Impact of risk for severe COVID-19 illness on physical activity during the pandemic.

BACKGROUND: Precautions to mitigate spread of COVID-19 such as the closing of exercise facilities impacted physical activity behaviors. Varied risks for severe COVID-19 may have influenced participation in regular physical activity to maintain precautions. OBJECTIVE: Describe differences in the amount and intensity of physical activity between adults at high versus low risk for severe COVID-19 illness during the pandemic. We hypothesized that over 13 months, 1) high-risk adults would have greater odds of inactivity than low-risk adults, and 2) when active, high-risk adults would have lower metabolic equivalent of task minutes (MET-min) than low-risk adults. METHODS: This longitudinal observational cohort study surveyed U.S. adults' demographics, health history, and physical activity beginning March 2020 using REDCap. Using self-report, health history was assessed with a modified Charlson Comorbidity Index and physical activity with the International Physical Activity Questionnaire. Repeated physical activity measurements were conducted in June, July, October, and December of 2020, and in April of 2021. Two models, a logistic model evaluating physical inactivity (hypothesis 1) and a gamma model evaluating total MET-min for physically active individuals (hypothesis 2), were used. Models were controlled for age, gender, and race. RESULTS: The final sample consisted of 640 participants (mean age 42.7 ± 15.7, 78% women, 90% white), with n = 175 categorized as high-risk and n = 465 as low-risk. The odds of inactivity for the high-risk adults were 2.8 to 4.1 times as high than for low-risk adults at baseline and 13 months. Active high-risk adults had lower MET-min levels than low-risk adults in March (28%, p = 0.001), June (29%, p = 0.002), and July of 2020 (30%, p = 0.005) only. CONCLUSIONS: Adults at high risk of severe COVID-19 illness were disproportionately more likely to be physically inactive and exhibit lower MET-min levels than adults at low risk during the early months of the COVID-19 pandemic.

Lung changes after COVID-19: What are the functional differences across the spectrum of disease severity?

The pulmonary limitations after COVID-19 are still not completely known. Lung function test (LFT) and 6-minute walk test (6MWT) are accessible and safe tests to access them. Aim(s): To evaluate the differences between non-severe and severe COVID-19 patients regarding LFT and 6MWT. Method(s): This study included patients with previous COVID-19 assessed in Pulmonology Department at 2 hospitals during 7 months who performed LFT and 6MWT. Baseline and immediately pos-6MWT heart rate (HR), SpO2, respiratory rate (RR) and perceived symptoms using a modified BORG scale were collected. We compared nonsevere and severe patients. Result(s): We included 151 patients, 69 (45.7%) with severe disease. LFT was performed 116.8+/-68.3days and the 6MWT 129.1+/-72.3days after COVID-19, without statistical difference between groups. We documented lower %FVC (94.4+/-14.7vs101.1+/-12.6%, p=0.003), %TLC (95.4+/-15.3vs107.1+/-12.3%, p=0.000) and %DLCO (68.8+/-16.5vs78.9+/-15.9%, p=0.000) in the severe group, without statistical differences in FEV1, FEV1/FVC and KCO. The 6MWT distance (m: 426.5+/-110.9vs498.2+/-93.5m, p=0.000;%:77.3+/-16.8%vs86.1+/-13.4%, p=0.001), estimated metabolic equivalents (3.03+/-0.5vs3.4+/-0.4, p=0.000) and minimal SpO2 (92.0+/-3.3vs93.8+/-3.1%, p=0.000) were lower in the severe group. The time spent below 90%SpO2 (5.6+/-19.4vs2.6+/-13.6%, p=0.039), %age-predicted maximal HR (68.5+/-10.5vs64.9+/-8.8%, p=0.023) and initial RR (19.1+/-5.1vs18.7+/-9.3 cpm, p=0.014) were higher. We did not document differences regarding the differential (maximal-initial) HR, final RR, differential (final-initial) RR and symptoms. Conclusion(s): Severe group showed higher functional limitation, mainly in lung volumes and in submaximal exercise evaluation.

Dietary habit, physical activity and perceived barriers during movement control order among undergraduate students in Puncak Alam, Selangor

The emergence of COVID-19 had affected people in terms of their physical activity and nutritional changes which may increase the risk of various non-communicable diseases (NCD) among them. This study aimed to identify the physical activity level, nutritional changes, and perceived barriers to engage physical activity among students of UiTM Selangor, Puncak Alam Campus during the Movement Control Order (MCO) in Malaysia. A total of 234 students aged 18-24 years old were chosen to participate in this study by using convenience sampling. The International Physical Activity Questionnaire (IPAQ), Physical Activity Resource Assessment (PARA), and adapted questionnaire from the Ministry of Health (MOH) Malaysia were used in this study. Findings reveal that students were able to engage in physical activity level during the pandemic period which required them to be quarantined. Moreover, there was an increase in the frequency of healthy eating behaviour as well as unhealthy eating behaviour during MCO.Copyright © 2023 The Authors.

The effect of lifestyle on the course of COVID-19 infection

Aim: Our study's goal was to see how pre-illness lifestyle affected the course of COVID-19 infection in patients hospitalized with COVID-19. Material(s) and Method(s): From January to May 2021, 66 patients aged 50 years and older whose PCR tests were positive for COVID-19 were studied in the pandemic service. The Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment (MNA) scale, and International Short Physical Activity Questionnaire (IPAQ) were utilized to examine the impact of COVID-19 infected individuals lifestyles such as sleep, nutrition and physical activities on the illness before the infection. Result(s): According to the PSQI scale;the increases in discharged lymphocyte measurements were significant compared to the first hospitalization in the good and bad sleep group cases. A higher increase in NLR for the first hospitalization was seen in the bad sleep group compared to good sleep group. According to the MNA scale, all three groups had increased lymphocyte counts in discharge disposition in comparison to the first hospitalization. Patients at risk of malnutrition had higher increases in lymphocytes at discharge than malnourished individuals (p=0.049). Normal nutritional status had greater platelet measures than patients at risk of malnutrition (p=0.028). According to the IPAQ survey, very active cases had higher platelet measurements than minimally active cases. Discussion(s): In our study on the effect of lifestyle on the course of COVID-19 infection, patients with proper nutrition, good sleep quality, and sufficient physical activity did not require treatment in the ICU. This finding revealed the importance of adopting and maintaining a healthy lifestyle.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Gender differences on factors affecting the resting metabolic rate of academicians

BACKGROUND: There is an increasing interest to improve the physical activity level of people working in offices mostly spending their time in sitting who may be under the risks of obesity. this is especially increasing its importance worldwide due to recent 'stay at home trend' of covid-19 pandemics. academicians are the group of people having tendency to develop a sedentary lifestyle and become overweight due to long sitting hours of work. thus, the aim of this study is to understand the gender differences on factors affecting the resting metabolic rate of academic personnel. MethodS: data on demographic information, Body Mass index, resting metabolic rate (rMr), physical activity levels of academicians (n.=62, 32W, 30M) have been collected. reSUltS: their total weekly energy expenditure in relation to total physical activity was similar to each other as 1743.4+/-2189.10 MET-min/week for men and 1074.04+/-1299.09 MET-min/week for women. The RMR was significantly higher in men (1994.66+/-683.41 kcal/day) than women (1467.81+/-311.47 kcal/day) (p<0.001). Supporting this outcome, percent body fat was found higher in women (26.38+/-6.62%) than men (21.46+/-6.17%) (p<0.05). Men spent longer times "sitting" (p<0.05), it had a weak effect on their total physical activity (p<0.05). conclUSionS: although women were sitting less than men during day, they were less physically active. Men were more involved with heavy to moderate physical activities with higher resting metabolic rate. Since walking was a preferred activity in both genders, they may be motivated to increase their walking based physical activity in and out of the campus as well as at home.Copyright © 2020 Edizioni Minerva Medica.

Long COVID: Rapid Evidence Review

Postacute sequelae of COVID-19, also known as long COVID, affects approximately 10% to 30% of the hundreds of millions of people who have had acute COVID-19. The Centers for Disease Control and Prevention defines long COVID as the presence of new, returning, or ongoing symptoms associated with acute COVID-19 that persist beyond 28 days. The diagnosis of long COVID can be based on a previous clinical diagnosis of COVID-19 and does not require a prior positive polymerase chain reaction or antigen test result to confirm infection. Patients with long COVID report a broad range of symptoms, including abdominal pain, anosmia, chest pain, cognitive impairment (brain fog), dizziness, dyspnea, fatigue, headache, insomnia, mood changes, palpitations, paresthesias, and postexertional malaise. The presentation is variable, and symptoms can fluctuate or persist and relapse and remit. The diagnostic approach is to differentiate long COVID from acute sequelae of COVID-19, previous comorbidities, unmasking of preexisting health conditions, reinfections, new acute concerns, and complications of prolonged illness, hospitalization, or isolation. Many presenting symptoms of long COVID are commonly seen in a primary care practice, and management can be improved by using established treatment paradigms and supportive care. Although several medications have been suggested for the treatment of fatigue related to long COVID, the evidence for their use is currently lacking. Holistic treatment strategies for long COVID include discussion of pacing and energy conservation;individualized, symptom-guided, phased return to activity programs;maintaining adequate hydration and a healthy diet;and treatment of underlying medical conditions.Copyright © 2022 American Academy of Family Physicians.

CARDIORESPIRATORY STATUS AFTER SARSCOV- 2 INFECTION: THE ROLE OF HYPERTENSION AS RISK FACTOR

Objective: Few data have been published regarding the holistic approach of post- Covid patients, examining physical health. The purpose of our study was to examine the impact of arterial hypertension in the cardiopulmonary status of post-covid patients 3 months after the first day of infection. Design and Method: All participants who recovered Covid-19 infection underwent cardiorespiratory exercise using either Bruce or modified Bruce protocol where all parameters were evaluated and transthoracic echocardiogram. The population was separated into two groups based on history of hypertension. Group I (n = 29) included hypertensive subjects and Group II (n = 75) included normotensive subjects. Results and Conclusion: A total of 104 patients were assessed 3 months after the onset of COVID-19 symptoms. We recorded a mean age of 49 ± 15 years, 50.5% of them were males, 8.7% had a history of coronary heart disease. Hypertensives had higher BMI (29.24 ± 24 vs 26.64 kg/m2 p < 0.01) and BSA (2.09 ± 0.25 vs. 1.95 ± 0.58, p = 0.001). They were hospitalized in higher percentage comparing to normotensives (72.4% vs. 41.3%, p < 0.01). Left atrial diameter (41 ± 6 vs. 35 ± 5.5 mm, p < 0.001) was significantly larger in hypertensives. Furthermore, A wave (79 ± 21 vs. 58 ± 18 cm/s p < 0.001) and ratios of E/A (1.01 ± 0.42 vs. 1.28 ± 0.44, p < 0.01) and E/E (7.3 ± 3.7 vs. 5.9 ± 4.3, p < 0.01) differed between two groups. Finally, LVEF (%) was significantly impaired in hypertensive comparing to normotesive subjects (53 ± 13% vs. 59 ± 7%). This finding was depicted in lower maximum oxygen consumption (VO2 22 ± 4.5 vs. 28 ± 8 ml/kg/min p < 0.001), metabolic equivalents (METS) at peak, 9.1 ± 3 vs. 14 ± 20 p < 0.001), maximum heart rate (maxHR 147 ± 17 vs. 165 ± 21 bpm p < 0.001) and HR1st minute recovery (123 ± 28 vs. 138 ± 21 bpm, p: 0.02) comparing to normotensive. Systolic blood pressure (SBP 180 ± 29 vs. 165 ± 25mmHg, p: 0.02) during the 1st minute of recovery was higher in hypertensives. Finally, the duration of exercise was significantly lower in patients with hypertension (7.3 ± 2.7 vs. 9 ± 4 min, p:0.02). To conclude, the current study highlighted the negative impact of hypertension in the ability to exercise. Regardless of the disease severity, post-covid patients need a comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity.

An analysis of emergency surgery on coronavirus disease positive patients and their outcomes during the coronavirus pandemic: A retrospective observational study.

Background: The primary objective of this study was to determine the outcome of emergency surgery in coronavirus disease 2019 (COVID-19) patients with regard to presently existing physical status, and highlight its subspecialty distribution. Methods: This retrospective observational study was done on all patients who underwent emergency surgery between March 2020 and Dec 2021 and were positive for COVID-19. Data collection included the age of the patients, gender, diagnosis, the type of surgery performed, and outcome. Physical status was assessed, as per Modified Medical Research Council Dyspnoea Scale (MMRC) and Metabolic Equivalent Scale (METS). Results: A total of 89 patients were analyzed from March 2020 to Dec 2021. There were 63 females and 26 males. The average age of the males was 53.8 ± 8.9 years and the average age of the females was 29.1 ± 4.6 years. The maximum number of surgeries done was lower segment cesarean section (57.3%). 55 out of 60 (91%) cases had a good grade on the MMRC scale (Grade 0 and 1). 3 patients had Grade 4 MMRC scale and all 3 were oncology cases. As per the METS scale, 56/60 (93.3%) patients had METS >10. Conclusion: This study has demonstrated that 55 out of 60 (91%) of cases had a good grade on the MMRC scale (Grade 0 and 1) 6 months to 1-year post-surgery. As per the METS scale, 56/60 (93.3%) patients had METS >10. Most of the cases were asymptomatic COVID-19-positive and presently have good physical status as determined by the study.

The Impact of Covid-19 on Patients in Cardiac Rehabilitation Phase II

Introduction: COVID-19 significantly affected outpatient cardiac rehabilitation which is a central resource for patients recovering from cardiovascular disease. The aim of the study was to examine the impact of COVID-19 on Cardiac Rehabilitation (CR) Phase II clinical outcomes. Method(s): A single-site retrospective chart review of CR Phase II patients who completed 12 or more visits during 2019 (pre-COVID) and 2020 (COVID) was performed. Depression was measured using the PHQ-9, functional capacity was measured by the 6-minute walk in distance (ft) and metabolic equivalents (METs), and quality of life (QOL) was measured by the Ferrans and Powers Index. Descriptive and linear mixed methods were used to analyze the data. Result(s): A total of 212 patients who were predominately male 67% and 66.5 (SD=10.8) years old were included. PHQ-9 results showed a significant interaction COVID*pre-post scores F(1, 119.66) = 4.66, p = 0.03. For the remaining scores, all results showed significant improvements in pre-post: distance F(1, 151.90) = 226.92, p <.001;METs F(1, 180.13) = 138.7, p <.001;and QOL F(1, 145.32) = 5.89, p =0.02. Interactions were not significant for the three variables. QOL results showed significant differences in the COVID group with F(1, 239.12) = 6.13, p = 0.01. Conclusion(s): All four outcomes improved significantly in the pre-COVID and COVID sample. COVID significantly impacted depression PHQ-9 score change, with a pre-post improvement of 0.62 points in the pre-COVID group and 2.08 points during COVID. Finally, the mean overall QOL score was significantly lower in the COVID group than the pre-COVID group.

IMPACT OF HYPERTENSION AS AN ADDITIONAL RISK FACTOR IN CARDIORESPIRATORY STATUS OF POST SARS-COV-2 INFECTED SUBJECTS

Objective: Few data have been published regarding the holistic approach of post- Covid patients, examining physical health. The purpose of our study was to examine the impact of arterial hypertension in the cardiopulmonary status of post-covid patients 3 months after the first day of infection. Design and method: All participants who recovered Covid-19 infection underwent cardiorespiratory exercise using either Bruce or modified Bruce protocol where all parameters were evaluated and transthoracic echocardiogram. The population was separated into two groups based on history of hypertension. Group I (n = 29) included hypertensive subjects and Group II (n = 75) included normotensive subjects. Results: A total of 104 patients were assessed 3 months after the onset of COVID- 19 symptoms. We recorded a mean age of 49 ± 15 years, 50.5% of them were males, 8.7% had a history of coronary heart disease. Hypertensives had higher BMI (29.24 ± 24 vs 26.64 kg/m2, p < 0.01) and BSA (2.09 ± 0.25 vs. 1.95 ± 0.58, p = 0.001). They were hospitalized in higher percentage comparing to normotensives (72.4% vs. 41.3%, p < 0.01). Left atrial diameter (41 ± 6 vs. 35 ± 5.5 mm, p < 0.001) was significantly larger in hypertensives. Furthermore, A wave (79 ± 21 vs. 58 ± 18 cm/s, p < 0.001) and ratios of E/A (1.01 ± 0.42 vs. 1.28 ± 0.44, p < 0.01) and E/E' (7.3 ± 3.7 vs. 5.9 ± 4.3, p < 0.01) differed between two groups. Finally, LVEF (%) was significantly impaired in hypertensive comparing to normotesive subjects (53 ± 13% vs. 59 ± 7%). This finding was depicted in lower maximum oxygen consumption (VO2 22 ± 4.5 vs.28 ± 8 ml/kg/min, p < 0.001), metabolic equivalents (METS) at peak, 9.1 ± 3 vs. 14 ± 20, p < 0.001), maximum heart rate (maxHR 147 ± 17 vs. 165 ± 21 bpm, p < 0.001) and HR1st minute recovery (123 ± 28 vs. 138 ± 21 bpm, p: 0.02) comparing to normotensive. Systolic blood pressure (SBP, 180 ± 29 vs. 165 ± 25mmHg, p: 0.02) during the 1st minute of recovery was higher in hypertensives. Finally, the duration of exercise was significantly lower in patients with hypertension (7.3 ± 2.7 vs. 9 ± 4 min, p:0.02) Conclusions: the current study highlighted the negative impact of hypertension in the ability to exercise. Regardless of the disease severity, post-covid patients need a comprehensive approach for rehabilitation including the modification of risk factors like hypertension and obesity.

PHYSICAL ACTIVITY AND LIFESTYLE CHANGES IN ITALY DURING THE COVID-19 LOCKDOWN: GENDER DIFFERENCES

Objective: Italy responded to the Covid-19 pandemic early by forcing the entire population into a 2-month domestic confinement. The aim of this study was to assess gender differences in the impact of lockdown on physical activity and lifestyle habits. Design and method: A cross-sectional web-based survey was conducted in April 2020 on a general population sample residing in Italy. Participants completed validated questionnaires. Gender differences were assessed using a multivariable adjusted logistic regression model using gender as independent and exposures as dependent variables. Metabolic equivalents-hour/week was used to evaluate physical activity. Results: A total of 2218 participants (761 men and 1457 women) agreed to participate in the study and completed the questionnaire. The survey found that women compared to men showed 1) a lower level of physical activity before the institution of lockdown, 2) a lower tendency to reduce physical activity levels during the lockdown, when gender differences in compliance with guideline recommendations for physical activity disappeared, 3) and a worsening of sleep and tool passage;men experienced an increase in alcohol consumption. Conclusions: Women, who previously had a lower level of physical activity than men, showed a lower tendency to reduce it during lockdown, revealing greater resilience than men. However, the worsening in sleep, in stool passage, and a trend to weight increase revealed signs of psychological suffering after a protracted lockdown period.

The Impact of the Pandemic COVID 19 on Adolescent's Sports Performance in Czech Republic

Background: During the COVID-19 pandemic, free move-ment, leisure activities and sports, both competitive and elite, were restricted by measures against the spread of the infection. The study aimed to evaluate the impact of the restrictions on the performance of Czech adolescent competitive athletes. Methods: The sample of the retrospective study comprised 125 participants (41 girls, 84 boys). The initial examination, the mean age of the entire sample was 15.5 +/- 1.2 (median 16.0) years;16.0 +/- 1.2 in girls and 15.5 +/- 1.2 in boys, respectively. All participants were examined during regular preventive sports health checks from September to November 2019 and a year later. The examination consisted of a complete medical history and physical examination, anthropometric measurements (height, weight and body mass index [BMI] calculations) and maximal exercise testing on a leg cycle ergometer, ECG and blood pressure recordings. The response variables in regression models were power output (W/kg) and MET. Results: In the entire sample, as well as in the boy and girl subgroups, body height, weight, BMI, BMI percentile and power output were significantly increased in 2020 compared to 2019, yet with a statistically significant reduction in both power output per kilogram of body weight and metabolic equivalent (MET). In 2020, the relative power output dropped by 0.13 W/kg and MET by 0.6. There was no statistically significant predictor of changes in relative power output and MET identified in regression models, including no significant impact of the sport type. There were no significant differences in results between genders. Conclusions: Performance and anthropometric parameters, specifically power output per kilogram of body weight and MET, worsened in the sample of adolescent male and female athletes.

A high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults.

Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (ß = -0·031 (-0·05; -0·01), P = 0·001) and the QoL (ß = -0·022 (-0·04; -0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.

CHANGES IN SEDENTARY AND PHYSICAL ACTIVITY HABITS OF WORKERS WHO SWITCHED TO TELEWORKING DURING THE COVID PANDEMIC19

Introduction: Confinement has led to changes in the work patterns of some workers that have an impact on habits such as physical activity. Objective:The aim was to analyse differences in sedentary time and physical activity before (2018) and after the pandemic (2021) in sedentary workers (N=44), differentiated by sex, who switched to teleworking. Material and Methods: Single-group retrospective observational before-after study. The variables age, sex, sedentary time and energy expenditure in metabolic equivalents were collected. Percentages, mean, median and standard deviation were calculated. Mann-Whitney U-test, t-test for independent and related samples and the sign test for absence of symmetry were applied. Results: Sedentary time decreased between 2018 and 2021 (p=0.005). Total expenditure and partial expenditure for heavy and light physical activity increased between the two years (p<0.001). Conclusion: Switching to telework decreased sedentary time and increased heavy and light physical activity.

Alcohol intake and mortality risk of COVID-19, pneumonia, and other infectious diseases: An analysis of 437191 UK biobank participants.

This study aims to investigate the association between alcohol consumption and COVID-19, infectious diseases, and pneumonia mortality. This is a prospective analysis of 437,191 UK Biobank participants (age 56.3 years, 54% female). The main exposure was self-reported alcohol consumption. In addition to never and previous drinkers, we applied quartiles-based and UK guidelines-based criteria to divide current drinkers by weekly consumption into four groups. Outcomes included COVID-19, infectious diseases, and pneumonia mortality, obtained from the national death registries until May 2020. After an 11-year follow-up, compared to never drinkers, previous drinkers had higher mortality risks of infectious diseases and pneumonia (adjusted HR: 1.29 [95% CI 1.06-1.57] and 1.35 [1.07-1.70], respectively), but not COVID-19. There was a curvilinear association of alcohol consumption with infectious diseases and pneumonia mortality. Drinking within-guidelines (<14 UK units/wk) and amounts up to double the recommendation (14 to < 28 UK units/wk) was associated with the lowest mortality risks of infectious diseases (0.70 [0.59-0.83] and 0.70 [0.59-0.83], respectively) and pneumonia (0.71 [0.58-0.87] and 0.72 [0.58-0.88], respectively). Alcohol consumption was associated with lower risks of COVID-19 mortality (e.g., drinking within-guidelines: 0.53 [0.33-0.86]). Drinkers reporting multiples of the recommended alcohol drinking amounts did not have higher mortality risks of COVID-19 and other infectious diseases than never drinkers. Despite the well-established unfavorable effects on general health, we found no deleterious associations between alcohol consumption and the risk of infectious diseases, including COVID-19. Future research with other study designs is needed to confirm the causality.

CHALLENGE: A phase III study of the impact of a physical activity program on disease-free survival in patients with high-risk stage II or stage III colon cancer: A randomized controlled trial (NCIC CTG CO.21)

Aims: To determine the efficacy of physical activity (PA) in reducing disease recurrence in patients with localised colon cancer. Our primary hypothesis is that a PA program will improve disease-free survival (DFS) in patients with resected stage II (high risk) and III colon cancer who have completed adjuvant therapy. In addition, we hypothesise that exercise can improve fatigue, quality of life (QOL), physical functioning and body composition. Methods : An international multi-centre phase 3 RCT primarily between Australia and Canada. Subjects are randomised to PA program or standard care. Primary objective compares DFS between patients in PA and control arms. Key secondary objectives are to compare: 1. fatigue, QOL, depression, anxiety, sleep, body composition, exercise behaviour and fitness;2. overall survival (OS);3. association of cytokines, and insulin axis levels with PA, fatigue, and DFS;4. Health economic evaluation of the PA intervention. The study intervention is a 36-month PA programme aiming to achieve > 10 metabolic equivalent rates/week above baseline. Study assessments include: Disease status, fitness, body composition, QOL questionnaires at 0/6/12/18/24/30/36 months. Then annual patient reported outcomes and disease status until study closure. Interim analysis (n = 273 with 12 months follow up) showed good intervention adherence, significant difference in PA with 10.5 MET hours/week difference between groups, and objective fitness improvements in PA group. Adaptations due to COVID: In 2020, rapid amendments were made in response to COVID-19 to provide alternative modes for intervention delivery (via phone or virtual) and assessments conducted virtually where possible, with option of electronic completion of patient-reported outcomes. Current Status: Number of randomisations = 792 (82% of planned sample size);270 from Australia (from 24 sites). Five sites continue recruitment in Australia: Concord, Royal Brisbane and Women's, Tamworth, Newcastle Private, and Northern Cancer Institute.