Globally altered sleep patterns and physical activity levels by confinement in 5056 individuals: ECLB COVID-19 international online survey

Ramadan intermittent fasting induced poorer training practices during the COVID-19 lockdown: A global cross-sectional study with 5529 athletes from 110 countries

Ramadan intermittent fasting during the COVID-19 lockdown (RIFL) may present unique demands. We investigated training practices (i.e., training load and training times) of athletes, using pre-defined survey criteria/questions, during the 'first' COVID-19 lockdown, comparing RIFL to lockdown-alone (LD) in Muslim athletes. Specifically, a within-subject, survey-based study saw athletes (n = 5,529; from 110 countries/territories) training practices (comparing RIFL to LD) explored by comparative variables of: sex; age; continent; athlete classification (e.g., world-class); sport classification (e.g., endurance); athlete status (e.g., professional); and level of training knowledge and beliefs/attitudes (ranked as: good/moderate/poor). During RIFL (compared to LD), athlete perceptions (ranges presented given variety of comparative variables) of their training load decreased (46-62%), were maintained (31-48%) or increased (2-13%). Decreases (≥ 5%, p < 0.05) affected more athletes aged 30-39 years than those 18-29 years (60 vs 55%); more national than international athletes (59 vs 51%); more team sports than precision sports (59 vs 46%); more North American than European athletes (62 vs 53%); more semi-professional than professional athletes (60 vs 54%); more athletes who rated their beliefs/attitudes 'good' compared to 'poor' and 'moderate' (61 vs 54 and 53%, respectively); and more athletes with 'moderate' than 'poor' knowledge (58 vs 53%). During RIFL, athletes had different strategies for training times, with 13-29% training twice a day (i.e., afternoon and night), 12-26% at night only, and 18-36% in the afternoon only, with ranges depending on the comparative variables. Training loads and activities were altered negatively during RIFL compared to LD. It would be prudent for decision-makers responsible for RIFL athletes to develop programs to support athletes during such challenges.

Long-Term Impact of COVID-19 Pandemic in Sleep Quality and Lifestyle in Young Adults

Due to the evolution of COVID-19,restrictive measures were implemented. The quarantine resulted in significant changes in the social, economic, and psychological status of the population; however, its long-term effects have not yet been elucidated, especially in young adults. In the present study, people aged 18-25 years were studied, in relation to their sleeping, smoking, eating, and drinking habits and their physical activity before, during, and after the implementation of quarantine. We included 540 respondents (21.2 ± 2.3 years, 62.8% female). During quarantine, from 23 March to 4 May 2020, we observed an increase in sleep hours by 1.17 ± 1.98 h (p < 0.001), time of sleep arrival by 11.90 ± 30.41 min (p < 0.001), and number of daily meals by 0.66 ± 1.4 (p < 0.001). The subjects who consumed alcoholic beverages never or almost never had an upward change of 27.04%, and the time of daily exercise was reduced by 10.16 ± 48.68 min (p < 0.001). After quarantine, cigarettes per day increased by 1.14 ± 3.62 (p < 0.001) and the awakenings during night time increased by 0.37 ± 1.93 (p < 0.001). Our results suggest that the quarantine brought about significant changes in smoking, sleeping habits, physical activity, dietary habits, and the consumption of alcoholic beverages, some of which continue after its termination.

The impact of COVID-19 lockdowns on physical activity amongst older adults: evidence from longitudinal data in the UK

Background

A sedentary lifestyle increases the risk of adverse health outcomes and frailty,particularly for older adults. To reduce transmission during the COVID-19 pandemic, people were instructed to stay at home, group sports were suspended, and gyms were closed, thereby limiting opportunities for physical activity. Whilst evidence suggests that physical activity levels reduced during the pandemic, it is unclear whether the proportion of older adults realising the recommended minimum level of physical activity changed throughout the various stages of lockdown.

Methods

We used a large sample of 3,660 older adults (aged ≥ 65) who took part in the UK Household Longitudinal Study’s annual and COVID-19 studies. We examined changes in the proportion of older adults who were realising the UK Chief Medical Officers’ physical activity recommendations for health maintenance at several time points before and after COVID-19 lockdowns were imposed. We stratified these trends by the presence of health conditions, age, neighbourhood deprivation, and pre-pandemic activity levels.

Results

There was a marked decline in older adults’ physical activity levels during the third national lockdown in January 2021. The proportion realising the Chief Medical Officers’ physical activity recommendations decreased from 43% in September 2020 to 33% in January 2021. This decrease in physical activity occurred regardless of health condition, age, neighbourhood deprivation, or pre-pandemic activity levels. Those doing the least activity pre-lockdown increased their activity during lockdowns and those doing the most decreased their activity levels.

Conclusions

Reductions in older adults’ physical activity levels during COVID-19 lockdowns have put them at risk of becoming deconditioned and developing adverse health outcomes. Resources should be allocated to promote the uptake of physical activity in older adults to reverse the effects of deconditioning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14156-y.

Football in Times of COVID-19: A Recapitulation of Preventive Measures and Infection Control Policies Aiming at a Safe Game Environment

Coronavirus disease 2019 (COVID-19) resulted in sporting event suspensions and cancellations, affecting competition calendars worldwide during 2020 and 2021. This challenged high-performance athletes' capacity to complete physical, technical, or tactical training during restricted movement measures (lockdown). With the Football World Cup organized in the last quarter of 2022, the past period of training and match disturbances challenged footballers concerning their performance and potential higher risk of injury at official matches' resumption. There has been considerable debate about the management of resuming professional football (soccer) during the COVID-19 pandemic. Governing bodies worldwide implemented measures to ensure a safe resumption of football. These precautionary measures aimed to protect the health of players, their support staff, and officials around the pitch and ensure the enjoyment of the event by spectators in the football stadiums. We have therefore narratively reviewed scientific papers about how football has resumed on the pitch and in the stands with special focus on the COVID-19 infection control strategies allowing footballers to perform again and supporters to enjoy the game after the 2020 global stop to sport.

Sleep behavior and training load in adolescent elite basketball players during COVID-19 pandemic development

The COVID-19 pandemic caused strong restrictions in organized sports. Specifically, adolescent athletes, whose daily routine is usually determined by school and practice schedules, experienced a sudden lifestyle change. The aim of this study was to examine sleep and training patterns of German elite adolescent basketball players (N = 115, 15.70 ± 1.22 years, female = 32.17%) during different phases of the 2021 lockdown. Sleep and training behavior were documented by a subjective monitoring over 10 days at three different lockdown phases in February, April, and June/July. A linear mixed model approach was conducted for the statistical analyses. Sleep duration and time in bed decreased between phase 1 (prohibition of organized sports) and phase 3 (normal training conditions), while sleep efficiency and quality increased. There was no change in training duration over time, but in training intensity, which peaked in the third phase. This study contains meaningful evidence to analyze the lockdown-related return to practice process. Athletes were able to maintain training duration with alternative protocols during pandemic conditions. Interestingly, athletes slept less under non-lockdown conditions, but reported a better sleep quality. It is recommended to consider athletes' individual preferences when planning training and recovery schedules.

Cognitive functions and anxiety among blue-collar workers in hospitals during COVID-19 pandemic

Background

The rapid spread of COVID-19 poses a major threat to public health worldwide. Hospital blue-collar workers, like other health care workers, may be under severe physical and psychological stress. This psychological distress is mainly described as symptoms of anxiety and depression, stress and cognitive function. This study aimed to investigate the effects of anxiety on cognitive function among laundry and sterilization center workers in 4 hospitals during COVID-19 pandemic.

Method

This study has a cross-sectional design and it was conducted among health service workers who were occupied in health facilities (laundry and sterilization center) in 4 hospitals. In the present study, two questionnaires and a test were used to collect the data included a general health questionnaire (GHQ-28), a health anxiety index questionnaire (HAI-18) and a cognitive function test. Descriptive statistics and Spearman correlation coefficient by SPSS version 19 were used.

Results

The results showed that the overall score of coronavirus anxiety in male and female workers was 38.72 ± 5.94 and 40.92 ± 4.11, respectively. The correlation between auditory attention and coronavirus anxiety is moderate and has a negative trend (P = 0.050, n = 50, and r = -0.315). Workers with higher anxiety expressed lower auditory attention. Also, correlation between visual attention and coronavirus anxiety was weak and negative (P = 0.032, n = 50, and r = -0.179).

Conclusion

This study revealed that cognitive and psychological aspects of mental health can be affected by COVID-19 exposure and its due anxiety in blue-collar workers in hospitals. These findings indicate that purposeful supportive interventions should be implemented to promote workers' health and cognitive function.

COVID-19 Lockdown: A Global Study Investigating the Effect of Athletes' Sport Classification and Sex on Training Practices

PURPOSE

To investigate differences in athletes' knowledge, beliefs, and training practices during COVID-19 lockdowns with reference to sport classification and sex. This work extends an initial descriptive evaluation focusing on athlete classification.

METHODS

Athletes (12,526; 66% male; 142 countries) completed an online survey (May-July 2020) assessing knowledge, beliefs, and practices toward training. Sports were classified as team sports (45%), endurance (20%), power/technical (10%), combat (9%), aquatic (6%), recreational (4%), racquet (3%), precision (2%), parasports (1%), and others (1%). Further analysis by sex was performed.

RESULTS

During lockdown, athletes practiced body-weight-based exercises routinely (67% females and 64% males), ranging from 50% (precision) to 78% (parasports). More sport-specific technical skills were performed in combat, parasports, and precision (∼50%) than other sports (∼35%). Most athletes (range: 50% [parasports] to 75% [endurance]) performed cardiorespiratory training (trivial sex differences). Compared to prelockdown, perceived training intensity was reduced by 29% to 41%, depending on sport (largest decline: ∼38% in team sports, unaffected by sex). Some athletes (range: 7%-49%) maintained their training intensity for strength, endurance, speed, plyometric, change-of-direction, and technical training. Athletes who previously trained ≥5 sessions per week reduced their volume (range: 18%-28%) during lockdown. The proportion of athletes (81%) training ≥60 min/session reduced by 31% to 43% during lockdown. Males and females had comparable moderate levels of training knowledge (56% vs 58%) and beliefs/attitudes (54% vs 56%).

CONCLUSIONS

Changes in athletes' training practices were sport-specific, with few or no sex differences. Team-based sports were generally more susceptible to changes than individual sports. Policy makers should provide athletes with specific training arrangements and educational resources to facilitate remote and/or home-based training during lockdown-type events.

Impact of COVID-19 lockdown on physical exercise among participants receiving the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) intervention: a repeated measure study

BACKGROUND

The potential decrease in daily physical activity associated with the COVID-19 pandemic lockdowns may have a negative impact on people living with dementia. Given the limited literature around the effects of home confinement in people living with dementia, this study investigated changes in physical exercise levels of participants in the intervention arm of the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) Randomised Controlled Trial during the first COVID-19 national lockdown. It hypothesised that participants would maintain physical exercise levels.

METHODS

A repeated measure (three time points) study involving 30 participants (mean age = 78.0 years, 15 male and 15 female, 22 (73.0%) living with their primary caregiver), from four regions in England receiving the PrAISED intervention. PrAISED is an individually tailored intervention of physical exercises and functional activities. Trained therapists deliver therapy sessions over a period of 52 weeks. Study participants received therapy sessions via phone or video calling during the COVID-19 lockdown. This study investigated self-reported minutes of physical exercise recorded on study calendars for the months of February (i.e., baseline - pre-lockdown), May (i.e., T1 - during lockdown), and August (i.e., T2-post-lockdown) 2020.

RESULTS

Participants reported a statistically significant increase in activity levels between February and May (Wilcoxon Z = -2.013, p = 0.044) and a statistically significant decrease between May and August (Wilcoxon Z = -2.726, p = 0.004). No significant difference was found in the physical activity levels from pre- to post-lockdown (Wilcoxon Z = 0.485, p = 0.620).

CONCLUSION

Despite concerns that the restrictions associated with the COVID-19 pandemic might lead to reductions in physical exercise, participants in receipt of the PrAISED intervention increased their amount of physical exercise during lockdown. Our findings support the potential of remote support for people living with dementia to help them maintain physical exercise levels in circumstances where face-to-face service provision is not possible.

TRIAL REGISTRATION

The PrAISED trial and process evaluation have received ethical approval number 18/YH/0059 from the Bradford/Leeds Ethics Committee. The Clinical Trial Identifier for PrAISED is: ISRCTN15320670 ( https://doi.org/10.1186/ISRCTN15320670 ). Registration was made on 04/09/2018.

Going digital - a commentary on the terminology used at the intersection of physical activity and digital health

In recent years digital technologies have become a major means for providing health-related services and this trend was strongly reinforced by the current Coronavirus disease 2019 (COVID-19) pandemic. As it is well-known that regular physical activity has positive effects on individual physical and mental health and thus is an important prerequisite for healthy aging, digital technologies are also increasingly used to promote unstructured and structured forms of physical activity. However, in the course of this development, several terms (e.g., Digital Health, Electronic Health, Mobile Health, Telehealth, Telemedicine, and Telerehabilitation) have been introduced to refer to the application of digital technologies to provide health-related services such as physical interventions. Unfortunately, the above-mentioned terms are often used in several different ways, but also relatively interchangeably. Given that ambiguous terminology is a major source of difficulty in scientific communication which can impede the progress of theoretical and empirical research, this article aims to make the reader aware of the subtle differences between the relevant terms which are applied at the intersection of physical activity and Digital Health and to provide state-of-art definitions for them.

Aerobic capacity of professional soccer players before and after COVID-19 infection

This investigation aimed to assess the aerobic capacity of professional soccer players pre-and post-COVID-19 infection. Twenty-one division-1 elite soccer players (age 24.24 ± 5.75 years, height 178.21 ± 5.44 cm, weight 74.12 ± 5.21 kg) participated in this study. This observational study compared the same players' aerobic capacity pre-, and 60-days post COVID-19 recovery. The statistical analysis demonstrated that the infected players had significantly lower VO_2max values [t₍₂₀₎ = 5.17, p < 0.01, d = 0.613 (medium effect)], and significantly lower VO₂ values at respiratory compensation point (RC) [t₍₂₀₎ = 2.97, p < 0.05, d = 0.39 (small effect)] after recovery. Furthermore, results indicated a significantly lower running time (RT) on the treadmill [t₍₂₀₎ = 4.84, p < 0.01, d = 0.46 (small effect)] when compared to the results that were obtained before they got infected. In addition, velocity at VO_2max (_VVO_2max) was significantly lower [t₍₂₀₎ = 2.34, p < 0.05, d = 0.41 (small effect)] and the heart rate values at ventilatory threshold (VT) [t₍₂₀₎ = −2.79, p < 0.01, d = 0.55 (medium effect)] and RC [t₍₂₀₎ = −3.72, p < 0.01, d = 0.52 (medium effect)] were significantly higher post-recovery. The aforementioned findings indicate that post COVID-19 soccer players may not reach full recovery at two months. Therefore, our results highlight that further adaptations and improvements are needed with regard to aerobic capacity before soccer players return to professional games.

Can Physical Exercise Help Deal With the COVID-19 Stressors? Comparing Somatic and Psychological Responses

This research aims to explore whether physical exercise can buffer the impact of the COVID-19 stressors. Based on the cross-stressor adaptation hypothesis, we proposed a moderated mediation model relating the COVID-19 stressors to sleep disorder via somatic and worry complaints, depending on the amount of physical exercise. A sample of working adults in Beijing (N = 207) filled surveys in two waves during the COVID-19 pandemic. Structural regression analysis showed that physical exercise moderates the impact of the COVID-19 stressors on sleep disorder via somatic complaints (index = -0.11, 95% CI [-0.22, -0.01]), rather than psychological worry complaints (index = -0.01, 95% CI [-0.07, 0.04]). Specifically, the COVID-19 stressors increase somatic complaints for people with a low amount of physical exercise (b = 0.17, p = 0.01]), while the COVID-19 stressors are not significantly related to somatic complaints for people with a high amount of physical exercise (b = -0.06, p = 0.33). This research extends the cross-stressor adaptation hypothesis and provides evidence on an individual intervention of physical exercise to deal with the COVID-19 pandemic.

The Impact of COVID-19 on Physical Activity Among Adults in Saudi Arabia: A Cross-Sectional Study

Background

Physical inactivity has been identified as a major factor in developing and progressing chronic non-communicable diseases such as obesity. The Kingdom of Saudi Arabia ranks high worldwide in rates of obesity. During the coronavirus disease 2019 (COVID-19) pandemic, public health measures have been enforced. These included social distancing, masking, reduction of workplace daily hours, prevention of social gatherings, and home quarantine measures. These ultimately restricted the ability to perform regular physical health activities. The aim of this study is to understand the impact of COVID-19 on physical activity among adults in the Kingdom of Saudi Arabia.

Methodology

A cross-sectional study was conducted among the Saudi population. An online survey was sent through social media to gather data regarding individual physical activity before and after the start of the COVID-19 restrictions. The data were collected from March 20, 2021, until May 20, 2021, and analyzed using chi-square and paired t-test using the SAS software version 9.4.

Results

In total, 433 participants completed the survey. There were 183 (42.3%) males, and the majority of the participants were Saudi nationals (284, 65.6%). Most of the participants (181, 41.8%) were in the age group 25-35 years and 253 (58%) had bachelor’s degrees. Although the results did not show a statistically significant difference between pre- and post-COVID-19 respondents in terms of physical activity, married participants, participants from the eastern province, and participants who did not exercise regularly were all significantly impacted by lack of exercise compared to their counterparts (p < 0.05).

Conclusions

Taking measures to prevent the spread of COVID-19 is essential. Nonetheless, recommendations should be sought for physical activity during lockdowns, and large-scale research should be conducted to better understand what causes the exaggeration of sedentary lifestyles during lockdowns and how to prevent them. Further studies need to be conducted, and national guidelines should be made available in case of a future lockdown.

Quality of Sleep and Work Productivity among White-Collar Workers during the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic has disrupted routine sleep and work patterns in the general population. We conducted an anonymous online survey among white-collar workers from various finance, IT and technology companies in Lithuania to define factors associated with worse sleep quality and diminished productivity during a COVID-19 lockdown. Materials and Methods: Employees of selected companies in Lithuania completed an anonymous questionnaire online that included the Pittsburgh Sleep Quality Index (PSQI), The Sleep Locus of Control (SLOC), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ). Respondents also provided information about their sleep hygiene, physical activity and alcohol use. Results: Data of 114 respondents (56, 49.1% male) were used for analysis. Among them, 49 (43.0%) suffered from poor sleep and 29 (25.4%) had clinically relevant levels of anxiety. However, there were only negligible levels of absenteeism in the sample (a median of zero hours of work lost over the past month). In a stepwise linear regression model (F(5,108) = 11.457, p < 0.001, R2adj = 0.316), high levels of anxiety, daily hours spent using the screen, use of electronic devices in the bedroom, smoking in the evening, and COVID-19-related changes in appetite were associated with worse sleep quality. Absenteeism was associated with physical activity of moderate intensity and decreased self-reported productivity during the pandemic (F(2,111) = 7.570, p = 0.001, R2adj = 0.104). However, there was no strong relationship between sleep-related variables (i.e., sleep hygiene, sleep locus of control, quality of sleep) or levels of anxiety and measures of work productivity. Conclusions: Our findings suggest that while bad sleep hygiene, anxiety, and changes in appetite are associated with worse sleep quality among white-collar workers during the pandemic, work productivity may remain high irrespective of disrupted sleep.

Effects of COVID-19 Lockdown on Physical Performance, Sleep Quality, and Health-Related Quality of Life in Professional Youth Soccer Players

Background

In March 2020, the COVID-19 outbreak led to the declaration of a pandemic. The accompanying restrictions on public life caused a change in the training routines of athletes worldwide. The present study aimed to investigate the effects of a 13-week supervised home training program on physical performance, sleep quality, and health-related quality of life in professional youth soccer players during the first COVID-19 lockdown in Germany.

Methods

Eight professional soccer players (age range 16–19; height: 1.81 ± 0.07 m; body weight: 72.05 ± 6.96 kg) from a Bundesliga team in Germany participated in this study. During the lockdown, they trained 5–6 days per week with home-based training plans and were monitored via tracking apps and video training. To determine the effects of home training, measurements were taken before (March 2020) and after (June 2020) the home training period. Bioelectrical impedance analysis was used to determine body composition, and an isokinetic strength test and a treadmill step test, including lactate measurements, were used to measure physical performance. Two questionnaires were responded to in order to assess health-related quality of life [Short-Form 36 Health Survey (SF-36)] and sleep quality (Pittsburgh Sleep Quality Index).

Results

When comparing measurements before and after the home training period, we observed significant increases in the following variables: body weight (72.05 ± 6.96 kg vs. 73.50 ± 6.68 kg, p = 0.034), fat mass (11.99 ± 3.13 % vs. 13.98 ± 3.92 %, p = 0.030), body mass index (22.04 ± 0.85 kg/m2 vs. 22.49 ± 0.92 kg/m2, p = 0.049), and mental health component summary score (MCS) of the questionnaire SF-36 (53.95 ± 3.47 vs. 58.33 ± 4.50, p = 0.044). Scores on the general health (77.88 ± 14.56 vs. 89.75 ± 13.76, p = 0.025) and mental health (81.50 ± 9.30 vs. 90.00 ± 11.71, p = 0.018) subscales of the SF-36 also increased significantly.

Conclusion

The COVID-19 lockdown led to an increase in body composition parameters and showed an improvement in the MCS and scores on the general and mental health subscales of the SF-36. Physical performance and sleep quality could be maintained during the home training period. These observations may help trainers for future training planning during longer interruptions in soccer training.

Social contact impacts physical activity and sedentary behavior among older adults in Japan due to COVID-19

Background

The coronavirus disease 2019 (COVID-19) has adversely affected social contact and physical activity. This study investigated the correlation between physical activity, social contact, and sedentary time among adults aged 65 years and above during the COVID-19 pandemic.

Methods

This study was conducted in N City, H Prefecture, Japan. The authors randomly selected 4,996 adults, aged 65 years and above (mean age 74.1 ± 6.1 years), living in N City, and survey forms were distributed by mail in mid-August 2020. Altogether, 1,925 participants were included in this study. The survey comprised questions concerning the participants’ sex, height, weight, age, smoking and drinking habits, living arrangements, social contact assessments, physical activity levels, and sedentary time. Moreover, linear regression analysis was utilized to investigate the associations between the variables.

Results

The reported median physical activity was 1272 metabolic equivalent of task-min/week (interquartile range 528–2628), and the reported median sedentary time was 360 min/week (interquartile range 240–600). COVID-19 “somewhat,” “quite a lot,” or “completely” hindered the frequency of in-person contact with friends among 75.5% of the respondents and hampered the frequency of virtual contact with friends among 38.8% of the respondents. Physical activity was associated significantly with in-person contact indicators: “interaction with friends” (B = -0.111; 95%CI: -0.187, -0.035; p = 0.004) and “social participation” (B = -0.163; 95%CI: -0.248, -0.079; p < 0.001). These associations remained significant for both multivariate analysis Models 1 (sex and age) and 2 (addition of body mass index [BMI], alcohol use, smoking, living alone, and the number of illnesses to Model 1). Additionally, sedentary time was significantly associated with the social contact variable of “interaction with friends” (B = 0.04; 95%CI: 0.016, 0.064; p = 0.001). This association remained significant in both multivariate analysis models.

Conclusions

Significant associations were confirmed between reduced social contact, decreased physical activity, and more sedentary behavior among older adults due to COVID-19. Hence, continuous monitoring and support for social activities among susceptible older adults in extraordinary circumstances are essential.

Did the Socio-Economic Gradient in Depression in Later-Life Deteriorate or Weaken during the COVID-19 Pandemic? New Evidence from England Using Path Analysis

It is well established that there is a socioeconomic gradient in adult mental health. However, little is known about whether and how this gradient has been exacerbated or mitigated by the COVID-19 pandemic. This study aims to identify the modifiable pathways involved in the association between socioeconomic position (SEP) and mental health during the COVID-19 pandemic. The analysis included 5107 adults aged 50+ living in England and participating in the English Longitudinal Study of Ageing Wave nine (2018–2019) and the COVID-19 study (June 2020). Mental health was measured using a shortened version of the Centre for Epidemiologic Studies Depression scale. Path analysis with multiple mediator models was used to estimate the direct effect of SEP (measured by educational qualification and household wealth) on mental health (measured by depression), along with the indirect effects of SEP via three mediators: COVID-19 infection symptoms, service accessibility and social contact. The results show that the prevalence of depression for the same cohort increased from 12.6% pre-pandemic to 19.7% during the first wave of the pandemic. The risk of depression increased amongst older people who experienced COVID-19 infection, difficulties accessing services and less frequent social contact. The total effects of education and wealth on depression were negatively significant. Through mediators, wealth and education were indirectly associated with depression. Wealth also directly affected the outcome. The findings suggest that the socioeconomic gradient in depression among older people may have deteriorated during the initial phase of the pandemic and that this could in part be explained by increased financial hardship, difficulties in accessing services and reduced social contact.

Physical Activity, Dietary Habits and Factors Associated with Depression Among Medical Students of Sindh, Pakistan, During the COVID-19 Pandemic

Objective

To find out the association of physical activity, dietary habits and factors associated with depression among medical students of Sindh, Pakistan, during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

An online cross-sectional study was conducted between June and August, 2020, on medical students from three medical institutions of Sindh, Pakistan. The study comprised three structured questionnaires related to demographic details, physical activity, dietary and sleep habits, COVID-19 pandemic-associated factors and patient health questionnaire, PHQ-9. A total of 864 students completed the questionnaires and participated in the study. The data was analysed on SPSS version 23.

Results

Our study showed that 244 (28.2%) medical students had mild depression, 192 (22.2%) had moderate depression, 80 (9.3%) had moderately severe depression and 80 (9.3%) had severe depression during the COVID-19 pandemic. Out of 864 students, 268 (31%) had no depression. Socioeconomic status, body mass index (BMI), chronic disease/comorbidity, addiction and non-medical prescription drug use were found to be statistically significant predictors of depression among medical students. On multilogistic regression analysis, physical activity, social media/app use and sleeping habits during COVID-19 were associated with depression (p-value < 0.05).

Conclusion

The COVID-19 pandemic adversely affected physical activity and sleeping habits in association with depression among medical students. Promoting healthy eating habits, adequate physical activity, and a healthy lifestyle, particularly among students during lockdowns, is a critical component of coping with mental stress and depression. The findings of this study will aid in future research and campaign design in preparation for future pandemics and lockdowns.

Influential factors for COVID-19 related distancing in daily life: a distinct focus on ego-gram

BACKGROUND

The coronavirus disease 2019 (COVID-19) has necessitated that individuals comply with personal quarantine rules in daily life. South Korea is implementing the concept of "distancing in daily life" to raise awareness on personal quarantine measures, which is communicated through various media channels and platforms. The continued rise in COVID-19 cases demands that all individuals strictly adhere to personal quarantine rules. It is worth paying particular attention to the college student group, which has the highest percentage of confirmed cases among all age groups in South Korea. This group understands and practices "distancing in daily life" but with drastic variations among individuals. Previous studies have reported that the level of adherence to social norms is different according to each ego stated, and media exposure level is reported as a major influencing factor. Therefore, this study examined the media exposure level to COVID-19 prevention rules and its effect on the observance of distancing in daily life; it also verified the moderating effect of ego-gram on the relationship between media exposure level and distancing in daily life.

METHODS

The participants comprised Korean university students (men = 143, women = 188, N = 331) aged 18-30 years, who were recruited through an online survey. The survey was conducted over 20 days from January 27 to February 15, 2021. Data were analyzed using SAS (version 9.4) to calculate hierarchical regression.

RESULTS

First, media exposure level and distancing in daily life among Korean university students was above average. Second, media exposure level (β = .161, P < .01) was identified as the most influential factor for distancing in daily life. Third, ego-grams had a moderating effect (β = .136, P < .05) on the relationship between media exposure levels and distancing in daily life.

CONCLUSIONS

This study examined the policy implications related to the development of diverse quarantine-related programs while considering influential factors and differences in how individuals' compliance with quarantine rules were presented. Considering the situation in which new infectious diseases such as COVID-19 occur every 4-5 years, this study serves as a preparation for future pandemics and is an important framework to enhance the level of personal quarantine.

Exerkines in health, resilience and disease

The health benefits of exercise are well-recognized and are observed across multiple organ systems. These beneficial effects enhance overall resilience, healthspan and longevity. The molecular mechanisms that underlie the beneficial effects of exercise, however, remain poorly understood. Since the discovery in 2000 that muscle contraction releases IL-6, the number of exercise-associated signalling molecules that have been identified has multiplied. Exerkines are defined as signalling moieties released in response to acute and/or chronic exercise, which exert their effects through endocrine, paracrine and/or autocrine pathways. A multitude of organs, cells and tissues release these factors, including skeletal muscle (myokines), the heart (cardiokines), liver (hepatokines), white adipose tissue (adipokines), brown adipose tissue (baptokines) and neurons (neurokines). Exerkines have potential roles in improving cardiovascular, metabolic, immune and neurological health. As such, exerkines have potential for the treatment of cardiovascular disease, type 2 diabetes mellitus and obesity, and possibly in the facilitation of healthy ageing. This Review summarizes the importance and current state of exerkine research, prevailing challenges and future directions.

Training During the COVID-19 Lockdown: Knowledge, Beliefs, and Practices of 12,526 Athletes from 142 Countries and Six Continents

OBJECTIVE

Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March-June 2020).

RESULTS

Overall, 85% of athletes wanted to "maintain training," and 79% disagreed with the statement that it is "okay to not train during lockdown," with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered "coaching by correspondence (remote coaching)" to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], plyometric exercise [30%]) at pre-lockdown levels (higher among world-class, international, and national athletes), with most (83%) training for "general fitness and health maintenance" during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification.

CONCLUSIONS

COVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to "maintain" training and the greatest opposition to "not training" during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered "coaching by correspondence" as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes' physical capacities and were also likely detrimental to athletes' mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness).

Recent update on application of dihydromyricetin in metabolic related diseases

As a new type of natural flavonoids, dihydromyricetin (DMY) has attracted more and more attention. It has a series of pharmacological effects, such as anti-inflammatory, anti-tumor, anti-oxidation, antibacterial and so on, and it is almost no toxicity and with excellent safety. Therefore, even if the bioavailability is poor, it is often added to daily food, beverages and even medicines. In recent years, some researchers have found that DMY can treat some diseases by anti-oxidation, anti-inflammation, promoting cell death and regulate the activity of lipid and glucose metabolism. In addition, the mechanism of DMY on these diseases was also related to the signal pathway of AMPK, PI3K/Akt, PPAR and the participation of microRNAs. This review describes the mechanism of DMY in metabolic related diseases from three aspects: metabolic diseases, liver diseases, and cancers, hoping to provide some new ideas for clinical researches.

Adherence to a guided walking program with amelioration of cognitive functions in subjects with schizophrenia even during COVID-19 pandemic

Background

Aim of the study was to enrol a group of individuals with schizophrenia in a long-term moderate-intensity physical activity program and to evaluate its effects on their cognitive functions and cardiovascular risk factors. An additional aim of the study was the comparison of the adherence to the physical activity program before and during the COVID-19 pandemic.

Methods

Forty sedentary patients diagnosed with schizophrenia (mean age 46.4 ± 9.6) followed by the Public Mental Health Department of Ferrara were included in the study. 28 of them followed a 1-year walking program consisting of two guided walking sessions/week, while 12 maintained their sedentary lifestyle and followed the usual Cognitive Rehabilitation program. To the participants following the walking program VO₂ peak and walking speed were assessed at baseline and at the end of the program. All participants were evaluated on blood pressure and anthropometric variable. Cognitive functions were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP) and with the Frontal Assessment Battery (FAB) questionnaires.

Results

The 20 participants completing the walking program displayed significant improvements in cognitive functions (d_ppc2 0.35 for SCIP and 0.26 for FAB), with a positive correlation between SCIP score and the number of sessions attended (R = 0.86, p < 0.001), evident in the patients attending to at least 75 of the 100 walking sessions. Walking speed and VO₂peak increased significantly and a decrease of body weight, BMI, systolic and diastolic blood pressure was also observed. The adherence to the walking program registered during Covid-19 period did not differ from that observed before the pandemic. The 12 CG (Control Group) patients maintaining the sedentary lifestyle did not display improvements of cognitive functions.

Conclusions

The main finding of this study is the improvement of cognitive functions which is significantly related to the number of walking sessions attended by participants with schizophrenia. The walking program, guided by exercise specialists, proved to be an enjoyable activity for people with mental disorder feasible even during the COVID-19 pandemic.

Trial registration Retrospectively registered on ISRCTN as non-randomized trial (n. ISRCTN14763786).

COVID-19 and screen-based sedentary behaviour: Systematic review of digital screen time and metabolic syndrome in adolescents

AIM

The COVID-19 pandemic has prompted governments around the globe to implement various restriction policies, including lockdown, social distancing, and school closures. Subsequently, there has been a surge in sedentary behaviour particularly screen time (ST) together with a significant decline in physical activity that was more marked amongst children and adolescents. Excessive screen exposure in adolescents has been correlated with cardio-metabolic risk factors including obesity, hypertension, high cholesterol, and glucose intolerance that may have adverse morbidity and mortality implications in adulthood. Thus, the current study aimed to synthesize the literature on the relationship between ST of various types and the risk of metabolic syndrome (MetS) in adolescents in the context of the COVID-19 pandemic.

METHODS

In August 2021, a systematic search of the literature was undertaken using electronic databases: PubMed, PsycINFO, and the Cochran library. Studies were considered if they met the following key eligibility criteria: (i) Measure of ST as an exposure (TV, computer, videogames, internet, smartphone, tablet), using quantified duration/frequency either self-reported or observed; (ii) Measure of MetS as an outcome with standard definition and/or criteria required to establish MetS diagnosis. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the risk of bias.

RESULTS

A total of ten studies met the inclusion criteria, and the majority were cross sectional studies. Most studies met fair bias scoring. Overall, the review revealed considerable evidence that suggests a significant negative association between ST and components of MetS among adolescents with dose-response association.

CONCLUSION

During the pandemic, screen usage may become more prevalent through periods of school closures, lockdowns, social isolation, and online learning classes. Public health policies and health promotion strategies targeting parents are needed to raise awareness of the adverse health effects associated with screen-based sedentary behaviour as a precursor of NCDs. Parent or home focused interventions might be effective in limiting adolescents' screen exposure, alternatively substituted with an appropriate level of physical activity.

PROSPERO REGISTRATION NUMBER

PROSPERO 2021 CRD42021272436.

Examining Psychosocial Factors and Community Mitigation Practices to Limit the Spread of COVID-19: Evidence from Nigeria

We examine the psychosocial factors influencing community adoption of non-pharmaceutical interventions (NPI) to limit the spread of COVID-19. Using data from 990 respondents in communities across Nigeria, we examine the correlation of health behaviors and socioeconomic indicators. We conduct logistic regression to estimate the relationship between mask wearing as a health-seeking NPI with demographic and socioeconomic variables. We estimate separate models in the sensitivity robustness checks with other NPIs and control for differences across sex, age, education, number in household, and the presence of a student in the respondent’s household. A crucial finding is that health-seeking NPI behaviors are statistically significantly affected in different ways by the menu of socioeconomic indicators. The control for age, sex, education, and household size indicates that there is intersectionality of how these factors influence specific mitigation practices. We find that women are more likely to engage in mask wearing, hand washing, and use of hand sanitizers and tissues than men, and the provision of palliatives and access to family supplies significantly enhances community mitigation. Palliatives and access to family supplies enhance most health-seeking behaviors. The implication for pandemic mitigation policy is that minimizing incidence rates requires having responsive initiatives such as information updates on pandemic progression.

Time to Sleep?-A Review of the Impact of the COVID-19 Pandemic on Sleep and Mental Health

Sleep is intrinsically tied to mental and overall health. Short sleep duration accompanies the modern lifestyle, possibly reaching epidemic proportions. The pandemic and subsequent lockdowns determined a fundamental shift in the modern lifestyle and had profound effects on sleep and mental health. This paper aims to provide an overview of the relationship between sleep, mental health and COVID-19. Contrasting outcomes on sleep health have been highlighted by most reports during the pandemic in the general population. Consequently, while longer sleep durations have been reported, this change was accompanied by decreases in sleep quality and altered sleep timing. Furthermore, an increased impact of sleep deficiencies and mental health burden was generally reported in health care workers as compared with the adult general population. Although not among the most frequent symptoms during the acute or persistent phase, an increased prevalence of sleep deficiencies has been reported in patients with acute and long COVID. The importance of sleep in immune regulation is well known. Consequently, sleep deficiencies may influence multiple aspects of COVID-19, such as the risk, severity, and prognosis of the infection and even vaccine response.

Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period

BACKGROUND

The COVID-19 pandemic has increased online counselling interventions, including those aimed at university students. The principal aim of the study is to evaluate the effectiveness of the online counselling intervention during the COVID-19 pandemic, also with regards to the effectiveness of the face-to-face intervention.

METHODS

34 students (Mean age = 23.74; Female = 27) who requested online university counselling during COVID-19 have been compared with 81 (Mean age = 22.8; Female = 60) students who requested university face-to-face counselling before the pandemic. The psychopathological problems were assessed with the Symptom Checklist 90 Revised, attachment styles with the Attachment Style Questionnaire, adverse childhood experiences with Adverse Childhood Experiences Questionnaire, and life satisfaction with the Life Satisfaction Scale.

RESULTS

At the pre-intervention phase, psychological distress was similar in both groups with no differences in the General Severity Index of the SCL-90 R, and there were no significant differences for secure/insecure attachment, adverse childhood experiences, and life satisfaction. The online counselling intervention during the pandemic was effective in reducing psychological distress scales as depression (p = .008), obsessive-compulsive (p = .008), interpersonal sensitivity (p = .005), and anxiety (p = .011), and in the total scale of the SCL-90 R (p = .017). The face-to-face counselling intervention was effective in reducing psychological distress in all subscales and in the total scale of the SCL-90 R (p = .000) and in increasing the level of life satisfaction (p = .023). Attachment style did not moderate the effectiveness of the online and face-to-face interventions.

CONCLUSIONS

Students seeking counselling, both before and during the pandemic, show similar levels of psychological distress. The online counselling intervention was almost as effective as face-to-face counselling intervention with respect to psychological distress; it was not effective in increasing life satisfaction.

Changes in sleep behavior, sleep problems, and psychological distress/health-related quality of life of young Japanese individuals before and during the COVID-19 pandemic

Social restrictions during the coronavirus disease (COVID-19) pandemic have impacted sleep behavior and sleep problems, and their related daytime functioning in young adults. However, no studies have examined such changes in young individuals from countries with mild infection intensity and social restrictions. Therefore, we focused on sleep behaviors and sleep issues in young people in Japan. This study was conducted before and after the pandemic (October 2019 and May 2020, respectively). In total, 2,222 (1,371 students and 851 workers) individuals participated and completed anonymous Web-based questionnaires concerning demographic characteristics, sleep behaviors, sleep problems using the Japanese version of the Epworth Sleepiness Scale (JESS) and the Athens Insomnia Scale (AIS-J), psychological distress using the Japanese version of the Kessler Psychological Distress Scale, and health-related quality of life (HRQoL) evaluated with the Short Form-8 (SF-8). A significantly delayed sleep phase was observed in the second survey compared to the first (p < .001) and was more pronounced in students than in workers (p < .001). The total sleep time, social jetlag degree, and JESS, AIS-J, and SF-8 scores were significantly improved after the pandemic (p < .001, p < .001, p < .001, p < .001, p < .05, and p < .001, respectively). Careful monitoring of whether these modest changes can lead to adjustment concerns is needed.

Determinants of poor sleep quality in adults during the coronavirus disease pandemic: COVID-Inconfidentes, a population-based study

BACKGROUND

The coronavirus disease (COVID-19) pandemic has adversely affected the health of the global population, with sleep quality being one of the affected parameters.

OBJECTIVES

To evaluate sleep quality and its associated factors in adults during the COVID-19 pandemic in Brazil.

DESIGN AND SETTING

A population-based cross-sectional serological survey of 1,762 adults in the Iron Quadrangle region of Brazil.

METHODS

The Pittsburgh Sleep Quality Index was used to assess sleep quality. Sociodemographic variables, health conditions, health-related behaviors, anxiety, vitamin D levels, weight gain/loss, and pandemic characteristics were assessed using a structured questionnaire. Univariate and multivariate analyses using Poisson regression with robust variance were performed to identify factors associated with sleep quality.

RESULTS

More than half of the participants reported poor sleep quality (52.5%). Multivariate analysis revealed that the factors associated with poor sleep quality included living alone (prevalence ratio [PR] = 1.34; 95% confidence interval [CI]: 1.04-1.73), anxiety disorder (PR = 1.32; 95% CI: 1.08-1.62), 5.0% weight loss (PR = 1.21; 95% CI: 1.02-1.44), 5.0% weight gain (PR = 1.27; 95% CI: 1.03-1.55), vitamin D deficiency (PR = 1.16; 95% CI: 1.01-1.35), and COVID-19 symptoms (PR = 1.29; 95% CI: 1.10-1.52).

CONCLUSIONS

Our study revealed that more than half of the participants experienced poor sleep quality during the COVID-19 pandemic. Factors associated with poor sleep quality included vitamin D deficiency and weight changes related to the pandemic.

Psychological Symptom Progression in School-Aged Children After COVID-19 Home Confinement: A Longitudinal Study

BACKGROUND

The long-term mental health effects of coronavirus disease 2019 (COVID-19) in children are rarely reported. We aimed to investigate the progression of depressive and anxiety symptoms among a cohort of children in the initial epicenter of COVID-19 in China.

METHODS

Two waves of surveys were conducted in the same two primary schools in Wuhan and Huangshi, Hubei province: Wave 1 from 28 February to 5 March, 2020 (children had been confined to home for 30-40 days) and Wave 2 from 27 November to 9 December, 2020 (schools had reopened for nearly 3 months). Depressive and anxiety symptoms were estimated using the Children's Depression Inventory - Short Form (CDI-S) and the Screen for Child Anxiety Related Emotional Disorders (SCARED), respectively. ΔCDI-S and ΔSCARED scores between Wave 2 and Wave 1 were calculated and further categorized into tertiles. Multivariable linear regression and multinomial logistic regression models were then applied.

RESULTS

A total of 1,224 children completed both surveys. The prevalence of mental health outcomes at Wave 2 increased significantly compared to Wave 1, specifically depressive symptoms (age-standardized prevalence rates: 37.5 vs. 21.8%) and anxiety symptoms (age-standardized prevalence rates: 24.0 vs. 19.6%). Higher ΔSCARED scores were observed in females and children in Wuhan, and children with experience of neglect had higher ΔCDI-S (β = 1.12; 95% CI = 0.67-1.58) and ΔSCARED (β = 6.46; 95% CI = 4.73-8.19) scores compared with those without experience of neglect. When the Δ scores were further categorized into tertiles, similar results were found.

CONCLUSIONS

The prevalence of depressive and anxiety symptoms after schools resumed was increased compared with that during the home quarantine period, even though the COVID-19 pandemic was under control. Females and children in Wuhan, and also children with experience of neglect were at increased risk of mental health disorders.

Effect of Neuromuscular Training Program on Quality of Life After COVID-19 Lockdown Among Young Healthy Participants: A Randomized Controlled Trial

Study in the period of coronavirus disease 2019 (COVID-19) lockdown and the effect of different exercise training programs on the quality of life (QoL) dimension are limited. This randomized control study as a part of which the impact of an 8-week neuromuscular training program on the 90 healthy young individuals' QoL after COVID-19 lockdown was assessed using a short form of the WHOQOL-BREF questionnaire comprising of four domains (physical health, psychological health, social relations, and the environment). The intervention group (NT) (n = 47) took part in a neuromuscular training program consisting of dynamic neuromuscular stabilization and whole-body vibration training. In contrast, the control group (CG) (n = 43) did not participate in any programmed physical activity. From pre- to post-intervention test, the NT group significantly and substantially improved [mean change (95% CI)] all the QoL domains, physical for 12.78 scores (8.89, 16.64), psychological for 13.12 scores (9.51, 16.74), social relationships for 20.57 scores (16.12, 25.02), and environmental for 24.40 scores (21.45, 27.35). These results suggest that the NT program could enhance QoL in young and healthy participants following COVID-19 lockdown.

Regression Analysis of Perceived Stress among Elite Athletes from Changes in Diet, Routine and Well-Being: Effects of the COVID-19 Lockdown and "Bubble" Training Camps

The COVID-19 pandemic has affected the lifestyles and training of elite athletes around the world. The detrimental effects of lockdown periods may vary among individuals, as well as among sports and sexes. This study investigated the changes in dietary habits, and the predictors of perceived stress during lockdown and a "bubble" training camp. This cross-sectional, online survey involved 76 elite and world-class athletes from six able-bodied sports and nine parasports, all of whom were involved in a 30-day "bubble" training camp. Questions were asked on socio-demographics, training routines and wellbeing, perceived stress, and dietary habits, pertaining to "normal" training (prelockdown), lockdown training, and "bubble" camp training periods. Changes in perceived stress were trivial to small during lockdown compared to "normal" training, and trivial to moderate during a "bubble" camp, compared to lockdown. Para-athletes, males, older athletes, less experienced athletes, married individuals, and specific ethnicities appeared to be more detrimentally affected (increased perceived stress) by lockdown. These negative experiences, however, were largely reversed during "bubble" camps. During lockdown, more athletes reported increased evening snack consumption (+8%), later meal-times (+6%), decreased fluid intake (-6%), and no breakfast (+7%). These changes were reversed during "bubble" camps (12-18% improvements). Sport classification accounted for 16% of the increased perceived stress (p = 0.001) during lockdown. Overall, socio-demographic factors, improvements in training routines, well-being, and dietary habits explained 28% of the decreased perceived stress during a "bubble" camp. In conclusion, better dietary habits, training routines and well-being have implications for reduced perceived stress. During lockdown, "bubble" camps may be beneficial, but this observation may be a case-by-case consideration, and short split "bubble" periods are recommended.

Are elite track and field athletes on track? The impact of COVID-19 outbreak on sleep behavior and training characteristics

The Covid-19 outbreak forced many governments to enter a nationwide lockdown. The aim of this study was to evaluate, by means of a survey, changes in sleep parameters and physical activity characteristics of elite track and field athletes in three periods: before the lockdown (T0), during the lockdown (09th March – 03rd May 2020, T1) and the first month after the lockdown (T2). This study was conducted from May 2020 to June 2020 and data were collected using an offline survey with 89 elite track and field athletes (mean age: 24.7 ± 5.4; n = 43 males; n = 46 females). The survey consisted of demographic data and questions on physical activity and sleep behavior at T0, T1 and T2. Athletes reported lower sleep quality scores at T1 compared to T0 and T2 (p < 0.0001) and registered delayed bedtime, wake-up time and longer sleep latency during the lockdown compared to pre-lockdown and post-lockdown whereas no changes in total sleep time were reported. No inter-group differences were detected in sleep characteristics between short- and long-term disciplines and between genders. The weekly training volume decreased from 16.1 ± 5.7 hours at T0 to 10.7 ± 5.7 hours at T1 (p < 0.0001) whereas no significant differences were detected in training volume during the lockdown in relation to the square footage of the house (p = 0.309). Alcohol (p = 0.136) and caffeine intake (p = 0.990) and use of electronic devices (p = 0.317) were similar pre-, during, and post-lockdown. The unprecedented circumstances of the Covid-19 pandemic had negative impacts on the Italian track and field athletes’ sleep and training volumes.

Organising football matches with spectators during the COVID-19 pandemic: What can we learn from the Amir Cup Football Final of Qatar 2020? A call for action

The COVID-19 pandemic is a potential threat to professional sporting events when they eventually return to their usual calendar with spectators’ capacity of football stadiums usually exceeding 40,000 seats for important events. Hence, a strategy for safe return to sporting events is needed in the COVID-19 pandemic to pave the way towards a new normalcy. We reviewed the guidelines and policies implemented in organising the Amir Cup Football Final of Qatar, which hosted about 20,000 fans. The authors evaluated the publicly available information on the official websites of the various organizations involved and highlight the importance and usefulness of the Covid-19 Rapid Antigen Assay-Kit as a tool for screening sports spectators as well as the importance of a rigorous spectator pathway, including their accurate traceability thanks to a specific mobile phone application. Despite the surging of COVID-19 all over the world, a big football event with around 20,000 spectators in the same stadium has been hosted under strongly controlled preventative measures. These preventative measures show that it is possible to organize a major football match held outdoors, with the presence of thousands of supporters. This article is a call for action for the organisers of such events where the supporters’ health status is traceable to provide the scientific community with actual data of post-event infection rates. Therefore, it is suggested to consider using procedures like the ones described in the present article as a potential model in the process of organizing big sporting events with spectators in times of COVID-19.

The impact of COVID-19 lockdown on professional soccer players' body composition and physical fitness

During the COVID-19 lockdown, professional soccer players ceased their regular team training sessions and were provided with exercise programs to follow independently. This investigation assessed the impact of a 7-week COVID-19 lockdown and home-based individual physical training on professional soccer players’ body composition and physical fitness. The study consisted of nineteen division 1 elite soccer players (age 27.68 ± 5.99 years, height 178.47 ± 5.44 cm) and compared the anthropometric and physical fitness parameters obtained post-transition period to those obtained post-COVID-19 lockdown. The statistical analysis indicated that body fat percentage was significantly higher after the lockdown period [t(18) = -5.59, p < 0.01, d = 0.56]. Furthermore, VO_2max [t(17) = -11.54, p < 0.01, d = 0.57] and running time [t(17) = 3.94, p < 0.01, d = 0.76] values were significantly higher after the COVID-19 lockdown than those obtained after the transition period. In addition, significantly higher level of performance was demonstrated on squat jump [t(18) = -4.10, p < 0.01, d = 0.30], countermovement jump [t(18) = -7.43, p < 0.01, d = 1.11] and sit and reach tests [t(19) = -5.33, p < 0.01, d = 0.32]. Concurrently, lower body strength was indicated to be significantly greater (p < 0.01) following the COVID-19 lockdown. The training protocol provided during the confinement, due to the COVID-19 outbreak, was effective in keeping physical fitness at a significantly higher level compared to the transition period. Coaches and trainers are encouraged to examine the effectiveness of this protocol, as it may help them develop effective periodization programs during the transition period. This protocol may aid in the development of effective periodization programs that require minimal equipment and can be followed in similar situations.

Age and clinical signs as predictors of COVID-19 symptoms and cycle threshold value

Many COVID-19 infected people remain asymptomatic, and hence the diagnosis at first presentation remains a challenge. Assessment at a presentation in primary care settings is usually done by visual triaging and basic clinical examination. This retrospective study involved investigating the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar for July 2020. The presence (symptomatic group) or the absence (asymptomatic group) of symptoms along with objective vital examination (ie; heart-rate (HR), temperature, haemoglobin saturation (SpO₂)) were analysed and linked to the viral load (ie; cycle threshold (Ct)) of COVID-19 positive patients. Four hundred eighty-one symptomatic (230 males) and 216 asymptomatic (101 males) patients were included. Compared to the asymptomatic male group, the symptomatic male group was older, had lower Ct value and SpO₂, and higher temperature and HR. Compared to the females asymptomatic group, the symptomatic females group had lower Ct value, and higher temperature. Compared to the asymptomatic group, the symptomatic group had lower Ct value and SpO₂, and higher temperature and HR. Compared to the asymptomatic group, the symptomatic group had lower Ct values (age groups [21–30], [31–40], [41–50] and [51–60]), higher temperature (age groups [21–30] and [31–40], Ct ranges [20.01–25.00] and [25.01–30.00]), higher HR (age groups [21–30] and [31–40], Ct range [15.01–20.00]); and lower SpO₂ (age groups [41–50] and [51–60], Ct ranges [15.01–20.00] and [35.01–40.00]). Compared with asymptomatic patients, symptomatic patients with COVID-19 are most likely to be febrile, tachycardic, hypoxic and having higher viral load. Higher viral load was associated with higher HR, higher temperature, lower SpO₂, but there was no relation between viral load and age.

COVID-19 Lockdowns: A Worldwide Survey of Circadian Rhythms and Sleep Quality in 3911 Athletes from 49 Countries, with Data-Driven Recommendations

Objective

In a convenience sample of athletes, we conducted a survey of COVID-19-mediated lockdown (termed ‘lockdown’ from this point forward) effects on: (i) circadian rhythms; (ii) sleep; (iii) eating; and (iv) training behaviors.

Methods

In total, 3911 athletes [mean age: 25.1 (range 18–61) years, 1764 female (45%), 2427 team-sport (63%) and 1442 elite (37%) athletes] from 49 countries completed a multilingual cross-sectional survey including the Pittsburgh Sleep Quality Index and Insomnia Severity Index questionnaires, alongside bespoke questions about napping, training, and nutrition behaviors.

Results

Pittsburgh Sleep Quality Index (4.3 ± 2.4 to 5.8 ± 3.1) and Insomnia Severity Index (4.8 ± 4.7 to 7.2 ± 6.4) scores increased from pre- to during lockdown (p < 0.001). Pittsburgh Sleep Quality Index was predominantly influenced by sleep-onset latency (p < 0.001; + 29.8%), sleep efficiency (p < 0.001; − 21.1%), and total sleep time (p < 0.001; − 20.1%), whilst Insomnia Severity Index was affected by sleep-onset latency (p < 0.001; + 21.4%), bedtime (p < 0.001; + 9.4%), and eating after midnight (p < 0.001; + 9.1%). During lockdown, athletes reported fewer training sessions per week (− 29.1%; d = 0.99). Athletes went to bed (+ 75 min; 5.4%; d = 1.14) and woke up (+ 150 min; 34.5%; d = 1.71) later during lockdown with an increased total sleep time (+ 48 min; 10.6%; d = 0.83). Lockdown-mediated circadian disruption had more deleterious effects on the sleep quality of individual-sport athletes compared with team-sport athletes (p < 0.001; d = 0.41), elite compared with non-elite athletes (p = 0.028; d = 0.44) and older compared with younger (p = 0.008; d = 0.46) athletes.

Conclusions

These lockdown-induced behavioral changes reduced sleep quality and increased insomnia in athletes. Data-driven and evidence-based recommendations to counter these include, but are not limited to: (i) early outdoor training; (ii) regular meal scheduling (whilst avoiding meals prior to bedtime and caffeine in the evening) with appropriate composition; (iii) regular bedtimes and wake-up times; and (iv) avoidance of long and/or late naps.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01601-y.

Medical students in Russia evaluate the training during the COVID-19 pandemic: a student survey

BACKGROUND

The aim of the study was to obtain feedback from medical students in Russia regarding their e-learning experience during COVID-19 Pandemic.

METHODS

Thirteen thousand forty students from 46 Medical Schools in Russia completed an original evaluation form validated by 6 experts. Criterion and construct validity were determined in a pilot study (n = 46). The study design was based on the use of Google Forms. Participants used the Visual Analog Scale from 1 to 10 to assess the level of knowledge acquired.

RESULTS

95.31% of medical schools in Russia switched to e-learning during the Pandemic. 39.8% of the students stated that the time to prepare for the class has doubled. For 19.9% of them, it increased by one third, while 26.6% did not report any changes. 38,4% of the participants are satisfied with particular elements of e-learning, 27.5% like such a format, 22.9% do not like it, and 11.2% could not answer the question. The average scores for the knowledge assessment were 5.9 for the humanities, 6.1 for fundamental science, and 6.0 for clinical training.

CONCLUSIONS

The most important findings are increased self-instruction time, insufficient knowledge gained and territorial and socio-economic inequalities within the country. Meanwhile, most students favor distance learning or its particular elements. Consequently, medical education leaders in Russia should consider the implementation of blended training in medicine taking into account specific regional factors, ensuring its effectiveness at all stages.

Sleep and stress in times of the COVID-19 pandemic: The role of personal resources

There is still little research on the association between COVID-19-related stress and insufficient sleep. As distress is assumed to be high in these times, the role of personal resources becomes more important. The current study aimed to investigate the predictive role of COVID-19-related stress, positive affect, and self-care behavior for subjective sleep quality and sleep change measures since the outbreak of COVID-19 in Germany. A sample of 991 adults (M = 34.11 years; SD = 12.99) answered questionnaires during the first lockdown period in Germany and afterward (between April 1 and June 5, 2020). A higher stress level predicted lower sleep quality and more negative changes in overall sleep and pre-sleep arousal. Higher levels of positive affect and self-care predicted higher sleep quality and more positive changes in sleep. Analyses showed a moderation of positive affect on the association between stress and change in pre-sleep arousal. The improvement in personal resources, especially positive affect, in times of high stress seems relevant to overcome sleep problems. Future research should include objective measurements of sleep and longitudinal designs to uncover causal directions of effects.

Physical activity disparities across Europe: clustering European regions by health-related physical activity levels

In the context of stagnating global levels of physical activity (PA), this study examines the geographical segmentation of PA at the regional level (196 regions) in Europe. Cluster analysis and multinomial logistic regression are applied. Cluster analysis provides a taxonomy of four differentiated groups according to the health-related PA levels of the European regions. This taxonomy shows that there are significant regional disparities among European countries in terms of the regional PA level. The cluster profiles in terms of regional socioeconomic characteristics are described for each group, emphasizing the regional characteristics associated with PA. Regional economic variables, tertiary education and social Internet use are significant variables for characterizing the types of regions. The results emphasize the relevance of a European regional approach for reducing inter-regional PA disparities and improving health through PA in Europe. Practical implications of this research are based on regional European coordination, such as collaborative models of sport infrastructure use, co-financing of inter-regional facilities, mutual physical educational scholar programs and promotion of common inter-regional sport competitions and sporting events. Finally, formal schemes for exchanging of best regional practices to promote health-enhancing PA might increase the perception and the role of PA at the regional level in the European society.

The COVID-19 pandemic and physical activity during intermittent fasting, is it safe? A call for action

Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the "Sunna" also encourages Muslims to practice IF all along the year (e.g.; two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic.

Physical Activity, Sedentary Behavior, and Satisfaction With Life of University Students in Qatar: Changes During Confinement Due to the COVID-19 Pandemic

This study explored the effects of home confinement on physical activity (PA) and satisfaction with life (SL) among university students during the COVID-19 pandemic. A total of 531 subjects participated [male: n=203; female: n=328; age: 33.1±5.2years; mass: 72.1±17.5kg; height: 1.67±0.12m; and body mass index (BMI): 25.7±5.06 kg/m2]. Online survey questions considered "before" and "during" confinement. Confinement reduced all PA intensities (ηp 2=0.09-0.45, p<0.001) and increased daily sitting time (ηp 2=0.58, p<0.001). The largest reduction was in moderate intensity PA [metabolic equivalent of task-minutes/week (MET), ηp 2=0.45, p<0.001]. SQL decreased, with the score for "I am satisfied with my life" (ηp 2=0.42, p<0.001) decreasing from 28.4±5.7 to 20.6±9.7 arbitrary units (AU). Concerning SL, the largest change was detected for "the conditions of my life are excellent" (ηp 2=0.54, p<0.001). Time changes in all variables were demonstrative of large negative changes in both sexes. The difference in change between sexes was largest in terms of magnitude for the variable "the conditions of my life are excellent" (difference between groups, Δd=0.98). In sum, COVID-19 confinement reduced PA, heightened sitting time, and reduced SL in Qatar University students. This investigation could have a significant impact in developing PA guidelines for health maintainance during COVID-19 and successive pandemics in university students.

Sleep as a Priority: 24-Hour Movement Guidelines and Mental Health of Chinese College Students during the COVID-19 Pandemic

Research on the combined role of 24-hour movement behaviors (sleep, sedentary behavior [SB], and physical activity) in adult mental health, though important, is in its infancy. In the context of Canadian 24-hour movement guidelines integrating quantitative recommendations for sleep, SB, and moderate-to-vigorous physical activity (MVPA), this study aimed to examine the associations between meeting guidelines and mental health among college students. The study used a cross-sectional sample of 1846 Chinese college students surveyed online in August 2020. Through network analysis and multivariate analysis of covariance, the individual and combined associations between meeting 24-hour movement guidelines and the levels of depression and anxiety after adjusting sociodemographic factors were analyzed. Results indicated that meeting the sleep guideline had stronger associations with depression and anxiety than meeting the SB or MVPA guideline. Specifically, compared to meeting no guidelines, meeting the sleep guideline (alone or in combination with other guidelines) was associated with significantly lower levels of depression and anxiety; meeting both SB and MVPA guidelines was also associated with a significantly lower level of depression. Hence, meeting more guidelines, especially adhering to a healthy sleep routine, may play an important role in promoting the mental health of young adults.

BNT162b2 COVID-19 Vaccine Hesitancy among Parents of 4023 Young Adolescents (12-15 Years) in Qatar

Parental vaccine hesitancy (VH) remains a barrier to full population inoculation, hence herd immunity against the SARS-CoV-2 virus. We aimed to determine parental VH rate, subgroups and influencing factors related to the BNT162b2 COVID-19 vaccine among their young adolescents (12-15 years old) in Qatar. A retrospective, cross-sectional study was conducted from 17 May to 3 June using vaccination booking records of 4023 young adolescents. Sociodemographic characteristics (i.e., age, sex, and nationality), health status and BNT162b2 COVID-19 vaccination booking status were analysed. Among respondents, the VH rate was 17.9%. Parents of 12-years adolescents were more hesitant (21.6%) as compared to the 13- (16.0%) and 15- (15.2%) years groups (p < 0.05). Parents of adolescents belonging to Gulf Countries (97% Qatari) were more hesitant (35.2%) as compared to the four remaining groups of nationalities (Asiatic; excluding Gulf Countries), North-African, African (excluding North-African), and European/American/Oceanian, 13.3-20.4%, (p < 0.001). Parental VH rates were higher when adolescents suffered from chronic disease as compared to those without the chronic disease (21.3% vs. 17.4%, p < 0.05) or who previously were COVID-19 infected as compared to non-previously COVID-19 infected (24.1 vs. 17.5%, p < 0.01). Results of logistic regression revealed that age groups, nationalities, and recovery from COVID-19 were the main predictors of VH level. Precisely, parents of 12 years old adolescents were 38% more likely to be hesitant as compared to the parents of the 15 years old adolescents (OR = 1.38; 95%CI: 1.12-1.70). Compared with the Gulf countries, parents of adolescents belonging to the other nationality categories; namely North-African, African, Asiatic and European/American/Oceanian were 48% (95%CI: 0.36-0.65), 41% (95% CI: 0.27-0.62), 38% (95%CI: 0.29-0.50) and 34% (95% CI 0.21-0.56) less likely to be hesitant, respectively. Furthermore, parents of young adolescents being previously COVID-19 infected were 37% more likely to be hesitant as compared to those with no previous COVID-19 infection (OR = 1.37; 95%CI: 1.02-1.84). Effective communication strategies specifically targeting Gulf Country populations, parents of younger children aged 12 years and of those with chronic disease or have been previously infected with COVID-19 are crucial to build community trust and vaccine confidence, thereby increasing COVID-19 vaccine uptake.

The Relationship Between Perceived Stress and Subjective Cognitive Decline During the COVID-19 Epidemic

During the outbreak of the COVID-19 epidemic, fear of disease and its consequences, recommended lifestyle changes, and severe restrictions set by governments acted as stressors and affected people's mood, emotions, mental health, and wellbeing. Many studies conducted during this crisis focused on affective and physiological responses to stress, but few studies examined how the crisis affected cognition. The present cross-sectional study examined the relationship between physiological, affective, and cognitive responses to the epidemic. In an online survey conducted at the height of the first wave of the epidemic in Slovenia (April 15-25, 2020), 830 Slovenian residents aged 18-85 years reported the effects of stressors (confinement, problems at home, problems at work, lack of necessities, and increased workload), experienced emotions, generalized anxiety, perceived stress, changes in health, fatigue and sleep quality, and perceived changes in cognition during the epidemic. Risk factors for stress (neuroticism, vulnerability, general health, gender, and age) were also recorded. We hypothesized that stressors and stress risk factors will be related to subjective cognitive decline, with negative emotions, generalized anxiety, perceived stress, and physical symptoms acting as mediator variables. On average, the results showed a mild subjective cognitive decline during the epidemic. In structural equation modeling, 34% of its variance was predicted by the mediator variables, with negative emotions and physical symptoms having the largest contribution. Stress risk factors were predictably related to the four mediator variables. Among the stressors, confinement showed the strongest effect on the four mediator variables, implying the importance of thoughtful communication about necessary restrictive measures during emergency circumstances. The results of this study indicate that the possibility of altered cognitive function should be considered when planning work and study activities during the epidemic.

Food Preferences and Food Choice Determinants in a Polish Adolescents' COVID-19 Experience (PLACE-19) Study

Food preferences are within the most important determinants of food choices; however, little is known about their complex associations, and no studies were conducted in the period of the COVID-19 pandemic. The aim of the study was to analyze the association between food preferences and food choice determinants in adolescents aged 15-20 years within the Polish Adolescents' COVID-19 Experience (PLACE-19) Study. The PLACE-19 Study included a random quota sampling conducted in the whole of Poland and covered a population-based sample of 2448 secondary school students. The food preferences were assessed using a validated Food Preference Questionnaire (FPQ), and the food choices were assessed using a validated Food Choice Questionnaire (FCQ). The statistical analysis comprised k-means clustering and linear regression adjusted for sex and age. Four homogenous clusters of respondents were defined based on the food choice motives-"healthy eaters" (health as the most important determinant of food choices), "hedonists" (convenience, sensory appeal, and price as the most important determinants), "indifferent consumers" (low significance for all determinants), and "demanding consumers" (high significance for all determinants). The preferences for all food categories differed when comparing between clusters presenting various food choice determinants (p < 0.001). The "healthy eaters" were characterized by the highest preference for vegetables; the "hedonists" preferred meat/fish, dairy, and snacks; the "demanding consumers" had a high preference for all food categories, while "indifferent consumers" had a low preference for all food categories. All preference scores were positively associated with mood, convenience, sensory appeal, natural content, and price (p < 0.05). The results confirmed the association between food preferences and food choice determinants in adolescents, as well as allowed adolescents to be clustered into segments to define various needs and motives among the identified segments. For public health purposes, it may be crucial to educate "hedonists," with a high preference for meat/fish, dairy and snacks, accompanied by convenience, sensory appeal, and price as the most important determinants of their food choices.

Changes in Eating Behaviour during SARS-CoV-2 Pandemic among the Inhabitants of Five European Countries

Psychological factors and restrictions imposed due to the pandemic may influence eating behaviours and physical activity. With the above thesis in mind, questionnaire-based surveys were conducted amongst residents of five European countries: Poland, Italy, Spain, Portugal and Great Britain (England and Scotland). A specially devised, structured questionnaire was used to conduct anonymous internet surveys between 28 April and 16 July 2020. It contained questions pertaining to sociodemographic data, eating behaviours, the impact of the pandemic on the diet and physical activity. The questionnaire was made available to internet users in Poland, Italy, Spain, Great Britain (England and Scotland), and Portugal. The questionnaire was translated by native speakers into five languages: Polish, English, Spanish, Italian and Portuguese. Survey results were then analysed using StatSoft's Statistica v. 13 software and Cytel's StatXact v. 9.0.0. Age was the parameter that impacted changing eating behaviours to the largest extent during the pandemic. It was also found that during the pandemic, regular consumption of meals was most dependent on various factors. The negative impact of the pandemic within this scope was most profound amongst women, city residents regardless of gender and people over 35 years of age. A change in the frequency of consumption of selected product groups during the pandemic was also observed. Reduced consumption of meat and fish was identified. Especially among people under 35 living in Portugal, almost half-45.5% (p = 0.0210) declared lower consumption of meat, and more than half-54.5% (p = 0.011) reported lower consumption of fish. An analysis of the obtained results also showed an increase in the consumption of products with lower nutritional values, particularly amongst people under 35 years of age and also amongst residents of Great Britain (regardless of age). Moreover, the results showed that the pandemic may have had an impact on the weight reduction diet. A negative impact was declared by 16.5% of people, compared to 9.7% who said that the pandemic facilitated the use of the weight reduction diet (p = 0.006). The results of our survey also showed a decrease in the level of physical activity among people over 35 living in Poland (69.6%, p = 0.0497) and people living in Portuguese cities (72.73%, p = 0.0245). Our survey results showed that the impact of the pandemic on eating behaviours was particularly profound when it came to meal consumption regularity. Changes to the consumption of products with lower nutritional values, which may decrease immunity, have also been found during the pandemic. Our results showed that the problem associated with consuming products with lower nutritional values was particularly evident amongst people under 35. Considering the global character of SARS-CoV-2 transmission, further research is necessary to determine its impact on the diet, nutritional status and physical activity.

Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis

BACKGROUND

The emerging novel coronavirus disease 2019 (COVID-19) has become one of the leading cause of deaths worldwide in 2020. The present systematic review and meta-analysis estimated the magnitude of sleep problems during the COVID-19 pandemic and its relationship with psychological distress.

METHODS

Five academic databases (Scopus, PubMed Central, ProQuest, ISI Web of Knowledge, and Embase) were searched. Observational studies including case-control studies and cross-sectional studies were included if relevant data relationships were reported (i.e., sleep assessed utilizing the Pittsburgh Sleep Quality Index or Insomnia Severity Index). All the studies were English, peer-reviewed papers published between December 2019 and February 2021. PROSPERO registration number: CRD42020181644.

FINDINGS

168 cross-sectional, four case-control, and five longitudinal design papers comprising 345,270 participants from 39 countries were identified. The corrected pooled estimated prevalence of sleep problems were 31% among healthcare professionals, 18% among the general population, and 57% among COVID-19 patients (all p-values < 0.05). Sleep problems were associated with depression among healthcare professionals, the general population, and COVID-19 patients, with Fisher's Z scores of -0.28, -0.30, and -0.36, respectively. Sleep problems were positively (and moderately) associated with anxiety among healthcare professionals, the general population, and COVID-19 patients, with Fisher's z scores of 0.55, 0.48, and 0.49, respectively.

INTERPRETATION

Sleep problems appear to have been common during the ongoing COVID-19 pandemic. Moreover, sleep problems were found to be associated with higher levels of psychological distress. With the use of effective programs treating sleep problems, psychological distress may be reduced. Vice versa, the use of effective programs treating psychological distress, sleep problems may be reduced.

FUNDING

The present study received no funding.

Four Weeks of Detraining Induced by COVID-19 Reverse Cardiac Improvements from Eight Weeks of Fitness-Dance Training in Older Adults with Mild Cognitive Impairment

Physical training is considered as a low-cost intervention to generate cardioprotective benefits and to promote physical and mental health, while reducing the severity of acute respiratory infection symptoms in older adults. However, lockdown measures during COVID-19 have limited people's opportunity to exercise regularly. The aim of this study was to investigate the effect of eight weeks of Fitness and Dance training, followed by four weeks of COVID-19-induced detraining, on cardiac adaptations and physical performance indicators in older adults with mild cognitive impairment (MCI). Twelve older adults (6 males and 6 females) with MCI (age, 73 ± 4.4 y; body mass, 75.3 ± 6.4 kg; height, 172 ± 8 cm; MMSE score: 24-27) participated in eight weeks of a combined Fitness-Dance training intervention (two sessions/week) followed by four weeks of training cessation induced by COVID-19 lockdowns. Wireless Polar Team Pro and Polar heart rate sensors (H10) were used to monitor covered distance, speed, heart rate (HR min, avg and max), time in HR zone 1 to 5, strenuousness (load score), beat-to-beat interval (max RR and avg RR) and heart rate variability (HRV-RMSSD). One-way ANOVA was used to analyze the data of the three test sessions (T1: first training session, T2: last training session of the eight-week training program, and T3: first training session after the four-week training cessation). Statistical analysis showed that eight weeks of combined Fitness-Dance training induced beneficial cardiac adaptations by decreasing HR (HR min, HR avg and HR max) with p < 0.001, ES = 0.5-0.6 and Δ = -7 to-9 bpm, and increasing HRV related responses (max and avg RR and RMSSD), with p < 0.01 and ES = 0.4. Consequently, participants spent more time in comfortable HR zones (e.g., p < 0.0005; ES = 0.7; Δ = 25% for HR zone 1) and showed reduced strenuousness (p = 0.02, Δ = -15% for load score), despite the higher covered total distance and average speed (p < 0.01; ES = 0.4). However, these changes were reversed after only four weeks of COVID-19 induced detraining, with values of all parameters returning to their baseline levels. In conclusion, eight weeks of combined Fitness-Dance training seems to be an efficient strategy to promote cardioprotective benefits in older adults with MCI. Importantly, to maintain these health benefits, training has to be continued and detraining periods should be reduced. During a pandemic, home-based exercise programs may provide an effective and efficient alternative of physical training.

The impact of COVID-19 home confinement on neuromuscular performance, functional capacity, and psychological state in Spanish people with Multiple Sclerosis

Background

The COVID-19 pandemic caused a global confinement of more than 2 months in Spain. As a result, the general population has significantly decreased their physical activity levels. The consequences of this abrupt, sedentary lifestyle in Spanish people with Multiple Sclerosis (pwMS) were unknown. Our aim was to examine the impact of COVID-19 home confinement on neuromuscular performance, functional capacity, physical self-perception, and anxiety in pwMS.

Methods

Eighteen pwMS (8:10 men/women, age: 43.41±10.88 years, Expanded Disability Status Scale: 2.85±1.34) participated in the study. Rate of force development (RFD) and maximal voluntary isometric contraction during knee extension in both legs, Timed-Up and Go test (TUG), sit-to-stand test, 6 min walk test, 10 m walk test, Physical-Self Perception Questionnaire (PSPQ) and State-Train Anxiety Inventory (STAI) were performed just before and after home confinement.

Results

A non-significant moderate effect (p = 0.07; ES = -0.48) was observed in the time in the sit-to-stand test compared to pre-home confinement. There was a significant increase in the time in TUG (p = 0.02; ES = -0.67). The PSQP score decreased (p = 0.01; ES = 0.79) and STAI-state increased (p = 0.01; ES = -0.65) following home confinement.

Conclusion

Home confinement had an impact on functional capacity, physical self-perception and state anxiety. However, neuromuscular performance was not altered after home confinement.