Relationship between physical performance and perception of stress and recovery in daily life post COVID-19-An explorative study.

INTRODUCTION: COVID-19 is a multi-systemic disease which can target the lungs and the cardiovascular system and can also affect parts of the brain for prolonged periods of time. Even healthy athletes without comorbidities can be psychologically affected long-term by COVID-19. OBJECTIVE: This study aimed to investigate athletes' perceived mental stress and recovery levels in daily life, and their maximal aerobic power, at three different time points, post COVID-19. METHODS: In total, 99 athletes (62.6% male), who had been infected by COVID-19, filled out the Recovery Stress Questionnaire for Athletes (REST-Q-Sport) and completed cardiopulmonary exercise testing (endpoint maximal aerobic power output (Pmax)) at the initial screening (t1: 4 months after infection). Follow-up assessments occurred three (t2, n = 37) and seven months after t1 (t3, n = 19). RESULTS: Subgroup means from the Recovery category were significantly below the reference value of four at all three time points, except "General Recovery" (3.76 (± 0.96), p = 0.275, d = 0.968) at t3."Overtiredness" (2.34 (± 1.27), p = 0.020, r = 0.224) was significantly above the reference value of two at t1, while all other Stress subgroups were not significantly different from the reference value or were significantly below the maximum threshold of two at t1, t2 and t3. Spearman's ρ revealed a negative association between Pmax and the subcategories of stress (ρ = -0.54 to ρ = -0.11, p < 0.050), and positive correlations between Pmax and "Somatic Recovery" (ρ = 0.43, p < 0.001) and "General Recovery" (ρ = 0.23, p = 0.040) at t1. Pmax (t1: 3.83 (± 0.99), t2: 3.78 (± 1.14), ß = 0.06, p < 0.003) increased significantly from t1 to t2. In addition, REST-Q-Sport indicated a decrease in "Sleep" (t2 = 2.35 (± 0.62), t3 = 2.28(± 0.61), ß = -0.18, p < 0.023) at t3, when compared to t2. CONCLUSION: The perceived recovery seems to be negatively affected in post COVID-19 athletes. Physical performance post COVID-19 correlates with both "Emotional and Somatic Stress" and "Somatic and General Recovery", indicating potential mental and physical benefits of exercise. While it is evident that COVID-19, like other viral infections, may have an influence on physical performance, monitoring stress and recovery perceptions of athletes is critical to facilitate their return-to-sports, while minimizing long-term COVID-19 induced negative effects like the athletic objective and subjective perceived recovery and stress levels.

Physical performance testing in post-COVID-19 patients: protocol for a systematic review of psychometric measurement properties.

INTRODUCTION: COVID-19 is an infectious disease that causes severe acute respiratory syndrome. A large variety of exercise capacity tests are used for the evaluation of post-COVID-19 patients, but the psychometric properties of these exercise tests remain undetermined in this population. This study aims to critically appraise, compare and summarise the psychometric properties (validity, reliability and responsiveness) of all physical performance tests that are used to assess exercise capacity in post-COVID-19 patients. METHODS AND ANALYSIS: This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will include studies with hospitalised adult post-COVID-19 patients (aged 18 years or older and with a confirmed diagnosis of COVID-19). The research will cover randomised controlled trials (RCTs), quasi-RCTs and observational studies published in English and performed in the following settings: hospital, rehabilitation centre, outpatient clinic. We will search the following databases with no date restrictions: PubMed/MEDLINE, EMBASE, SciELO, Cochrane Library, CINAHL and Web of Science. Two authors will independently assess the risk of bias (using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of bias checklist) and the certainty of evidence (using the Grading of Recommendations, Assessment, Development and Evaluations). According to the results obtained, data will be meta-analysed or reported narratively. ETHICS AND DISSEMINATION: No ethical approval is required for this publication since it will be based on published data. Results of this review will be disseminated via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021242334.

Physical performance and compensation strategies of older adults to maintain physical fitness and well-being during the COVID-19 pandemic in Germany.

INTRODUCTION: During the first wave of the COVID-19 pandemic in March 2020, worldwide restrictions in social life, including the closure of sport facilities, led to a reduction of physical activity and subjective well-being. The aim of this study is to describe physical training habits, and subjective well-being in relation to objective training data from a chip-controlled fitness circuit in the rural area of Oldenburg, Germany. MATERIALS AND METHODS: Overall, 35 older adults (20 women 71 ± 6 y/o and 15 men, 72 ± 7 y/o), regularly exercising in a chip-controlled fitness circuit before the lockdown in March 2020, were interviewed. The training data from February to August 2020 from six strength and two endurance exercise devices were extracted and compared to data before and up to three months after the lockdown. Additionally, participants' personal characteristics, physical activities and quality of life before, during, and after the first lockdown were assessed. RESULTS: The leg score (pre, postJune, postJuly, postAugust: 1207 ± 469 kg, 1248 ± 477 kg, 1254 ± 516 kg, 1283 ± 493 kg; p = 0.137) and endurance scores (ergometer: 0.93 ± 0.35 min- 1 · watt- 1, 0.86 ± 0.31 min- 1 · watt- 1, 0.86 ± 0.31 min- 1 · watt- 1, 0.85 ± 0.28 min- 1 · watt- 1 ; p = 0.442) were not significantly different, in contrast to the rowing score (1426 ± 582 kg, 1558 ± 704 kg, 1630 ± 757 kg, 1680 ± 837 kg; p < 0.001). A significant increase of total energy expenditure (p = 0.026), mainly through gardening, walking, and bike riding was observed. The greatest personal limitation reported, was the loss of social contacts. CONCLUSION: The presented data did not show a decrease in training performance, but a slight trend towards an increase. A compensatory increase in regular outdoor activities seems to have a protective effect against a loss of training performance and may have the potential to stabilize subjective well-being during lockdown periods.

Home-based high-intensity interval training can improve physical performance in young female athletes during a quarantine

Abstract Aim: To verify the effects of a 2-week of high-intensity interval training (HIIT) on physical performance in young female athletes. Methods: female rugby players (n = 13; 15.92 ± 0.76 years old) participated in an 8-session of HIIT supervised through online video calls for two weeks. They were evaluated pre- and post-HIIT for 3-min of burpees, 1-min of sit-ups, maximum push-ups, and 1-min of squats. Perceptions related to training protocols were collected through the Physical Activity Enjoyment Scale (PACES) post-intervention. Results: Significant improvements in burpees (pre:54.15 ± 18.03 and after: 63.15 ± 15.18), sit-ups (pre:24.38 ± 13.38 and after: 31.15 ± 13.15), push-ups (pre: 9.46 ± 6.59 and after: 13.85 ± 7.33) and squats (pre: 48.00 ± 8.37 and after: 54.85 ± 8.79) were observed. PACES revealed positive perceptions related to the enjoyment of participating in this HIIT. Conclusion: Virtually supervised HIIT improved physical performance in young female athletes during the COVID-19 pandemic, and maybe an efficient strategy for the quarantine period.

Training load, sports performance, physical and mental health during the COVID-19 pandemic: A prospective cohort of Swiss elite athletes.

BACKGROUND: The COVID-19 pandemic and associated restrictions have led to abrupt changes in the lives of elite athletes. OBJECTIVES: The objective of this prospective cohort study was to examine training load, subjective sports performance, physical and mental health among Swiss elite athletes during a 6-month follow-up period starting with the first Swiss lockdown. METHODS: Swiss elite athletes (n = 203) participated in a repeated online survey evaluating health, training, and performance related metrics. After the first assessment during the first lockdown between April and May 2020, there were monthly follow-ups over 6 months. RESULTS: Out of 203 athletes completing the first survey during the first lockdown, 73 athletes (36%) completed all assessments during the entire 6-month follow-up period. Sports performance and training load decreased during the first lockdown and increased again at the beginning of the second lockdown in October 2020, while symptoms of depression and financial fears showed only a transient increase during the first lockdown. Self-reported injuries and illnesses did not change significantly at any timepoint in the study. Stricter COVID-19 restrictions, as measured by the Government Stringency Index (GSI), were associated with reduced subjective sports performance, as well as lower training intensity, increased financial fears, poorer coping with restrictions, and more depressive symptoms, as measured by the 9-item module of the Patient Health Questionnaire-9 (PHQ-9). CONCLUSION: This study revealed a negative impact of the COVID-19 restrictions on sports performance, training load and mental health among Swiss elite athletes, while the rate of self-reported injuries and illnesses remained unaffected.

Effects of l-Arginine Plus Vitamin C Supplementation on Physical Performance, Endothelial Function, and Persistent Fatigue in Adults with Long COVID: A Single-Blind Randomized Controlled Trial.

Long COVID, a condition characterized by symptom and/or sign persistence following an acute COVID-19 episode, is associated with reduced physical performance and endothelial dysfunction. Supplementation of l-arginine may improve endothelial and muscle function by stimulating nitric oxide synthesis. A single-blind randomized, placebo-controlled trial was conducted in adults aged between 20 and 60 years with persistent fatigue attending a post-acute COVID-19 outpatient clinic. Participants were randomized 1:1 to receive twice-daily orally either a combination of 1.66 g l-arginine plus 500 mg liposomal vitamin C or a placebo for 28 days. The primary outcome was the distance walked on the 6 min walk test. Secondary outcomes were handgrip strength, flow-mediated dilation, and fatigue persistence. Fifty participants were randomized to receive either l-arginine plus vitamin C or a placebo. Forty-six participants (median (interquartile range) age 51 (14), 30 [65%] women), 23 per group, received the intervention to which they were allocated and completed the study. At 28 days, l-arginine plus vitamin C increased the 6 min walk distance (+30 (40.5) m; placebo: +0 (75) m, p = 0.001) and induced a greater improvement in handgrip strength (+3.4 (7.5) kg) compared with the placebo (+1 (6.6) kg, p = 0.03). The flow-mediated dilation was greater in the active group than in the placebo (14.3% (7.3) vs. 9.4% (5.8), p = 0.03). At 28 days, fatigue was reported by two participants in the active group (8.7%) and 21 in the placebo group (80.1%; p < 0.0001). l-arginine plus vitamin C supplementation improved walking performance, muscle strength, endothelial function, and fatigue in adults with long COVID. This supplement may, therefore, be considered to restore physical performance and relieve persistent symptoms in this patient population.

Effects of COVID-19 home confinement on musculoskeletal health and physical performance in a cross-sectional study: results of the COVID-19 era online survey.

Introduction: the global pandemic of COVID-19 is the unique health crisis, the populations were exposed to situations of unprecedented confinement, this represents a major public health challenge, with a high risk of developing musculoskeletal disorders. The objective of the present work is to identify the potential effects of sedentary behavior on musculoskeletal health and physical performance. Methods: after two months of confinement a survey was uploaded and shared on Google's online survey platform. Two research laboratories, University Moulay Ismail, University Ibn Tofail, promoted the survey which was developed on the basis of two questionnaires: the French version of the Nordic questionnaire musculoskeletal disorders and the French version of the Global Physical Activity Questionnaire (GPAQ). Results: out of 384 respondents, 209 (54.4%) were females 124 (32.3%) were between 30-49 years old (6.8%) and 123 (32%) had an underweight and overweight levels, respectively. One hundred and thirty-nine 139 (36.2%) reported sitting more than eight hours. The results of our survey show that many of our respondents had developed some sort of musculoskeletal pain during the confinement. One hundred and sixty two (42.2%) reported to have pain in the lower back region, 108 (28.1%) of participants reported to have pain in the neck region, 93 (28.2%) in the shoulder region, 97 (25.3) - in the upper back region and more women than men reported musculoskeletal pain in more than five regions. The results of our survey also show that 322 (83,9%) of the participants, after two months of confinement, were unable to do high intensity exercises for at least 10 min per day in their usual daytime activity, the prevalence of musculoskeletal pain differed across categories of body mass index (BMI) between males and females, (p<0.05). Conclusion: the results of this study show the existence of musculoskeletal disorders and deterioration in physical performance and strongly recommend the urgent implementation of prevention and remediation interventions.

Exercise training as part of multidisciplinary rehabilitation in cancer survivors: an observational study on changes in physical performance and patient-reported outcomes.

PURPOSE: To describe changes in physical performance and patient-reported outcomes in cancer survivors who participated in an exercise program as part of usual-care multidisciplinary rehabilitation and the influence of training adaptations during the coronavirus-19 (COVID-19) pandemic. METHODS: In an observational cohort study, cancer survivors underwent usual-care multidisciplinary rehabilitation including a 10-week exercise program. During the COVID-19 pandemic, the exercise program was adapted with reduced training time and frequency. Mean changes and 95% confidence intervals in physical performance (peak oxygen uptake (VO2peak), peak work rate during a steep ramp test (SRT-WRpeak), 6-min walking distance, muscle strength) and patient-reported outcomes (health-related quality of life, fatigue, anxiety, and depression) were assessed between the start and the end of the exercise program. Linear regression analysis, adjusting for baseline levels of outcomes, was used to investigate differences in changes in outcomes between participants who underwent the original and the adapted program. RESULTS: All outcomes statistically significantly improved over time, regardless of adaptations in the exercise program. VO2peak increased with 9.6% and 7.7% in the original and adapted program, respectively. Significant smaller improvements were observed in SRT-WRpeak (- 3.9%) and upper body muscle strength (- 10.8%) after participation in the adapted compared to the original program. No significant between-group differences were observed for other outcomes. CONCLUSION: Physical performance and patient-reported outcomes statistically and clinically significantly improved in cancer survivors who participated in an exercise program as part of usual-care multidisciplinary rehabilitation. Improvements of performance outcomes were smaller since the training adaptations, though only significant for SRT-WRpeak and upper body strength.

The Impact of Charlson Comorbidity Index on the Functional Capacity of COVID-19 Survivors: A Prospective Cohort Study with One-Year Follow-Up.

OBJECTIVE: To determine the association between the Charlson comorbidity index (CCI) score after discharge with 6-min walk test (6MWT) 1 year after discharge in a cohort of COVID-19 survivors. METHODS: In this prospective study, data were collected from a consecutive sample of patients hospitalized for COVID-19. The CCI score was calculated from the comorbidity data. The main outcome was the distance walked in the 6MWT at 1 year after discharge. Associations between CCI and meters covered in the 6MWT were assessed through crude and adjusted linear regressions. The model was adjusted for possible confounding factors (sex, days of hospitalization, and basal physical capacity through sit-to-stand test one month after discharge). RESULTS: A total of 41 patients were included (mean age 58.8 ± 12.7 years, 20/21 men/women). A significant association was observed between CCI and 6MWT (meters): (i) crude model: ß = -18.7, 95% CI = -34.7 to -2.6, p < 0.05; (ii) model adjusted for propensity score including sex, days of hospitalization, and sit-to-stand: ß = -23.0, 95% CI = -39.1 to -6.8, p < 0.05. CONCLUSIONS: A higher CCI score after discharge indicates worse performance on the 6MWT at 1-year follow-up in COVID-19 survivors. The CCI score could also be used as a screening tool to make important clinical decisions.

Effects of different exercise training programs on the functional performance in fibrosing interstitial lung diseases: A randomized trial.

OBJECTIVES: We aimed to compare the effects of different aerobic exercise training (ET) programs on respiratory performance, exercise capacity, and quality of life in fibrosing interstitial lung diseases (f-ILD). METHODS: A case-control study where 31 patients with f-ILD diagnosis based on chest high-resolution computed tomography were recruited from Main Alexandria University hospital-Egypt. Ten patients were randomly assigned for only lower limbs (LL) endurance training program, and 10 patients for upper limbs, lower limbs, and breathing exercises (ULB) program for consecutive 18 sessions (3 sessions/week for 6 consecutive weeks). Eleven patients who refused to participate in the ET program were considered as control. All patients were subjected for St George's respiratory questionnaire (SGRQ), 6-minute walk test (6-MWT), forced spirometry and cardiopulmonary exercise testing (CPET) before and after ET programs. RESULTS: Fibrosing non-specific interstitial pneumonia (NSIP) and collagenic associated-ILD were the commonest pathologies among the ET groups (30% each) with mean age of 44.4±12.25 and 41.90±7.58 years for LL and ULB groups respectively and moderate-to-severe lung restriction. 6-MWT and SGRQ significantly improved after both ET programs (p<0.001). Peak oxygen consumption (VO2) improved significantly after both LL training (median of 22 (interquartile range (IQR) = 17.0-24.0) vs. 17.5 (IQR = 13.0-23.0) ml/kg/min, p = 0.032) and ULB training (median of 13.5 (IQR = 11.0-21.0) vs. 10.5 (IQR = 5.0-16.0) ml/kg/min, p = 0.018). Further, maximal work load and minute ventilation (VE) significantly improved after both types of ET training (p<0.05); however, neither ventilation equivalent (VE/VCO2) nor FVC% improved after ET (p = 0.052 and 0.259 respectively). There were no statistically significant important differences between LL and ULB training programs regarding 6-MWT, SGRQ or CPET parameters (p>0.05). CONCLUSIONS: ET was associated with improvements in exercise capacity and quality of life in f-ILD patients irrespective of the type of ET program provided.

Improvements of Physical Activity Performance and Motivation in Adult Men through Augmented Reality Approach: A Randomized Controlled Trial.

The COVID-19 pandemic had a global impact, increasing the prevalence of physical inactivity, which is mostly due to the lockdown and social distancing measures adopted during the pandemic. Hence, this study aimed to compare the efficacy of augmented reality-based training on physical activity performance and motivation in healthy adults to mirror visual feedback training and conventional physical therapy. This study used the randomized control trial pretest-posttest research design. Forty-eight healthy men aged 18-35 years who were engaged in recreational physical activities were enrolled and randomly divided into four groups: augmented reality-based training reality (ART), mirror visual feedback training (MVFT), therapist-based training (TBT), and control group. The total training program was held for four weeks. The isokinetic dynamometer, sit-and-reach test, Y balance test, and the intrinsic motivation inventory-22 were used to measure the outcomes before and after the intervention. Paired sample t-test was used to compare the changes before and after the intervention within groups, while the one-way ANOVA was used for the comparison between the groups. Results of the study showed that, after four weeks of intervention, balance, muscle strength, and muscle endurance in all groups significantly improved except for the control group. The ART group showed the highest increase in muscle strength, muscle endurance, and balance compared to the other groups. The motivation level increased in all three feedback groups and was observed in the following order: ART group > MVFT group > TBT group > control group. This study highlighted the most effective method that may be applied for home training during and after this period of the pandemic. The findings revealed that training while receiving real-time feedback via AR devices improves both physical performance and motivation. Augmented reality-based training can be used as an effective training option for improving physical activity and motivation and can be suggested for home training programs.

Effects of a New Multicomponent Nutritional Supplement on Muscle Mass and Physical Performance in Adult and Old Patients Recovered from COVID-19: A Pilot Observational Case-Control Study.

OBJECTIVE: The purpose of the present study was to assess the effect of a specific oral nutritional supplement among patients recovered from COVID-19 but suffering symptoms of fatigue. METHODS: This is an observational case-control study involving a sample of 66 COVID-19 survivors divided in two groups, 33 subjects in the intervention group who received the nutritional supplement and 33 subjects in the control group. The nutritional supplement received by subjects in the active group was based on amino acids; vitamin B6 and B1; and malic, succinic and citric acids. After an 8-week follow-up, the main outcomes considered were skeletal muscle index (measured by bioelectrical impedance analysis), physical performance measures (handgrip strength, one-minute chair-stand test, six-minute walking test), and quality of life (using EuroQol visual analogue scale). RESULTS: All the considered areas increased significantly in the subjects receiving the active treatment with oral nutritional supplement in comparison with the baseline values. After adjusting for age, gender, and baseline values, skeletal muscle index, handgrip strength test, the one-minute chair-stand test, and six-minute walking test values were higher among participants in the treatment group compared with subjects in control group. The oral nutritional supplement significantly improved the handgrip strength; similarly, participants in the active group showed a higher improvement in skeletal muscle index, the one-minute chair-stand test, the six-minute walking test, and in quality of life. CONCLUSION: The nutritional supplement containing nine essential amino acids plus cysteine; vitamin B6 and B1; and malic, succinic and citric acids had a positive effect on nutritional status, functional recovery, and quality of life in COVID-19 survivors still suffering from fatigue. Additional controlled clinical trials are required to corroborate these results.

Effects of Medical Face Masks on Physical Performance in Patients With Coronary Artery Disease or Hypertension.

In this randomized, prospective monocentric study, 40 subjects with coronary artery disease or hypertension (cardiovascular disease [CVD] group) were assigned to either surgical mask (SM) or class 2 filtering facepiece mask (FFP2). They performed cycle ergometry exercise tests with progressive intensity until exhaustion with the assigned mask and another test with no mask (NM) in random order. A control group of 10 healthy subjects randomly performed 3 exercise tests with NM, SM, and FFP2, respectively. Blood pressure, heart rate, 12-lead electrocardiogram, exertion, shortness of breath, and capillary blood gases from the earlobe were documented. Across all groups, exercise testing with face masks resulted in a significantly reduced peak power output in watts compared with testing with NM (CVD group: SM vs NM: -5.0 ± 7.0%, p = 0.005; FFP2 vs NM: -4.7 ± 14%, p = 0.03; control group: SM vs NM: -6.8 ± 4.4%, p = 0.008; FFP2 vs NM: -8.9 ± 6.3%; p = 0.01) without differences in hemodynamic parameters, such as maximum heart rate and systolic blood pressure. Wearing an FFP2 compared with NM resulted in significant higher carbon dioxide partial pressure (CVD group: FFP2: 36.0 ± 3.2 mm Hg vs NM: 33.3 ± 4.4 mm Hg, p = 0.019; control group: FFP2: 32.6 ± 2.8 mm Hg vs NM: 28.1 ± 1.7 mm Hg, p <0.001) with corresponding differences in hydrogen carbonate and base excess, but not to a clinically critical extent. In conclusion, exercise testing with SM and FFP2 resulted in a significant reduction of peak power output without differences in hemodynamic parameters in subjects with preexisting CVD and in healthy subjects.

Poor Physical Performance Is Associated with Postoperative Complications and Mortality in Preoperative Patients with Colorectal Cancer.

INTRODUCTION: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. METHODS: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. RESULTS: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37-4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37-5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). CONCLUSIONS: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.

Effectiveness of a Telerehabilitative Home Exercise Program on Elder Adults' Physical Performance, Depression and Fear of Falling.

Our aim in this study was to analyze the effects of a home exercise program of calisthenic exercises delivered through telerehabilitation on physical performance, depression, and risk of falling in elder adults. Our participants were elder adults aged 65 and over, divided into exercise and control groups. We initiated a 4-week telerehabilitation calisthenic exercise program in the exercise group following initial assessments, while our control group received no formal exercise training. Both groups were evaluated online before and after this 4-week period with the Geriatric Depression Scale (GDS), Modified Falls Efficacy Scale (MFES), and Short Physical Performance Battery (SPPB). In total, 255 elder adults participated, with 132 (males = 72, females = 60) allocated to calisthenic exercise and 123 (males = 66, females = 57) allocated to the control group. While the groups did not differ significantly on any of our parameters before the exercise, there were statistically significant post-exercise group differences in GDS (p ≤ .001) and MFES (p ≤ .001) scores related to remarkable physical improvements achieved in the calisthenic exercise group. The exercise group showed significant increases in their scores on the SPPB Balance Test (p = .049), SPPB Chair Test (p = .009), and SPPB Total (p = .002) while there was no significant increase in any of these scores among control group participants (p > .05). Thus, calisthenic exercises performed via telerehabilitation significantly improved elder adults' physical performance, fear of falling, and depression. Telerehabilitation is a useful remote means of assessing, inducing, and following-up exercise training, particularly during the ongoing COVID-19 pandemic.

Prospective telehealth analysis of functional performance, frailty, quality of life, and mental health after COVID-19 hospitalization.

BACKGROUND: COVID-19 is a global pandemic with poorly understood long-term consequences. Determining the trajectory of recovery following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation. The purpose of this study was to prospectively evaluate recovery following COVID-19 hospitalization. METHODS: Participants age 18 years or older who were hospitalized for ≥24 h due to COVID-19 completed phone/video call virtual assessments (including the 10-time chair rise test) and survey forms at three time points (2-6, 12, and 18 weeks) after hospital discharge. Univariate logistic and linear regression models assessed the associations of the outcomes with primary predictors (categorical age, sex, race/ethnicity group, and categorical pre-hospitalization frailty) at baseline; the same were used to assess differences in change from week 2-6 (continuous outcomes) or outcome persistence/worsening (categorical) at last contact. RESULTS: One hundred nine adults (age 53.0 [standard deviation 13.1]; 53% female) participated including 43 (39%) age 60 or greater; 59% identified as an ethnic and/or racial minority. Over 18 weeks, the mean time to complete the 10-time chair rise test decreased (i.e., improved) by 6.0 s (95% CI: 4.1, 7.9 s; p < 0.001); this change did not differ by pre-hospital frailty, race/ethnicity group, or sex, but those age ≥ 60 had greater improvement. At weeks 2-6, 67% of participants reported a worse Clinical Frailty Scale category compared to their pre-hospitalization level, whereas 42% reported a worse frailty score at 18 weeks. Participants who did not return to pre-hospitalization levels were more likely to be female, younger, and report a pre-hospitalization category of 'very fit' or 'well'. CONCLUSIONS: We found that functional performance improved from weeks 2-6 to 18 weeks of follow-up; that incident clinical frailty developed in some individuals following COVID-19; and that age, sex, race/ethnicity, and pre-hospitalization frailty status may impact recovery from COVID-19. Notably, individuals age 60 and older were more likely than those under age 45 years to return to their pre-hospitalization status and to make greater improvements in functional performance. The results of the present study provide insight into the trajectory of recovery among a representative cohort of individuals hospitalized due to COVID-19.

Biological, Psychological, and Physical Performance Variations in Football Players during the COVID-19 Lockdown: A Prospective Cohort Study.

This prospective cohort study aimed to evaluate whether COVID-19 lockdown caused biological, psychological, and/or physical performance variations in footballers. We compared the 2018/2019 and 2019/2020 seasons evaluating the plasma volume, hematological parameters, iron/ferritin, creatine kinase, vitamin D, cortisol, testosterone, and physiological state of players of the Italian football major league (Serie A). Measurements were performed before the preparatory period (T0), at the beginning (T1) and in the middle (T2) of the championship, and in March (T3) and at the end of season (T4). The results showed that in the 2019/2020 season affected by the lockdown, the weight, BMI, and fat mass percentage were higher than in the previous season. Hematocrit, hemoglobin, red blood cells, and ferritin decreased during both seasons, more significantly than in the regular season. During both seasons, creatine kinase increased from T2 whilst iron concentrations decreased in T3. Testosterone increased in both seasons from T0 to T3 and returned to initial levels at T4; cortisol increased in T2 and T3 during the 2018/2019 season but not during the COVID-19 season. Physical performance tests revealed differences associated with lockdown. Thus, although from a medical point of view, none of the evaluated changes between the two seasons were clinically relevant, training at home during lockdown did not allow the players to maintain the jumping power levels typical of a competitive period.

Remote administration of physical performance tests among persons with and without a cancer history: Establishing reliability and agreement with in-person assessment.

OBJECTIVES: To assess the reliability of using videoconference technology to remotely administer the Short Physical Performance Battery (SPPB), including the 5-time sit-to-stand (5XSTS) and usual 4-m walk (4mWT), and the Timed Up and Go (TUG) tests and agreement with in-person administration among adults with and without cancer. METHODS: Participants from two ongoing clinical exercise trials in cancer survivors, one that included partners without cancer, comprised the available sample (n = 176; mean age 62.5 ± 11.5 years.). Remote tests were administered on two separate days by either the same or a different assessor to determine intra-rater and inter-rater reliability, respectively. We also compared tests conducted remotely and in-person using the same assessor and the same participant. Intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI) were used for all comparisons, except for the SPPB score, which used Cohen's kappa and Krippendorf's alpha for intra- and inter-rater reliability, respectively. RESULTS: Remote assessment of the TUG test had excellent intra-rater reliability (0.98, 95% CI 0.93-0.99), inter-rater reliability (ICC = 0.96, 95% CI 0.90-0.99), and good agreement with in-person tests (ICC = 0.88, 95% CI 0.74-0.94). The 5XSTS and 4mWT showed excellent (ICC = 0.92, 95% CI 0.84-0.96) and good (ICC = 0.87, 95% CI 0.71-0.94) intra-rater reliability, respectively, but somewhat lower inter-rater reliability (5XSTS: ICC = 0.65, 95% CI 0.34-0.83 and 4mWT: ICC = 0.62, 95% CI 0.30-0.81). Remote 5XSTS had moderate agreement (ICC = 0.72, 95% CI 0.62-0.80) and 4mWT had poor agreement (ICC = 0.48, 95% CI -0.07-0.76) with in-person tests. CONCLUSIONS: Remote assessment of common physical function tests in older adults, including those who have cancer, is feasible and highly reliable when using the same assessor. TUG may be the most methodologically robust measure for remote assessment because it is also highly reliable when using different assessors and correlates strongly with in-person testing. Adapting administration of objective measures of physical function for the remote environment could significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.

Effects of Face Masks on Physical Performance and Physiological Response during a Submaximal Bicycle Ergometer Test.

The ongoing COVID-19 pandemic requires wearing face masks in many areas of our daily life; hence, the potential side effects of mask use are discussed. Therefore, the present study explores whether wearing a medical face mask (MedMask) affects physical working capacity (PWC). Secondary, the influence of a filtering facepiece mask with exhalation valve class 2 (FFP2exhal) and a cotton fabric mask (community mask) on PWC was also investigated. Furthermore, corresponding physiological and subjective responses when wearing face masks as well as a potential moderating role of subjects' individual cardiorespiratory fitness and sex on face mask effects were analyzed. Thirty-nine subjects (20 males, 19 females) with different cardiorespiratory fitness levels participated in a standardized submaximal bicycle ergometer protocol using either a MedMask, FFP2exhal, community mask, or no mask (control) on four days, in randomized order. PWC130 and PWC150 as the mechanical load at the heart rates of 130 and 150 beats per minute were measured as well as transcutaneous carbon dioxide partial pressure, saturation of peripheral capillary oxygen, breathing frequency, blood pressure, perceived respiratory effort, and physical exhaustion. Using the MedMask did not lead to changes in PWC or physiological response compared to control. Neither appeared changes exceeding normal ranges when the FFP2exhal or community mask was worn. Perceived respiratory effort was up to one point higher (zero-to-ten Likert scale) when using face masks (p < 0.05) compared to control. Sex and cardiorespiratory fitness were not factors influencing the effects of the masks. The results of the present study provide reason to believe that wearing face masks for infection prevention during the COVID-19 pandemic does not pose relevant additional physical demands on the user although some more respiratory effort is required.