis and there is limited data on its clinical course of recovery. Further research is needed to develop specific exercise guidelines for Post-Covid Syndrome.

Utilizing the Cool-Down Phenomenon to Differentiate Supraventricular Tachycardias in a Patient with COVID-19 Infection.

A 63-year-old male patient with a history of hypertension, diabetes mellitus type 2, prostate cancer and class two obesity was admitted for encephalopathy. During his hospital stay he developed narrow complex tachycardia and it was difficult to definitively diagnose the underlying arrhythmia. Observation of the cool down phenomenon on telemetry strip allowed us to make the diagnosis of atrial tachycardia and elegantly rule out other causes. We report this interesting case of narrow complex tachycardia.