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.

COVID-19 pandemic: regular physical activity and respiratory exercises at home as prevention and treatment

The main question in the field of exercise and rehabilitation medicine is whether physical activity and therapeutic exercise are suitable activities for CoVid-19 patients who are recovering at home. There have been few public health guidelines provided about what people can do in relationship with exercise and respiratory care. For this reason, it is necessary that physical therapists give some recommendations concerning safe respiratory and physical exercises that could be executed by people with confirmed, suspected, or probable CoVid-19 who stay at home.Copyright © 2022 University School of Physical Education in WrocAaw. All rights reserved.

Impact of 3 months of detraining after high intensity exercise on menopause-related symptoms in early postmenopausal women - results of the randomized controlled actlife project.

Regular exercise might reduce postmenopausal symptoms, however even short-moderate periods of absence from exercise training might significantly reduce these positive effects. The aim of the study was thus to determine detraining effects on postmenopausal symptoms after a 3-month detraining period in early post-menopausal women. After 13 months, the exercise group (EG: n = 27; 54.6 ± 2.0; 23.6 ± 3.3 kg/m2) had to abruptly stop their supervised, facility-based, high intensity aerobic and resistance group exercise conducted three times per week due to the COVID-19 pandemic and the corresponding lockdown of all training facilities in Germany. In parallel, the control group (CG: n = 27; 55.6 ± 1.6 years, 25.2 ± 5.2 kg/m2) had to terminate their low-intensity exercise program performed once per week. Study endpoint as determined after 3 months of detraining was menopausal symptoms as determined by the Menopausal Rating Scale II (MRS II). The intention to treat principle with multiple imputation was applied. After 13 months of intense multicomponent exercise and significant exercise-induced effects on menopausal symptoms, a further 3 months of detraining resulted in non-significant deteriorations (p = .106) in the exercise group, while non-significant improvements were observed in the control group (p = .180). Corresponding group differences were significant (p = .036) after detraining. Of importance, self-reported individual outdoor activities increased by about 40% in both groups during the three-month lock-down period. Three months of absence from a supervised high-intensity group exercise protocol resulted in detraining effects on postmenopausal symptoms even when outdoor physical activity was increased significantly. Trial registration number: ClinicalTrials.gov: NCT03959995.

The impact of COVID-19 pandemic on physical activity in persons with multiple sclerosis: an international RIMSSIG Mobility study

Introduction: Restrictions aiming to slow down the spread of COVID-19 had consequences on the amount and content of physical activity in persons with multiple sclerosis (PwMS). Objectives & Aims: To investigate the impact of the COVID-19 pandemic on physical activity in PwMS. Method(s): An online survey was distributed during May - July 2021 in 11 countries. The survey gathered various metrics of physical activity (e.g. type, intensity, use of technology) performed prior to (2019) and during the pandemic (2021). Factors associated with stopping physical activity were also investigated. Result(s): The survey was completed by 3725 PwMS. Prepandemic 83% of the respondents reported being physically active, whereas during the pandemic 75% reported being physically active. Concern of contracting COVID-19 and loss of support were highly predictive factors associated with stopping physical activity. The decrease in physical activity was significant for both moderate and high intensity physical activity (p<.0001). Prior to the pandemic, 66% of the respondents reported physical activity behaviour indicating that they met the physical activity guidelines, while during the pandemic the respondents meeting the physical activity guidelines was 50%. The proportion of respondents meeting the guidelines decreased with increasing disability (Pre/during-pandemic: mild: 64%/ 55%;moderate: 52%/ 43%;severe: 39%/ 30%). Walking was the most frequent activity pre-pandemic (27%) and during the pandemic (33%). Of the 25% respondents who were inactive during the pandemic, 31% reported no interest in changing their physical activity behaviours, and 44% expressed a preference for a face-to-face format to conduct physical activity after the pandemic. During the pandemic, the most used technology (24%) were wearables (e.g. smart watch). Conclusion(s): Physical activity was reduced in PwMS from before to during the pandemic. Concerns of contracting COVID-19 and a loss of support were highly associated with reduced physical activity. There is a need to support PwMS aiming to increase physical activity. Physical activity programmes which address walking (the most frequent), disability and the use of wearable technology may be preferable.

The Effects of Wearing Facemasks during Vigorous Exercise in the Aspect of Cardiopulmonary Response, In-Mask Environment, and Subject Discomfort.

Non-pharmaceutical intervention such as wearing a mask during the pandemic of SARS-CoV-2 is one of the most important ways to prevent the spread of the virus. However, despite high effectiveness and easy to access, the biggest problem is 'discomfort'. The purpose of this study was to measure the changes of cardiopulmonary response and related factors affecting breathing discomfort when wearing a mask during vigorous exercise. Fifteen healthy male adults participated in this study. The experimental protocol consisted of three conditions: no mask; KF-94 mask; and sports mask. Each condition consisted of three stages: stage I, 2 m/s on even level; stage II, 2 m/s with 5° inclination; and stage III, 3 m/s on even level. Oxygen saturation (SaO2) and heart rate (HR), partial pressure of carbon dioxide (pCO2), energy expenditure index (EEI), in-mask temperature, humidity, and a five-point scale questionnaire to evaluate subjective discomfort were measured. The results show that there was a significantly higher discomfort score in mask conditions compared with no mask (p < 0.05) and only pCO2 change significantly related to subjective discomfort during exercise (p < 0.05). Moreover, the pCO2 washout was significantly disturbed when wearing a sports mask in stages 2 and 3, which was related to wearer subjective discomfort.

Closure of outpatient cardiac rehabilitation during the first COVID-19 lockdown in Austria in spring 2020 resulted in deteriorating physical exercise capacity: A mixed-methods study

Background: Group-based cardiac rehabilitation (CR) has inevitably been disrupted by COVID-19-related public health measures, increasing the risk of deterioration in modifiable risk factors for patients with cardiovascular disease (CVD). Purpose: To examine the impact of CR closure during the first COVID- 19-related national lockdown in Austria in spring 2020 on patients' maintenance of physical activity, physical fitness levels, and cardiovascular risk profile;and to describe the patient experience of lack of group-based CR training due to COVID-19. Methods: This mixed-methods study recruited patients from an outpatient CR centre in Austria during summer 2020. Eligibility criteria were regular attendance at weekly group-based exercise training at the centre until the COVID-19-related lockdown in March 2020;pre-lockdown completion of a maximal cycle ergometer test;no contraindications for maximal exercise testing;and no new complaints limiting exercise performance. Participants underwent post-lockdown quantitative assessment of physical fitness (maximal cycle ergometer testing, submaximal cycle ergometer training session at individual pre-lockdown settings) and cardiovascular risk status. These were compared with pre-lockdown data from medical records. Participants gave qualitative interviews about their experience of maintaining exercise during lockdown. Interviews were audio-recorded, transcribed, coded, and interpreted using framework analysis. Results: Twenty-eight (57%) of 49 eligible patients were recruited, 1 withdrew, and 27 completed all study procedures. Two participants were excluded from analysis of physical fitness data, due to subsequent diagnosis of new complaints limiting exercise performance. Mean (SD) age was 69 (7.4) years. Six (22%) were female. Median (IQR) time since first CVD event was 8 (5.5, 9) years. In maximal ergometer testing, 14 (56%) had deteriorated, 10 (40%) were unchanged, and 1 (4%) had improved postlockdown. At group level, power was significantly reduced (maximal ergometer testing, submaximal ergometer training), whereas CVD risk factors remained unchanged from pre- to post-lockdown (table 1). Qualitative analysis corroborated the negative impact of the closure of CR classes (table 2). Conclusions: This patient cohort was heterogeneous with respect to physical activity levels and exercise capacity, yet overall motivated and experienced in exercise training, having regularly attended training sessions at the centre before the lockdown. Despite individually seeking out alternative exercise options during lockdown, group average exercise capacity deteriorated even in this motivated and exercise-conscious group. This highlights the importance of providing group-based opportunities for supervised high intensity training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service. (Figure Presented).

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

During the pandemic, several studies were carried out on the short-term effects of acute SARS-CoV-2 infection in athletes. As some cases of young athletes with serious complications like myocarditis or thromboembolism and even sudden death were reported, strict recommendations for return to sport were published. However, we have less data about athletes who have already returned to high-intensity trainings after a SARS-CoV-2 infection. Athletes underwent cardiology screening (personal history, physical examination, 12-lead resting ECG, laboratory tests with necroenzyme levels and echocardiography) 2 to 3 weeks after suffering a SARS-CoV-2 infection. In case of negative results, they were advised to start low intensity trainings and increase training intensity regularly until achieving maximal intensity a minimum of 3 weeks later. A second step of cardiology screening was also carried out after returning to maximal intensity trainings. The above mentioned screening protocol was repeated and was completed with vita maxima cardiopulmonary exercise testing (CPET) on running treadmill. If the previous examinations indicated, 24h Holter ECG recording, 24h ambulatory blood pressure monitoring or cardiac MR imaging were also carried out. Data are presented as mean±SD. Two-step screening after SARS-CoV-2 infection was carried out in 111 athletes (male:74, age:22.4±7.4y, elite athlete:90%, training hours:14.8±5.8 h/w, ice hockey players:31.5%, water polo players:22.5%, wrestlers:18.9%, basketball players:18.0%). Second screenings were carried out 94.5±31.5 days after the first symptoms of the infection. A 5% of the athletes was still complaining of tiredness and decreased exercise capacity. Resting heart rate was 70.3±13.0 b.p.m., During CPET examinations, athletes achieved a maximal heart rate of 187.3±11.6 b.p.m., maximal relative aerobic capacity of 49.2±5.5 ml/kg/min, and maximal ventilation of 138.6±31.2 l/min. The athletes reached their anaerobic threshold at 87.8±6.3% of their maximal aerobic capacity, with a heart rate of 93.3±3.7% of their maximal values. Heart rate recovery was 29.9±9.2/min. During the CPET examinations, short supraventricular runs, repetititve ventricular premature beats + ventricular quadrigeminy and inferior ST depression were found in 1-1 cases. Slightly higher pulmonary pressure was measured on the echocardiography in 4 cases. Hypertension requiring drug treatment was found in 5.4% of the cases. Laboratory examinations revealed decreased vitamin D3 levels in 26 cases, decreased iron storage levels in 18 athletes. No SARS-CoV-2 infection related CMR changes were revealed in our athlete population. Three months after SARS-CoV-2 infection, most of the athletes examined had satisfactory fitness levels. However, some cases of decreased exercise capacity, decreased vitamin D3 or iron storage levels, arrhythmias, hypertension and elevated pulmonary pressure requiring further examinations, treatment or follow-up were revealed.

Detraining Effects on Musculoskeletal Parameters in Early Postmenopausal Osteopenic Women: 3-Month Follow-Up of the Randomized Controlled ACTLIFE Study.

Periods of absence from supervised group exercise while maintaining physical activity might be a frequent pattern in adults' exercise habits. The aim of the present study was to determine detraining effects on musculoskeletal outcomes after a 3-month detraining period in early post-menopausal, osteopenic women. Due to the COVID-19 pandemic, we terminated the 18-month randomized controlled ACTLIFE exercise intervention immediately after the 13-month follow-up assessment. This put an abrupt stop to the high-intensity aerobic and resistance group exercise sessions undertaken three times per week by the exercise group (EG: n = 27) and the gentle exercise program performed once per week for the attention control group (CG: n = 27); but both groups were permitted to conduct individual outdoor activity for the 3-month lock-down period. Study endpoints were lean body mass (LBM), bone mineral density (BMD) at the lumbar spine (LS), maximum hip-/leg extension strength and power. Detraining-induced reductions of LBM, hip/leg strength and power (but not BMD-LS) were significantly greater (p < 0.001 to p = 0.044) compared with the CG. Significant exercise effects, i.e. differences between EG and CG, present after 13 months of exercise, were lost after 3 months of detraining for LBM (p = 0.157) and BMD-LS (p = 0.065), but not for strength (p < 0.001) and power (p < 0.001). Of note, self-reported individual outdoor activities and exercise increased by about 40% in both groups during the lock-down period. Three months' absence from a supervised group exercise protocol resulted in considerable detraining effects for musculoskeletal parameters. Thus, exercise programs for adults should be continuous rather than intermittent.Trial registration number: ClinicalTrials.gov: NCT04420806, 06.05.2020.

Exercise against SARS-CoV-2 (COVID-19): Does workout intensity matter? (A mini review of some indirect evidence related to obesity).

SARS-CoV-2 (COVID-19) is a new virus causing respiratory illness outbreak. Nowadays, COVID-19 has spread to several countries around the world and is presently a major global concern. It appears that no certain effective pharmaceutical agent is currently available for it. It seems that obesity is one of the biggest risk factors related to COVID-19 hospitalization and critical illness. The strengthening of the body systems by non-drug ways is very important especially in obese people. On the basis of some indirect evidence, it seems that moderate physical activity can be recommended as a non-pharmacological, inexpensive, and viable way to cope with corona. On the other hand, recommending higher intensity exercise needs further consideration to make final decision in this regard.