Cardiovascular, Respiratory, and Functional Effects of Home-Based Exercise Training after COVID-19 Hospitalization.

INTRODUCTION: The present randomized, single-center, and single-blinded clinical trial tested the hypothesis that tele-supervised home-based exercise training (exercise) is an effective strategy for improving cardiovascular, respiratory, and functional capacity parameters in individuals who were hospitalized due to coronavirus disease 2019 (COVID-19). METHODS: Thirty-two individuals (52 ± 10 yr; 17 were female) randomly assigned to exercise ( n = 12) or control groups ( n = 20) had their anthropometric (weight, body mass index), hemodynamic (brachial and central blood pressure), vascular (arterial stiffness), ventilatory (pulmonary function and respiratory muscle strength), and functional parameters (handgrip strength, five-time sit to stand, timed up and go test, and 6-min walking test) assessed at baseline (30-45 d of hospital discharged) and after 12 wk of follow-up. RESULTS: Both groups similarly increased ( P < 0.001) forced vital capacity (absolute and percent of predicted), forced expiratory volume in the first second (absolute and percent of predicted), and handgrip strength during follow-up. However, only the exercise group reduced carotid-femoral pulse wave velocity (-2.0 ± 0.6 m·s -1 , P = 0.048) and increased ( P < 0.05) resting oxygen saturation (1.9% ± 0.6%), mean inspiratory pressure (24.7 ± 7.1 cm H 2 O), mean expiratory pressure (20.3 ± 5.8 cm H 2 O), and percent of predicted mean expiratory pressure (14% ± 22%) during follow-up. No significant changes were found in any other variable during follow-up. CONCLUSIONS: Present findings suggest that tele-supervised home-based exercise training can be a potential adjunct therapeutic to rehabilitate individuals who were hospitalized due to COVID-19.

Exercise modulates the immune system in cardiorespiratory disease patients: Implications for clinical practice during the COVID-19 pandemic.

BACKGROUND: Patients with cardiorespiratory problems often suffer from systemic inflammation. Stress due to the disease and continuous inflammation can undermine the success of the rehabilitation program. OBJECTIVE: This review has been undertaken primarily to understand the effectiveness of exercise training on the immune system in individuals undergoing cardiorespiratory rehabilitation and its implications for further management during the COVID-19 pandemic. METHODS: Assessors analyzed related studies identified in the MEDLINE, PROQUEST, PUBMED, Cochrane Library, CINAHL, EMBASE, Google Scholar, Physiotherapy Evidence, and Science Direct databases. The studies were divided into groups focused on the effect of exercise on blood leukocytes, the anti-inflammatory effect, and the role of nutrition and exercise in resolving inflammation. RESULTS: Twenty-eight studies were included in this review. The number of studies included in each section was as follows: the effects of exercise training on leukocytes in cardiorespiratory conditions (n = 8), anti-inflammatory effect (n = 6), and the role of nutrition and exercise in resolving inflammation (n = 14). The bias risk assessment showed poor internal validity; most included studies were assigned no and unclear descriptors. CONCLUSIONS: Substantive evidence is presented that emphasizes the role of moderate-intensity exercise in boosting the immune system in patients with cardiorespiratory diseases. Exercise has anti-inflammatory effects that are vital for overall well-being and resolving longstanding inflammation. Individuals with an active lifestyle had a better pathogen immune response than more sedentary individuals. Our findings highlight the current need to investigate the long-term effects of cardiorespiratory rehabilitation programs.

Intra- and Interrater Reliability of Short-Term Measurement of Heart Rate Variability on Rest in Individuals Post-COVID-19.

Individuals affected by COVID-19 have an alteration in autonomic balance, associated with impaired cardiac parasympathetic modulation and, consequently, a decrease in heart rate variability (HRV). This study examines the inter- and intrarater reliability of HRV) parameters derived from short-term recordings in individuals post-COVID. Sixty-nine participants of both genders post-COVID were included. The RR interval, the time elapsed between two successive R-waves of the QRS signal on the electrocardiogram (RRi), were recorded during a 10 min period in a supine position using a portable heart rate monitor (Polar® V800 model). The data were transferred into Kubios® HRV standard analysis software and analyzed within the stable sessions containing 256 sequential RRi. The intraclass correlation coefficient (ICC) ranged from 0.920 to 1.000 according to the intrarater analysis by Researcher 01 and 0.959 to 0.999 according to the intrarater by Researcher 02. The interrater ICC ranged from 0.912 to 0.998. The coefficient of variation was up to 9.23 for Researcher 01 intrarater analysis, 6.96 for Researcher 02 intrarater analysis and 8.83 for interrater analysis. The measurement of HRV in post-COVID-19 individuals is reliable and presents a small amount of error inherent to the method, supporting its use in the clinical environment and in scientific research.

Exercise modulates the immune system in cardiorespiratory disease patients: implications for clinical practice during the COVID-19 pandemic

Background Patients with cardiorespiratory problems often suffer from systemic inflammation. Stress due to the disease and continuous inflammation can undermine the success of the rehabilitation program. Objective This review has been undertaken primarily to understand the effectiveness of exercise training on the immune system in individuals undergoing cardiorespiratory rehabilitation and its implications for further management during the COVID-19 pandemic. Methods Assessors analyzed related studies identified in the MEDLINE, PROQUEST, PUBMED, Cochrane Library, CINAHL, EMBASE, Google Scholar, Physiotherapy Evidence, and Science Direct databases. The studies were divided into groups focused on the effect of exercise on blood leukocytes, the anti-inflammatory effect, and the role of nutrition and exercise in resolving inflammation. Results Twenty-eight studies were included in this review. The number of studies included in each section was as follows: the effects of exercise training on leukocytes in cardiorespiratory conditions (n=8), anti-inflammatory effect (n=6), and the role of nutrition and exercise in resolving inflammation (n=14). The bias risk assessment showed poor internal validity;most included studies were assigned no and unclear descriptors. Conclusions Substantive evidence is presented that emphasizes the role of moderate-intensity exercise in boosting the immune system in patients with cardiorespiratory diseases. Exercise has anti-inflammatory effects that are vital for overall well-being and resolving long-standing inflammation. Individuals with an active lifestyle had a better pathogen immune response than more sedentary individuals. Our findings highlight the current need to investigate the long-term effects of cardiorespiratory rehabilitation programs.

Results and effects of patients who have recovered from COVID-19: identifying the relationship with risk factors and comorbidities.

The number of deaths from COVID-19 is closely associated with multimorbidities. This study aimed to review the clinical and functional conditions of patients who recovered from COVID-19. Additionally, identify the relationship with risk factors and comorbidities. Systemic arterial hypertension (SAH) was more frequently observed in patients with severe COVID-19. Diabetes mellitus (DM) is one of the comorbidities that has contributed the most to the increase in the number of hospitalizations due to complications and the number of deaths due to infection by COVID-19. Obesity has been shown to be a risk factor for hospitalization in patients with COVID-19 under 60 years of age. Most survivors of COVID-19 suffer primarily from muscle fatigue or weakness. In addition, patients who were more seriously ill during their hospital stay have greater impairment of functional capacity, pulmonary diffusion and fatigue symptoms, and are the main target population for long-term recovery interventions. To optimize the post-hospitalization rehabilitation of patients after discharge from COVID-19, the need for multidisciplinary work in rehabilitation, the reinforcement of public policies to ensure equity in access to the public health system and training should be considered of the health team in view of the new demands and realities generated by COVID-19.

Can Previous Levels of Physical Activity Affect Risk Factors for Cardiorespiratory Diseases and Functional Capacity after COVID-19 Hospitalization? A Prospective Cohort Study.

Purpose: To evaluate the influence of previous levels of physical activity on hemodynamic, vascular, ventilatory, and functional outcomes after coronavirus disease 2019 (COVID-19) hospitalization. Methods: Sixty-three individuals with COVID-19 had their clinical status and previous levels (12 month) of physical activity (Baecke Questionnaire of Habitual Physical Activity) assessed at hospital admission. Individuals were then allocated to lower levels of physical activity (ACTLOWER; N = 22), intermediate levels of physical activity (ACTINTERMEDIATE; N = 22), or higher levels of physical activity (ACTHIGHER; N = 19) groups, according to tertiles of physical activity. Resting hemodynamic (heart rate and brachial/central blood pressures) and vascular (carotid-femoral pulse wave velocity, augmentation index, and brachial artery flow-mediated dilation) variables, pulmonary function (spirometry), respiratory muscle strength (maximal respiratory pressures), and functional capacity (handgrip strength, five-time sit-to-stand, timed-up and go, and six-minute walking tests) were measured at 30 to 45 days after hospital discharge. Results: ACTLOWER showed lower levels (P < 0.05) of forced vital capacity, forced expiratory volume in the first second, maximal voluntary ventilation, and maximal expiratory pressure than ACTHIGHER. ACTLOWER also had lower (P = 0.023) walking distance (~21%,) and lower percentage of predicted walking distance (~20%) at six-minute walking test during follow-up than ACTINTERMEDIATE. However, hemodynamic and vascular variables, handgrip strength, five-time sit-to-stand, and timed-up and go were not different among groups. Conclusion: ACTLOWER showed impaired ventilatory parameters and walking performance when compared with ACTHIGHER and ACTINTERMEDIATE, respectively. These results suggest that previous levels of physical activity may impact ventilatory and exercise capacity outcomes 30 to 45 days after COVID-19 hospitalization discharge.

COVID-19 seen from a syndemic perspective: Impact of unhealthy habits and future perspectives to combat these negative interactions in Latin America.

COVID-19 has to this point led to more than 5 million deaths and has imposed numerous measures restricting populations worldwide, including Latin America (LA). However, analyzing COVID-19 from the perspective of a syndemic, it demonstrates the relationship between the interaction of multiple comorbidities and the increase of contagion in people who are socially vulnerable. The number of deaths by COVID-19 in LA is strongly associated with multi-morbidities (diabetes, obesity, sedentary, smoking, among others) and disproportionately attacks communities located in poorer, low-income regions and ethnic minorities. This review aims to revisit the relationship between COVID-19 and both unhealthy living habits (i.e., sedentary lifestyle, poor nutritional habits, overweight and obesity, smoking) and cardiovascular disease in Latin American countries. In addition, this review aims to introduce strategies and policies that combat social inequalities and enable healthy living behaviors in LA countries. If LA countries do not work on public policies that decrease multi-morbidities and social inequalities, we will be unable to eliminate COVID-19, as well as possible other outbreaks that may arise in the future.

Noninvasive ventilation in patients with COVID-19 from the perspective of the risk of contamination: a narrative review.

INTRODUCTION: noninvasive ventilation (NIV) can be a useful resource to treat acute respiratory failure (ARF), which occurs in patients with COVID-19. However, it is important to consider that there are still no clinical studies that have verified the safety of its use in increase of contamination. AREAS COVERED: Given the potential benefits and simultaneous concerns over the use of NIV in patients with COVID-19, further inquiry is necessary to reach a clinical consensus and provide recommendations for safe use, avoiding contamination. In this context, this narrative review, which included articles published in the Embase, SciELO, PEDro, PubMed and Cochrane up to August 2021, is focused to evaluate available studies related to interfaces, types of circuits, recommended filters, cares for the environment and protective factors for NIV use in patients with COVID-19. EXPERT OPINION: The studies analyzed recommend that the use of NIV can be safe: 1) with equipment that allows the use of the helmet as a safer interface; 2) with double circuit and antimicrobial filter in the expiratory branch; 3) in an environment that allows negative pressure, reducing the dispersion of aerosol particles in the environment; 4) the health team must use the recommended PPE to avoid contamination.

Covid-19 and the impact on the physical activity level of elderly people: A systematic review.

INTRODUCTION: Social isolation and lifestyle changes provoked by the COVID-19 pandemic have negatively affected the level of physical activity of the elderly people. OBJECTIVE: To evaluate the available evidence related to the level of physical activity (PA) of elderly people during the COVID-19 pandemic. METHODS: This is a systematic review, registered on PROSPERO (CRD42021241116), which included cross-sectional and cohort studies. Embase, Pubmed, Cochrane, Web of Science and Scopus databases were used to search for the studies. Finally, the New Castle-Ottawa Quality Assessment scale was used to measure the quality of the studies. RESULTS: 25 studies were found, being 14 cross-sectional and 11 cohort studies. The studies showed that the elderly population was highly affected in relation to the level of physical activity and lifestyle during restrictions, quarantine and lockdowns caused by the COVID-19. There was a significant reduction in physical activity levels, leading to declines in physical fitness and increased sedentary lifestyle, factors directly related to the increase in frailty in this population. CONCLUSION: The level of physical activity in the elderly population decreased during the quarantine period of COVID-19 worldwide. Strategies to maintain physical condition must be encouraged with physical exercises that meets the needs of the elderly in the current pandemic scenario, in order to maintain and improve the health of this population.

Determinants of endothelial dysfunction in noncritically ill hospitalized COVID-19 patients: A cross-sectional study.

OBJECTIVE: The aim of this study was to identify determinants of endothelial dysfunction in patients hospitalized with acute COVID-19. METHODS: A total of 109 hospitalized COVID-19 patients in noncritical status were cross-sectionally studied. Clinical data (age, sex, comorbidities, and medications) and BMI were assessed. Laboratory tests included serum hemoglobin, leukocytes, lymphocytes, platelets, C-reactive protein, ferritin, D-dimer, and creatinine. Physical status was evaluated using a handgrip dynamometer. Endothelial function was assessed noninvasively using the flow-mediated dilation (FMD) method. RESULTS: The sample average age was 51 years, 51% of patients were male, and the most frequent comorbidity was obesity (62%). Univariate analysis showed association of lower FMD with higher BMI, hypertension, use of oral antihypertensive, higher blood levels of creatinine, and larger baseline artery diameter. After adjusting for confounders, the multivariate analysis showed BMI (95% CI: -0.26 to -0.11; p < 0.001) as the major factor associated with FMD. Other factors associated with FMD were baseline artery diameter (95% CI: -1.77 to -0.29; p = 0.007) and blood levels of creatinine (95% CI: -1.99 to -0.16; p = 0.022). CONCLUSIONS: Increased BMI was the major factor associated with endothelial dysfunction in noncritically hospitalized COVID-19 patients. This may explain one of the pathways in which obesity may increase the risk for severe COVID-19.

Revisiting pulmonary rehabilitation during COVID-19 pandemic: a narrative review.

There has been an apparent association between the risks of complications with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with a history of existing chronic respiratory diseases during the pandemic of coronavirus disease 2019 (COVID-19). SARS-CoV-2 poses a severe risk in cardiopulmonary management. Moreover, chronic respiratory diseases may further amplify the risk of morbidity and mortality among the afflicted population in the pandemic era. The present review outlines the importance of pulmonary rehabilitation (PR) in persons with chronic respiratory diseases (Chronic obstructive pulmonary disease (COPD) and Asthma) during the COVID-19 era. In this context, amongst the population with a pre-existing pulmonary diagnosis who have contracted SARS-CoV-2, following initial medical management and acute recovery, exercise-based pulmonary rehabilitation (PR) may play a crucial role in long-term management and recovery. The energy conservation techniques will play a pragmatic role in PR of mild to moderate severity cases to counter post-COVID-19 fatigue. Moreover, there is also an urgent need to effectively address post-COVID-19 anxiety and depression, affecting the PR delivery system.

Endothelial function provides early prognostic information in patients with COVID-19: A cohort study.

BACKGROUND: The prothrombotic phenotype and diffuse intravascular coagulation observed in COVID-19 reflect endothelial dysfunction, which is linked to blood flow delivery deficiencies and cardiovascular risk. Assessments of detect vascular deficiencies among newly diagnosed and hospitalized patients due to COVID-19 have yet to be determined. OBJECTIVE: To assess endothelial function characteristics in relation to length of hospitalization and mortality in patients diagnosed with COVID-19 and compare to patients without COVID-19. METHODS: A prospective observational study involving 180 patients with confirmed COVID-19 (COVID-19 group) or suspected and ruled out COVID-19 (Non-COVID-19 group). Clinical evaluation and flow mediated vasodilation (FMD) were performed between the first 24-48 h of hospitalization. Patients were followed until death or discharge. RESULTS: We evaluated 98 patients (COVID-19 group) and 82 (Non-COVID-19 group), COVID-19 group remained hospitalized longer and more deaths occurred compared to the Non-COVID-19 group (p = 0.01; and p < 0.01). Patients in COVID-19 group also had a significantly greater reduction in both FMDmm and FMD% (p < 0.01 in both). We found that absolute FMD≤0.26 mm and relative FMD≤3.43% were the ideal cutoff point to predict mortality and longer hospital stay. In Kaplan Meyer's analysis patients had a high probability of death within a period of up to 10 days of hospitalization. CONCLUSION: Patients hospitalized for COVID-19 present endothelial vascular dysfunction early, remained hospitalized longer and had a higher number of deaths, when compared with patients without COVID-19.

Lifestyle and rehabilitation during the COVID-19 pandemic: guidance for health professionals and support for exercise and rehabilitation programs.

Introduction: The coronavirus disease-2019 (COVID-19) is a highly contagious respiratory viral disease for both the general population and healthcare professionals caring for infected patients. Of particular concern is the potential for significant respiratory, cardiovascular, physical, and psychological dysfunctions.Areas covered: In this context, the current review will focus on the following areas: 1) staying physically active during the COVID-19 pandemic; 2) highlighting the importance of understanding COVID-19 mechanisms; 3) preventing infections for healthcare workers by using personal protective equipment; 4) highlighting importance of respiratory care and physical therapy during hospitalization in patients with COVID-19; and 5) facilitating referral to a rehabilitation program in patients recovering from COVID-19.Expert opinion: We recommend daily physical exercise, outdoors or at home, as physical exercise increases the synthesis of anti-inflammatory cytokines; Patients with COVID-19 may develop severe acute respiratory syndrome, hypoxemia, diffuse alveolar damage, ACE2 reduction in the cardiovascular system and muscle weakness acquired through a prolonged hospital stay; The role of the physiotherapist in the hospital environment is of fundamental importance-early mobilization is highly recommended in severe cases of COVID-19.

Cardiorespiratory and skeletal muscle damage due to COVID-19: making the urgent case for rehabilitation.

INTRODUCTION: It has become increasingly evident that COVID-19 contributes to multiorgan pathophysiology. The systemic inflammatory response increases both pro-inflammatory cytokine and chemokine levels, leading to immune dysregulation and increasing the likelihood of incurring cardiac and pulmonary injuries. AREAS COVERED: Longer periods of hospitalization (~20 days) increase susceptibility to ICU-acquired muscle weakness and deconditioning, which decreases muscle function and functional capacity. These conditions affect the quality of life in the post-COVID-19 period and require multi-disciplinary approaches to rehabilitate the cardiopulmonary and musculoskeletal systems of these patients. In this context, this narrative review, which included articles published in the Embase, PEDro and PubMed databases up to December 2020, is focused on discussing the essential role of exercise and rehabilitation health professionals in the COVID-19 recovery process, from hospitalization to hospital discharge, addressing strategies for professionals to mitigate the cardiac and pulmonary impairments associated with hospitalization to home or ambulatory rehabilitation, purposing ways to conduct rehabilitation programs to restore their functional status and quality of life after the infection. EXPERT OPINION: In the current environment, these findings further point to the vital role of rehabilitation health professionals in the coming years and the urgent need to develop strategies to assist COVID-19 survivors.