Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures

From the Lab to Real Life: Monitoring Cardiorespiratory Fitness during the COVID-19 Pandemic through Wearable Devices. An Exploratory Longitudinal Study on Healthy Participants

COVID-19 containment measures hampered population cardiorespiratory fitness (which can be quantified as peak oxygen consumption (V.O_2peak)) and the possibility to assess it using laboratory-based techniques. Although it is useful to ascertain the V.O_2peak recovery after lockdowns, the community and most scientific institutions were unable to evaluate it. Wearable devices may provide the opportunity to estimate cardiorespiratory fitness outside of the laboratory, without breaking self-isolation; herein, we explore the feasibility of this approach. Fifteen healthy participants were tested every 2 weeks for 10 weeks during a reduction of containment measures after a strict lockdown. Physical activity levels were measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). V.O_2peak was estimated through a previously validated test based on the speed of a 60 m sprint run, the baseline-to-peak heart rate (HR) variation, and the velocity of HR decay after the sprint, and measured through a wearable HR monitor. Participants increased physical activity from the end of lockdown (1833 [917–2594] MET-min/week; median [1st quartile–3rd quartile]) until the end of follow-up (2730 [1325–3380] MET-min/week). The estimated V.O_2peak increased by 0.24 ± 0.19 mL/(min*kg*week) (regression coefficient ± standard error). Based on previous knowledge on the impact of inactivity on V.O_2peak, our study indicates that a 10-week period of reducing the stringency of containment measures may not be sufficient to counteract the detrimental effects of the preceding lockdown.

Feasibility of a Home-Based Exercise Program for Managing Posttransplant Metabolic Syndrome in Lung and Liver Transplant Recipients: Protocol for a Pilot Randomized Controlled Trial

Background

Posttransplant metabolic syndrome (PTMS) is a common contributor to morbidity and mortality among solid organ transplant recipients in the late posttransplant period (≥1 year). Patients diagnosed with PTMS are at a higher risk of cardiovascular disease and frequently experience decreased physical function and health-related quality of life (HRQL). Studies in the early posttransplant period (<1 year) have shown the benefits of facility-based exercise training on physical function and HRQL, but have not evaluated the effects on metabolic risk factors. It remains unclear whether home-based exercise programs are feasible and can be delivered at a sufficient exercise dose to have effects on PTMS. This protocol outlines the methodology of a randomized controlled trial of a partly supervised home-based exercise program in lung transplant (LTx) and orthotopic liver transplant (OLT) recipients.

Objective

This study aims to evaluate the feasibility (ie, recruitment rate, program adherence, attrition, safety, and participant satisfaction) of a 12-week individualized, home-based aerobic and resistance training program in LTx and OLT recipients initiated 12 to 18 months after transplantation, and to assess estimates of intervention efficacy on metabolic risk factors, exercise self-efficacy, and HRQL.

Methods

In total, 20 LTx and 20 OLT recipients with ≥2 cardiometabolic risk factors at 12 to 18 months after transplantation will be randomized to an intervention (home-based exercise training) or control group. The intervention group will receive an individualized exercise prescription comprising aerobic and resistance training, 3 to 5 times a week for 12 weeks. Participants will meet on a weekly basis (via videoconference) with a qualified exercise professional who will supervise exercise progression, provide support, and support exercise self-efficacy. Participants in both study groups will receive a counseling session on healthy eating with a dietitian at the beginning of the intervention. For the primary aim, feasibility will be assessed through recruitment rate, program adherence, satisfaction, attrition, and safety parameters. Secondary outcomes will be measured at baseline and 12 weeks, including assessments of metabolic risk factors (ie, insulin resistance, abdominal obesity, blood pressure, and cholesterol), HRQL, and exercise self-efficacy. Descriptive statistics will be used to summarize program feasibility and effect estimates (means and 95% CIs) for sample size calculations in future trials.

Results

Enrollment started in July 2021. It is estimated that the study period will be 18 months, with data collection to be completed by December 2022.

Conclusions

A partly supervised home-based, individually tailored exercise program that promotes aerobic and resistance training and exercise self-efficacy may be an important intervention for improving the metabolic profile of LTx and OLT recipients with cardiometabolic risk factors. Thus, characterizing the feasibility and effect estimates of home-based exercise constitutes the first step in developing future clinical trials designed to reduce the high morbidity associated with PTMS.

Trial Registration

ClinicalTrials.gov NCT04965142; https://clinicaltrials.gov/ct2/show/NCT04965142

International Registered Report Identifier (IRRID)

DERR1-10.2196/35700

State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions

For centuries, regular exercise has been acknowledged as a potent stimulus to promote, maintain, and restore healthy functioning of nearly every physiological system of the human body. With advancing understanding of the complexity of human physiology, continually evolving methodological possibilities, and an increasingly dire public health situation, the study of exercise as a preventative or therapeutic treatment has never been more interdisciplinary, or more impactful. During the early stages of the NIH Common Fund Molecular Transducers of Physical Activity Consortium (MoTrPAC) Initiative, the field is well-positioned to build substantially upon the existing understanding of the mechanisms underlying benefits associated with exercise. Thus, we present a comprehensive body of the knowledge detailing the current literature basis surrounding the molecular adaptations to exercise in humans to provide a view of the state of the field at this critical juncture, as well as a resource for scientists bringing external expertise to the field of exercise physiology. In reviewing current literature related to molecular and cellular processes underlying exercise-induced benefits and adaptations, we also draw attention to existing knowledge gaps warranting continued research effort. © 2021 American Physiological Society. Compr Physiol 12:3193-3279, 2022.

Strength Level of Professional Elite Soccer Players after the COVID-19 Lockdown Period: A Retrospective Double-Arm Cohort Study

Background

It is well known that periods of inactivity generate a loss of muscle strength, a fundamental component of sports performance in soccer. However, little information is available on the decrease in strength levels in professional soccer players after the quarantine lockdown that occurred during the COVID-19 pandemic.

Aim

To compare the isokinetic peak torque profiles of professional soccer players from different teams before and after the quarantine period generated by COVID-19.

Methods

A retrospective observational study was performed using data collected from two different professional elite-level soccer teams just before and immediately after the COVID-19 quarantine period. One team gave individual instructions to its players for conditioning maintenance at home during the quarantine period, while the other team used regular video calls to maintain the player's conditioning status on home training. The main outcomes were the mean peak torque of knee extensors and flexors, from concentric and eccentric contractions of each playing position. Analysis. A two-way ANOVA analysis was used to compare peak torque before and after the quarantine period and between both teams' strategies, showing a statistically significant reduction in eccentric knee flexor peak torque from the team that did not have remote monitoring.

Conclusions

Remote monitoring programs are recommended so that athletes are less affected by the deleterious effects of confinement.

Adolescents and Resilience: Factors Contributing to Health-Related Quality of Life during the COVID-19 Pandemic

This study aimed to examine health-related quality of life of adolescents before and during the COVID-19 outbreak, and its relationship to resilience embodied in hope and a sense of coherence. Typically developed adolescents between the ages of 13 to 18 participated in the study; 84 were recruited before the pandemic outbreak and 64 in March to April 2020 during the worldwide outbreak. The participants completed the Pediatric Quality of Life Inventory, Sense of Coherence Scale, and Children’s Hope Scale. During the outbreak, adolescents reported higher physical health-related quality of life scores (F(1146) = 3.710, p < 0.05, η² = 0.027) and lower school health-related quality of life scores (F(1146) = 5.748, p < 0.05, η2 = 0.028), compared to adolescents during the pre-outbreak period. Furthermore, adolescents during the outbreak reported a significantly (p < 0.05) higher sense of coherence but no difference in levels of hope. Finally, the results of multiple linear regression indicated that resilience factors (hope and sense of coherence) contributed to the prediction of health-related quality of life, independent of socio-demographic variables. Hope and a sense of coherence were both found to positively impact one core aspect of health, which highlights the importance of addressing resilience factors in educational and therapeutic settings for adolescents thus that they are better able to adapt to stressful events such as pandemics.

Radiotherapy-Related Fatigue Associated Impairments in Lung Cancer Survivors during COVID-19 Voluntary Isolation

The main objective of this study was to investigate the impairments presented after COVID-19 voluntary isolation by lung cancer survivors that experienced radiotherapy-related fatigue. In this observational study, data were collected after COVID-19 voluntary isolation. Patients were divided into two groups according to their fatigue severity reported with the Fatigue Severity Scale. Health status was assessed by the EuroQol-5D, anxiety and depression by the Hospital Anxiety and Depression Scale, and disability by the World Health Organization Disability Assessment Schedule 2.0. A total of 120 patients were included in the study. Patients with severe fatigue obtained higher impairment results compared to patients without severe fatigue, with significant differences in all the variables (p < 0.05). Lung cancer survivors who experienced severe radiotherapy-related fatigue presented higher impairments after COVID-19 voluntary isolation than lung cancer patients who did not experience severe radiotherapy-related fatigue, and showed high levels of anxiety, depression and disability, and a poor self-perceived health status.

Rethinking COVID-19 and Beyond: Prevention, Remedies, and Recovery

In a relatively short timeframe, millions of deaths and illnesses associated with COVID-19 have been reported, accompanied by substantial economic losses, and overall, negatively impacting society. This experience should serve as a wakeup call to those in public health and healthcare, along with politicians and citizens: COVID-19 is considered a predictable and preventable disaster. While various reactive responses to address the pandemic were implemented, some with adverse effects, proactive measures in the years before COVID-19 were neglected. Predominately this involved the development of a preventable overfat pandemic, which played a key role in both rising rates of chronic disease, the comorbidities that increase the risk for COVID-19, along with associated inflammation and malnutrition. This increased the risk of infection in billions of people worldwide, which, in essence, primed society for high rates of COVID-19 infection. Excess body fat evolves primarily from poor nutrition, particularly the overconsumption of sugar and other refined carbohydrates, which replace the vital nutrients needed for optimal immune function. Sugar and refined carbohydrates must be considered the new tobacco, as these foods are also devoid of nutrients, and underly inflammatory chronic diseases. A balanced diet of nutrient-dense wholefood must be emphasized to combat infectious and inflammatory diseases. Implementing proactive preventive lifestyle changes must begin now, starting with simple, safe, and inexpensive dietary modifications that can quickly lead to a healthier population.

Unraveling Muscle Impairment Associated With COVID-19 and the Role of 3D Culture in Its Investigation

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been considered a public health emergency, extensively investigated by researchers. Accordingly, the respiratory tract has been the main research focus, with some other studies outlining the effects on the neurological, cardiovascular, and renal systems. However, concerning SARS-CoV-2 outcomes on skeletal muscle, scientific evidence is still not sufficiently strong to trace, treat and prevent possible muscle impairment due to the COVID-19. Simultaneously, there has been a considerable amount of studies reporting skeletal muscle damage in the context of COVID-19. Among the detrimental musculoskeletal conditions associated with the viral infection, the most commonly described are sarcopenia, cachexia, myalgia, myositis, rhabdomyolysis, atrophy, peripheral neuropathy, and Guillain-Barré Syndrome. Of note, the risk of developing sarcopenia during or after COVID-19 is relatively high, which poses special importance to the condition amid the SARS-CoV-2 infection. The yet uncovered mechanisms by which musculoskeletal injury takes place in COVID-19 and the lack of published methods tailored to study the correlation between COVID-19 and skeletal muscle hinder the ability of healthcare professionals to provide SARS-CoV-2 infected patients with an adequate treatment plan. The present review aims to minimize this burden by both thoroughly exploring the interaction between COVID-19 and the musculoskeletal system and examining the cutting-edge 3D cell culture techniques capable of revolutionizing the study of muscle dynamics.

Muscle hypertrophy induced by N-3 PUFA supplementation in absence of exercise: a systematic review of randomized controlled trials

The use of omega-3 polyunsaturated fatty acids (n-3 PUFA) has been studied in physically active population, however, there is a lack of information about the effects of n-3 PUFA supplementation on people with a sedentary behavior or who are undergoing a period of limb immobilization. This systematic review aims to examine the effect of n-3 PUFA on lean mass and muscle protein synthesis (MPS) in absence of physical training. The PubMed, Web of Science, MEDLINE, CINAHL and SPORTDiscus databases were searched following the PRISMA guidelines. Only randomized controlled trials, at least single blind, performed with sedentary humans were considered. Seven studies on a total of 192 individuals were included. Five of the six studies which measured changes in skeletal muscle volume and mass showed higher values with n-3 PUFA. Only two studies measured skeletal muscle protein expression. Both showed beneficial effects of supplementation in muscle protein fractional synthesis rate (FSR), while no effect of n-3 PUFA was observed for mechanistic target of rapamycin (mTOR) and kinase protein (Akt). In addition, ribosomal protein S6 kinase 1 (p70s6k) improved with n-3 PUFA only in one study. Finally, the two studies which measured the skeletal muscle gene expression observed no effect of supplementation.

Case Report: Overlap Between Long COVID and Functional Neurological Disorders

Long lasting symptoms have been reported in a considerable proportion of patients after a severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection. This condition, defined as either "post-acute coronavirus disease (COVID)," "long COVID," or "long-haul COVID," has also been described in outpatients and in individuals who are asymptomatic during the acute infection. A possible overlap exists between this condition and the functional neurological disorders (FNDs). We report a 23-year-old man who developed, after asymptomatic COVID-19, a complex symptomatology characterized by fatigue, episodic shortness of breath, nocturnal tachycardia, and chest pain. He also complained of attention and memory difficulties, fluctuating limb dysesthesia, and weakness of his left arm. After neurological examination, a diagnosis of FND was made. Notably, the patient was also evaluated at a post-COVID center and received a diagnosis of long COVID-19 syndrome. After 4 months of psychoanalytic psychotherapy and targeted physical therapy in our center for FNDs, dysesthesia and motor symptoms had resolved, and the subjective cognitive complaints had improved significantly. However, the patient had not fully recovered as mild symptoms persisted limiting physical activities. Long-term post COVID symptoms and FNDs may share underlying biological mechanisms, such as stress and inflammation. Our case suggests that functional symptoms may coexist with the long COVID symptoms and may improve with targeted interventions. In patients presenting with new fluctuating symptoms after SARS-CoV-2 infection, the diagnosis of FNDs should be considered, and the positive clinical signs should be carefully investigated.

Pandemic-Related Challenges and Organizational Support Among Personnel in Canada's Defense Establishment

In the final week of March 2020, 2.8 million Canadians were away from their usual places of work and engaging in remote and/or telework to mitigate the spread of COVID-19 (Statistics Canada, 2020). The Government of Canada's Department of National Defence (DND) and the Canadian Armed Forces (CAF) were no exception, with most members from the regular force (Reg F), the primary reserve force (P Res), and the DND public service (DND PS) working from home. The COVID-19 Defence Team Survey was administered from April 29th, 2020, and May 22nd, 2020, to gain insight into work, health, and family-related challenges since the onset of the pandemic and change in work arrangements. Responses from five open-ended questions were qualitatively analyzed to determine general themes of concern regarding work, personal, and family related challenges, stress-management and coping strategies, and recommendations for improving the work situation and personal well-being. Given the different roles and conditions of employment, responses of the different groups or “components” of respondents (Reg F, P Res, DND PS) were compared to identify common and unique challenges to inform targeted organizational responses. A total of 26,207 members (Reg F = 13,668, 52.2%; P Res = 5,052, 19.3%; DND PS = 7,487, 28.6%) responded to the survey's five open-ended questions, which yielded a total of 75,000 open-ended responses. When asked about work-related challenges, respondents' most common challenges included dissatisfaction with technology/software, work arrangements, ergonomics, work-life balance, communication within the organization, and the uncertainties regarding career development. In terms of personal and/or family-related challenges, the most common challenges included social isolation, the impact of the pandemic on mental health, school closures and homeschooling, caring for vulnerable family members, and childcare concerns. The most common stress-management and coping strategies included exercise, spending time outdoors, communicating or spending time with family members, household chores/projects, mind-body wellness exercises, and playing games. The most common recommendations made by respondents to improve their work- or personal-related situations included improving technological capabilities, streamlining communication, providing hardware and software necessary to ensure comfortable ergonomics, the provision of flexibility in terms of telework schedules, return-to-work decisions, and the expansion of benefits and access to childcare services. In terms of differences among the components, DND PS personnel were most likely to report dissatisfaction with technological changes and ergonomics, and to recommend improving these technological limitations to maximize productivity. Reg F members, on the other hand, were most likely to recommend increased support and access to childcare, and both Reg F and P Res members were more likely to mention that increased benefits and entitlements in response to the COVID-19 pandemic would be ameliorative. The results of this study highlight several important facts about the impact of the COVID-19 pandemic on personnel working in large, diverse organizations. For example, advancements in organizational technological capabilities were highlighted herein, and these are likely to grow to maintain productivity should remote work come to be used more extensively in the long-term. This study also highlighted the importance of flexibility and accommodation in relation to individual needs – a trend that was already underway but has taken on greater relevance and urgency in light of the pandemic. This is clearly essential to the organization's role in supporting the well-being of personnel and their families. Clear and streamlined communication regarding organizational changes and support services is also essential to minimize uncertainty and to provide useful supports for coping with this and other stressful situations.

The Impact of COVID-19 Lockdown on Patients with Lymphedema

Background: The coronavirus disease 2019 (COVID-19) pandemic poses a challenge to management of lymphedema. The aim of this study was to assess general health conditions and evaluate the problems and concerns of lymphedema patients with regard to access to care and provision of management and control follow-ups during the lockdown period between March and June 2020. Methods: A web-based online survey, which included questions about demographic and clinical properties, compliance with restrictions and self-management, complications, needs, and difficulties in accessing health care, as well as the presence of psychological symptoms, was applied. Results: Two hundred three patients (190 female and 13 male) replied. Majority of them (73.4%) were between 30 and 60 years old and had high school/university education (67%). The duration of lymphedema was more than 3 years and sites were commonly extremities with mild to moderate intensity in 70.5% patients. Majority of them adhered to stay home warnings (88.7%). Weight gain was a common problem and self-care methods were generally skipped (81.8%). Seventeen percent of them had wounds and/or cellulitis. Forty percent of patients needed to apply to health centers to renew the pressure garment, but could not reach it. More than 70% of patients had sleep disorders and anxiety/stress. Majority of patients used television and social media to get information related to COVID-19 and the exposure time was commonly 2 to 6 hours. Conclusions: The COVID-19 lockdown had a great impact on lymphedema patients' health care not only from medical but also from psychosocial aspects. All these implications have to be identified and dealt with properly to avoid concerns and consequences of future pandemic lockdowns. Lymphedema services should be well prepared to be delivered virtually, enable effective care, and share knowledge to meet the needs of patients suffering from lymphedema.

The impact of COVID-19 on physical activity behaviour in Italian primary school children: a comparison before and during pandemic considering gender differences

BACKGROUND

The World Health Organization stated an average of 60 min of Moderate to Vigorous Physical Activity (MVPA) that children should accumulate every day. Nevertheless physical inactivity is growing and, due to restrictions imposed during pandemic, PA levels of children might be more negatively affected. The study aimed to analyse the impact of COVID-19 on the PA of an Italian sample of primary school children by comparing it before and during COVID-19 considering gender differences.

METHODS

A pre-post analysis (October 2019-January 2021) was conducted using a randomized sample (N = 77) from the I-MOVE study settled in an Italian primary school. Both objective (Actigraph accelerometers) and self-reported (PAQ-c questionnaires) assessments of PA were performed. Changes were compared using T-Student and Chi-Square test. Gender differences were calculated using Anova.

RESULTS

Weekly and daily minutes time spent in MVPA significantly decreased respectively by - 30.59 ± 120.87 and - 15.32 ± 16.21 from before to during pandemic while the weekly time spent in sedentary behaviour increased (+ 1196.01 ± 381.49). PAQ-c scores followed the same negative trend (- 0.87 ± 0.72). Boys seem to have suffered more than girls from the imposed restrictions.

CONCLUSION

These findings outline the need for strategies to promote PA and reduce sedentary behaviours in children to prevent COVID-19 restriction long-term effects.

COVID-19 collateral damage-psychological burden and behavioural changes among older adults during the first outbreak in Stockholm, Sweden: a cross-sectional study

OBJECTIVES

To explore the indirect negative effects of COVID-19 restrictions (collateral damage) on the lives and health of older adults living in central Stockholm, and to characterise the sociodemographic profile of those with the highest susceptibility to this damage.

DESIGN

Cross-sectional study.

SETTING

District of Kungsholmen in Stockholm, Sweden.

PARTICIPANTS

Older adults aged 68 years and above (n=1231) who participated in the ad hoc COVID-19-related phone questionnaire administered by trained staff between May and June 2020 and who had previously attended the regular follow-up assessment of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) during 2016-2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

Three dimensions of collateral damage: psychological burden (feelings of worry, stress and loneliness), reductions in social and physical activities, and reductions in medical and social care use since the beginning of the pandemic. Logistic regression models were used to test the association between age, sex, education and living arrangement, and the risk of collateral damage.

RESULTS

Vast majority of participants adhered to the national public health recommendations, with over three-quarters practising self-isolation (n=928). Half of the sample reported psychological burden, 55.3% reported reductions in social or physical activity, and 11.3% reported decreased medical or social care use. Over three quarters of participants (77.8%) were affected by at least one of the three collateral damage dimensions. Female sex was the strongest sociodemographic predictor of both individual and co-occurring dimensions of collateral damage.

CONCLUSIONS

COVID-19 and its restrictions during the first half of 2020 had a negative effect on the health and lives of a majority of the elderly living in central Stockholm. Women were at a higher risk of these negative consequences. We emphasise the need for predefined, evidence-based interventions to support those who are most susceptible to these consequences, both during the pandemic and once the outbreak is overcome.

Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic

SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting and fatigue. In addition, there is evidence of a direct SARS-CoV-2 viral infiltration into skeletal muscle. Aging is often characterized by sarcopenia or sarcopenic obesity These conditions are risk factors for severe acute COVID-19 and long-COVID-19 syndrome. From these observations we may predict a strong association between COVID-19 and decreased muscle mass and functions. While the relationship between physical inactivity, chronic inflammation, oxidative stress and muscle dysfunction is well-known, the effects on muscle mass of COVID-19-related hypoxemia are inadequately investigated. The aim of this review is to highlight metabolic, immunity-related and redox biomarkers potentially affected by reduced oxygen availability and/or muscle fatigue in order to shed light on the negative impact of COVID-19 on muscle mass and function. Possible countermeasures are also reviewed.

Pandemic decrease of in-person physiotherapy as a factor in parent perceived decline in function in children with neuromuscular disorders

PURPOSE

Restrictions related to the COVID-19 pandemic can negatively affect patients who require physiotherapy. This study aimed to analyze the consequences of limited physiotherapy on the functional state of children with neuromuscular diseases (NMD). In addition, the caregivers' well-being and caregiver opinions on physiotherapy were analyzed.

METHODS

A questionnaire was shared with parents of children with NMD immediately after the COVID-19 lockdown. The survey included questions regarding the physical and mental condition of children and parents before the pandemic and during lockdown as well as their views on physiotherapy and telephysiotherapy. Statistical analysis was performed using the Wilcoxon Matched-Pairs Signed Ranks test, Spearman's Rank Correlation test, McNemar test, and Chi-square test.

RESULTS

Parents of 235 children participated in the study. Results indicated that children devoted more time to physiotherapy before the pandemic than during the lockdown period, which was true for those living in cities and the countryside. The functional state of 50.2% of the children deteriorated during the lockdown, in the opinion of their parents. Significant correlations were found between limited physiotherapy time and the deterioration of children's functional condition, ability to maintain a standing position, and increased anxiety. The majority of parents reported increased levels of fear and anxiety (72.8%), fatigue (67.7%), and pain (53.2%). In-person physiotherapy was rated significantly higher than telephysiotherapy by parents.

CONCLUSIONS

Limited access to physiotherapy and shorter therapy times may lead to functional deterioration in children with NMD, but this assumption needs to be objectively confirmed. According to the parents' opinions, telephysiotherapy is less beneficial than direct physiotherapy but may support therapy conducted directly by a physiotherapist. Results based on subjective parental opinions may be helpful in planning future projects.

Impact of Covid-19 on Lifestyle Related Behaviors of Nigerians

Introduction: A great threat of a novel virus – coronavirus otherwise known as COVID-19 pandemic rocked the entire world in the wake of the year 2020. The threat is so strenuous that the entire world was placed on lockdown in the matter of social restriction such as on international and national transport links, market or business transactions, school and organizational activities, and all related social and religious gatherings. This restriction might change people’s lifestyle. This study was aimed at assessing the lifestyle changes caused by the pandemic among Nigerians.

Methodology: A web based cross sectional survey was conducted using an e-questionnaire. A paired t-test, independent t-test were used to test hypothesis while mean, frequency, and percentage were used to summarize the data.

Results: Majority of the participants were male (72.1%), single (83.2%), and middle class (79.5%) of social status. There was a decrease in the habit of consuming meals routinely at regular intervals during COVID-19 (19.4% vs 25.7%). There were significant differences in eating patterns before and during COVID-19 (P<0.05). Likewise, significant differences in physical activity before and during COVID-19 were observed.

Conclusion: Some of the protocol put in place in curtailing the virus has been proven to have a positive impact on the lifestyle of Nigerians Such health benefits include but not limited to an increase in moderate exercise, increase in the consumption of healthy and reduction in the consumption of unhealthy food.

Social Isolation, Loneliness and Generalized Anxiety: Implications and Associations during the COVID-19 Quarantine

The COVID-19 pandemic has resulted in a predominantly global quarantine response that has been associated with social isolation, loneliness, and anxiety. The foregoing experiences have been amply documented to have profound impacts on health, morbidity, and mortality. This narrative review uses the extant neurobiological and theoretical literature to explore the association between social isolation, loneliness, and anxiety in the context of quarantine during the COVID-19 pandemic. Emerging evidence suggests that distinct health issues (e.g., a sedentary lifestyle, a diminished overall sense of well-being) are associated with social isolation and loneliness. The health implications of social isolation and loneliness during quarantine have a heterogenous and comorbid nature and, as a result, form a link to anxiety. The limbic system plays a role in fear and anxiety response; the bed nucleus of the stria terminalis, amygdala, HPA axis, hippocampus, prefrontal cortex, insula, and locus coeruleus have an impact in a prolonged anxious state. In the conclusion, possible solutions are considered and remarks are made on future areas of exploration.

The Effect of Pandemic Movement Restriction Policies on Children's Physical Fitness, Activity, Screen Time, and Sleep

Background: The negative impact of isolation, confinement, and physical (in)activity due to pandemic movement restriction has been well-documented over the past year, but less is known on the impact of these policies on children's physical fitness. This study was designed to determine the effects of pandemic movement restriction policies on the 24-hour movement behavior (24-HMB) of children, and whether any alterations are reflected in worsening physical fitness outcomes determined via direct testing. Methods: A two-phase, repeated-measures study with matched controls was conducted. Phase One: N = 62 schoolchildren (N = 31 female) completed self-assessment questionnaires on 24-HMB in October 2018 (pre-pandemic) and again in April 2020, at the height of movement restrictions enacted in response to the COVID-19 pandemic first wave. Phase Two: physical fitness of the original N = 62 children were determined directly pre- and post-isolation using an eight-component standardized fitness test battery and compared to N = 62 control children who were matched for age, sex, school region, and fitness centile scores. Results: During lockdown (total duration: 63 days), moderate-to-vigorous physical activity (MVPA) decreased by ~46 min per day, screen time demonstrated a significant interaction effect, such that kids reported spending less recreational screen time on weekends during lockdown compared to no restriction, and sleep duration was consistently lower (95% CI: -104.1 to -45.5 min, p < 0.001). No interaction effect was present for direct fitness indicators, including: hand tapping (reaction time), standing broad jump, polygon backward obstacle course (coordination), sit-ups, stand-and-reach, bent-arm hang, 60-m, and 600-m run (p ≥ 0.05) although significant main effects are noted for both sexes. Conclusion: Initial changes in 24-HMB did not translate to reductions in physical fitness per se, likely due to the high initial fitness levels of the children. Further work is needed to confirm whether longer or repeated movement restrictions exacerbate initial negative 24-HMB trends, especially for children who are less fit when restrictions are initiated, prolonged, or repeated.

Training Intensity, Not Duration, May Be Key to Upregulating Presynaptic Proteins of Calcium Dynamics and Calcium-Dependent Exocytosis in Fast- and Slow-Twitch Skeletal Muscles, in Addition to Maintaining Performance After Detraining

Neuromuscular adaptations are essential for improving athletic performance. However, little is known about the effect of different endurance training protocols and their subsequent detraining on the gene expression of critical factors for neuromuscular synaptic transmission. Therefore, this study investigated the effects of endurance training (high-intensity interval training [HIIT], continuous [cEND], mixed interval [Mix], and all protocols combined [Comb]) and detraining on performance and gene expression (GE) of the alpha-1a, synaptotagmin II (Syt-II), synaptobrevin II (Vamp2), and acetylcholinesterase (AChE) in the gastrocnemius and soleus of Wistar rats. Eighty rodents were randomly divided into control, HIIT, cEND, Mix, Comb, and detraining groups. The rodents trained for 6 weeks (5 × /week), followed by 2 weeks of detraining. Performance improved in all training groups and decreased following detraining (p < 0.05), except HIIT. In the gastrocnemius, alpha-1a GE was upregulated in the Mix. Syt-II and AChE GE were upregulated in HIIT, Mix, and Comb. Vamp2 GE was upregulated in all groups. In the soleus, alpha-1a GE was upregulated in HIIT, Mix, and Comb. Syt-II and Vamp2 GE were upregulated in all groups. AChE GE was upregulated in cEND, Mix, and Comb. Detraining downregulated mostly the gene expression in the skeletal muscles. We conclude that training intensity appears to be a key factor for the upregulation of molecules involved in neuromuscular synaptic transmission. Such changes occur to be involved in improving running performance. On the other hand, detraining negatively affects synaptic transmission and performance.

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.

The impact of COVID19 on advanced practice nursing education and practice: A qualitative study

AIM

To explore Master of Nursing students' perspectives toward the impact of coronavirus disease 2019 (COVID-19) on the advanced practice nurse preparatory education and practice.

BACKGROUND

Like many nursing education programmes, the advanced practice nurse preparatory training was greatly affected and had to radically change to adapt to the disruptions caused by the pandemic. The COVID-19 pandemic has created a strain on the healthcare system and advanced practice nurses have been expected to modify their normal practice to provide care in unprecedented ways.

METHODS

The study used a descriptive qualitative design. Semi-structured video-conference interviews were conducted in an autonomous university (June-July 2020). The recruitment of participants (n = 14) concluded upon data saturation. A thematic analysis was conducted. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used.

FINDINGS

Three main themes were identified: (1) overcome adversity through innovation, (2) acceptance of remote learning and (3) versatility of advanced practice nurses in an ongoing pandemic. Each theme was further explained by two subthemes to further elucidate the impact of COVID-19 on the advanced practice nurse preparatory training and practice.

DISCUSSION

The evolution of the advanced practice nurse preparatory education catalysed by the COVID-19 pandemic brought on innovation. The ability of advanced practice nurses to adapt to evolving healthcare needs was also highlighted.

CONCLUSION

Although face-to-face teaching and services are gradually returning, some innovations that arose during the pandemic may be worth keeping.

IMPLICATIONS FOR NURSING

Nursing educators in higher education institutions can benefit from adopting technology to mitigate the challenges posed by the ongoing pandemic IMPLICATIONS FOR NURSING POLICY: Nurse leaders should review the role of advanced practice nurses to determine how best to capitalise on their practice to meet rising healthcare needs.

Effects of the COVID-19 Pandemic on Physical Activity in Chronic Diseases: A Systematic Review and Meta-Analysis

The management of chronic diseases (CD) includes physical activity (PA). It is necessary to determine the effects of COVID-19 restrictions in CD. The aim was to review the research related to PA levels before and during the COVID-19 pandemic in people with CD. This review was designed according to PRISMA guidelines and registered in PROSPERO: CRD42020218825. The search was performed in CINAHL, Medline, Scopus, and Web of Science up to January 2021. The PICOS recommendations were applied. The search was conducted by two reviewers, who completed the data extraction of included articles. Methodological quality was assessed using the STROBE checklist, and a meta-analysis was conducted. The literature search strategy identified 227 articles. Five studies remained and were included. Only three studies were included in the meta-analysis. Two articles used accelerometers to objectively compare PA levels before and during the pandemic. Three studies made this comparison using an online survey. All articles showed a decrease in PA levels during the COVID-19 pandemic. The meta-analysis showed a significant reduction in PA levels during pandemic. PA levels during the COVID-19 pandemic have been reduced with respect to previous levels of PA in patients with CD.

Gluteal Muscle Atrophy and Increased Intramuscular Lipid Concentration Are Not Mitigated by Daily Artificial Gravity Following 60-Day Head-Down Tilt Bed Rest

Exposure to spaceflight and head-down tilt (HDT) bed rest leads to decreases in the mass of the gluteal muscle. Preliminary results have suggested that interventions, such as artificial gravity (AG), can partially mitigate some of the physiological adaptations induced by HDT bed rest. However, its effect on the gluteal muscles is currently unknown. This study investigated the effects of daily AG on the gluteal muscles during 60-day HDT bed rest. Twenty-four healthy individuals participated in the study: eight received 30 min of continuous AG; eight received 6 × 5 min of AG, interspersed with rest periods; eight belonged to a control group. T1-weighted Dixon magnetic resonance imaging of the hip region was conducted at baseline and day 59 of HDT bed rest to establish changes in volumes and intramuscular lipid concentration (ILC). Results showed that, across groups, muscle volumes decreased by 9.2% for gluteus maximus (GMAX), 8.0% for gluteus medius (GMED), and 10.5% for gluteus minimus after 59-day HDT bed rest (all p < 0.005). The ILC increased by 1.3% for GMAX and 0.5% for GMED (both p < 0.05). Neither of the AG protocols mitigated deconditioning of the gluteal muscles. Whereas all gluteal muscles atrophied, the ratio of lipids to intramuscular water increased only in GMAX and GMED muscles. These changes could impair the function of the hip joint and increased the risk of falls. The deconditioning of the gluteal muscles in space may negatively impact the hip joint stability of astronauts when reexpose to terrestrial gravity.

Federal medical biological agency of Russia's efforts to support Russian athletes during COVID-19 outbreak

This paper dwells upon COVID-19-related efforts of the Center for Sports Medicine, Federal Medical and Biological Agency of Russia. The Agency has the following precautions in place: regular polymerase chain reaction (PCR) testing of athletes and staff; double PCR testing before going to training camps or medical examinations; isolating athletes and their traceable contacts when COVID is suspected; observation and isolation wards set up at training camp venues. Athlete vaccination has begun. Athletes are provided online advice on health, diet, and exercising plus special care for chronically ill athletes and remote psychological counseling. Athletes recovering from COVID-19 are offered rehabilitation programs and doctor-supervised return to training. Specialists of the Research Department at FMBA’s Center for Sports Medicine carried out a research dedicated to the prevalence of COVID-19 and different variants of its course in Russian athletes. The study period lasted from March to December 2020. A total of 27,438 records were analyzed. In May, June, July and August 2020, the percentage of positive PCR tests for athletes was significantly lower than the nationwide percentage at p < 0.05, Pearson’s chi-squared test. However, the differences were nullified by September–October. The disease was mild or asymptomatic in most patients. Athletes of summer sports were found to be most likely to contract COVID-19.

Impact of the COVID-19 Lockdown and Confinement Measures on the Musculoskeletal Health of the Urban Geriatric Population

Background Owing to the coronavirus disease 2019 (COVID-19) pandemic, a nationwide lockdown was imposed in India, with strict confinement measures imposed on the elderly. Because mobility and regular physical activity are considered to be the key determinants of musculoskeletal health, this study aimed to investigate the effect of lockdown and confinement measures on the musculoskeletal health and activities of daily living of the urban geriatric population. Methodology A cross-sectional survey was conducted among the elderly aged ≥60 years. The survey instrument consisted of a questionnaire, a modified Nordic Musculoskeletal Questionnaire (mNMQ), and the Barthel activities of daily living (ADL) index. The net mNMQ score and Barthel ADL index were compared before and during the lockdown. Univariate and multivariate analyses were performed to determine which factors could result in the worsening of the net mNMQ score. In addition, floor and ceiling effects of the net mNMQ score were determined. Results In this study, a total of 105 out of 150 eligible participants were enrolled. A significant decline in physical activity status was noted during the lockdown. Overall, 54.3% of the respondents reported that their medical services were impacted during the lockdown. The net mNMQ score showed a significant worsening during the lockdown (P < 0.0001). A statistically significant increase in the modified NMQ score was noted for the lower limb (P < 0.0001) and spine (P = 0.002), but not for the upper limb (P = 0.052). Elderly whose medical services were impacted during lockdown had significantly worse net mNMQ scores than those whose services were not impacted (odds ratio = 6.16; 95% confidence interval = 2.51-15.08; P = 0.0001). Age, gender, ambulatory status, increase in body weight, and indulgence in exercise before and during lockdown had no effect on the change in the net mNMQ score. A significant ceiling effect was noted in the mNMQ score; however, no floor effect was noted. Conclusions Lockdown and confinement measures resulted in a significant decline in physical activity as well as the overall musculoskeletal health of the urban geriatric population in the present study. Hence, policymakers should ensure uninterrupted medical care to the elderly during extended periods of confinement and develop optimal home-based physical activity programs to counter the problems associated with sedentarism.

Design and Evaluation of an Online Squat Fitness System: Lessons Learned During the Early COVID-19 Pandemic in Japan

COVID-19 has changed our lives and limited our ability to have adequate physical activity (PA). It is necessary to replace outdoor PA with home-based fitness. However, people lack access, skills, and even motivation for home-based fitness. To address these issues, we designed a free access self-monitoring and coaching and music-based interactive online squat fitness system. Body weight squat was utilized for fitness exercise and evaluated based on three indices: knee width, hip depth, and rhythm. An online survey on changes in exercise due to the COVID-19 pandemic and exercise habits was conducted to investigate the effect of the COVID-19 pandemic on PA. We collected data from 557 respondents 5 months after the system first released and analyzed 200 visitors' performance on squat exercise and the other relevant parameters. Visitors were divided into three groups according to their age: younger, middle, and older groups. Results showed that the younger group had better squat performance than the middle and older groups in terms of hip depth and rhythm. We highlighted the lessons learned about the system design, fitness performance evaluation, and social aspects, for future study of the design and development of similar home-based fitness systems. We provided first-hand results on the relation between the COVID-19 pandemic and physical exercise among different age groups in Japan, which was valuable for policy making in the post-COVID-19 era.

Responses of a Pre-hospital Emergency Medical Service During Military Conflict Versus COVID-19: A Retrospective Comparative Cohort Study

Background

Decreases in routine healthcare practices have been shown to occur during disasters. However, research regarding the impacts of natural disasters, pandemics, or military conflicts on emergency medical services (EMS) is scarce.

Objectives

This study assessed the impact of a military conflict versus the coronavirus disease 2019 (COVID-19) pandemic on a national EMS organization in terms of responses to overall daily emergencies, medical illnesses, motor vehicle collisions, and other injuries.

Methods

This retrospective comparative cohort study assessed daily routine emergency ambulance calls to Magen David Adom (MDA), Israel’s national EMS organization. This included overall emergency calls as well as those related to medical illnesses, motor vehicle collisions (MVCs), and other injuries. All data were obtained from the MDA command and control database. During the military conflict Operation Protective Edge (2014), the civilian population was subjected to intensive rocket attacks for 24 days, followed by 26 days of a progressive withdrawal of operations and then to a post-conflict period. During the first wave of the COVID-19 pandemic (March-April 2020), the population was subjected to 32 days of total lockdown, followed by 27 days of progressive relief of confinement, and then to a post-lockdown period.

Results

The total number of emergency calls in this study was 330,430. During the conflict, the mean number of daily calls decreased, followed by an increase during Relief and Post-Conflict with higher values in Post-Conflict than in Pre-Conflict. During the COVID-19 pandemic, there was a decrease in the mean daily number of calls during Lockdown. It remained low during Relief and increased during Post-Lockdown. However, it remained lower in Post-Lockdown than during Pre-Lockdown. Calls related to medical illnesses decreased during the conflict and during the lockdown. The post-conflict period was characterized by a similar baseline call magnitude but not during the post-lockdown period. Decreases in calls for MVC and other injuries were significant during the lockdown but not during the military conflict. Post-lockdown was accompanied by return to baseline call volumes for MVC, whereas calls for other injuries increased above baseline both after the lockdown and military conflict.

Conclusion

This study shows decreasing trends in routine daily calls for EMS during both Operation Protective Edge and COVID-19. However, different patterns of needs for EMS were evidenced for medical illnesses, MVC, or calls concerning other injuries. These results are instrumental for managing the operational demands of EMS during military conflicts and pandemics.

Life in a time of COVID: a mixed method study of the changes in lifestyle, mental and psychosocial health during and after lockdown in Western Australians

BACKGROUND

Since the beginning of the COVID-19 pandemic, the Western Australian government imposed multiple restrictions that impacted daily life activities and the social life. The aim of this study was to examine the effects of COVID-19 lockdown on the community's physical, mental and psychosocial health.

METHODS

Approximately 2 months after a three-month lockdown, a cross-sectional study was opened to Western Australian adults for an 8-week period (25th August - 21 October 2020). Participants competed a 25-min questionnaire adapted from the Western Australia Health and Wellbeing Surveillance system. Participants provided information on their socio-demographic status, lifestyle behaviours, mental health, and psychosocial health during and post-lockdown. Open-ended questions explored key issues in greater detail. Changes between the lockdown and post-lockdown period were assessed using Wilcoxon signed rank test and One-Sample Kolmogorov-Smirnov Normal tests as appropriate. Sex differences were examined using the Mann-Whitney U test. A content analysis approach examined responses to the open-ended questions with frequencies and variations in responses determined using Chi-Square tests.

RESULTS

A total of 547 complete responses were obtained. Compared to post-lockdown period, lockdown was associated with a significantly lower levels of physical activity, poorer mental well-being and sense of control over one's life, and a higher level of loneliness. Similarly, during lockdown, there was a significantly higher consumption of junk food, soft drinks and alcoholic drinks but no change in fruit and vegetable intake. Participants recalled health campaigns on hand washing and social distancing and there was a retrospective view that more timely and informative campaigns on physical activity, nutrition and mental well-being should have been available during lockdown.

CONCLUSIONS

While advice on infection control measures were appropriately provided, there is a need for concurrent health promotional information to help combat the changes in physical, mental and psychosocial well-being observed during quarantine to prevent negative health consequences in the community even if there are minimal effects of the pandemic itself.

Has COVID-19 Changed the Lifestyle and Dietary Habits in the Spanish Population after Confinement?

Since 2020, the world has been immersed in a change in lifestyle (social, lifestyle, nutri-tion and physical activity patterns), due to the appearance of COVID-19 and the strict mobility measures which were implemented to prevent its spread. All these changes had a nutritional impact on people, modifying their dietary guidelines. This cross-sectional study was carried out to assess whether dietary habits, lifestyle, and adherence to the Mediterranean diet among the Spanish adult population (25-65 years old) during confinement was modified during the post-confinement period, using an e-survey through social networks, involving 510 subjects. A decrease in the intake of ultra-processed products, with a correlation between weekly food delivery orders at home and the consumption of salty snacks, sugary drinks, and processed pastries was also recorded. Most of the subjects performed physical exercise on a regular basis, maintaining the body weight in half of the participants. During the post-confinement period a substantial proportion of the population had healthy lifestyle and dietary habits, including the adequate consumption of fruits, vegetables and legumes; adequate time was spent preparing meals and the population did not regularly order food at home, which in the long term, reduced the risk of several diseases.

Relationships among Physical Self-Concept, Physical Activity and Mediterranean Diet in Adolescents from the Province of Granada

The aim of the present research was to analyse the relationships among physical self-concept, physical activity engagement and Mediterranean diet adherence in a sample of 1650 secondary school students from the province of Granada. The study design was descriptive-exploratory, cross-sectional and ex post facto. Measurements were taken from a single group. The PSQ, PAQ-A and KIDMED questionnaires were used to measure diet quality. Results showed the presence of a positive relationship among all dimensions of physical self-concept and physical activity engagement, with better outcomes being achieved in this self-perception with increasing engagement in sport. With regard to diet quality and its repercussions on physical self-concept, it was highlighted that the dimensions of the general self-concept, physical attractiveness and strength tended to be more positive as quality improved. In contrast, worse outcomes were produced in those with a low-quality diet. In this way, it was deemed necessary to continue investigating psychosocial factors with the aim of clarifying the relationships with psychological factors and health indicators. This would enable the development of prevention and intervention programs focused on promoting wellbeing in adolescents.

The Preventive Role of Exercise on the Physiological, Psychological, and Psychophysiological Parameters of Coronavirus 2 (SARS-CoV-2): A Mini Review

The world has been severely challenged by the Coronavirus Disease (COVID-19) outbreak since the early 2020s. Worldwide, there have been more than 66 million cases of infection and over 3,880,450 deaths caused by this highly contagious disease. All sections of the population including those who are affected, those who are not affected and those who have recovered from this disease, are suffering physiologically, psychologically or psychophysiologically. In this paper we briefly discuss the consequences of COVID-19 on physiological, psychological and psychophysiological vulnerability. We also attempt to provide evidence in support of exercise management as a prevention strategy for improving and minimizing the physiological, psychological and psychophysiological effects of COVID-19. Moderate exercise including walking, yoga and tai-chi to name but a few exercise regimes are critical in preventing COVID-19 and its complications. Governments, public health authorities and the general population should maintain physical activity during the COVID-19 pandemic to prevent additional physical and mental distress.

Deconditioning in people living with dementia during the COVID-19 pandemic: qualitative study from the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation

Background

Restrictions introduced in response to the COVID-19 pandemic led to increased risk of deconditioning in the general population. No empirical evidence of this effect however has been gathered in people living with dementia. This study aims to identify the causes and effects of COVID-19-related deconditioning in people living with dementia.

Methods

This is a longitudinal phenomenological qualitative study. Participants living with dementia, their caregivers and therapists involved in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation during the COVID-19 pandemic were qualitatively interviewed at two time points: the baseline 2 months after the national lockdown was imposed in England (i.e., May 2020), the follow up 2 months after the first set (i.e. July 2020). The data were analysed through deductive thematic analysis.

Results

Twenty-four participants living with dementia, 19 caregivers and 15 therapists took part in the study. Two themes were identified: Causes of deconditioning in people living with dementia during the COVID-19 pandemic and effects of deconditioning in people living with dementia during the COVID-19 pandemic. A self-reinforcing pattern was common, whereby lockdown made the person apathetic, demotivated, socially disengaged, and frailer. This reduced activity levels, which in turn reinforced the effects of deconditioning over time. Without external supporters, most participants lacked the motivation / cognitive abilities to keep active. Provided the proper infrastructure and support, some participants could use tele-rehabilitation to combat deconditioning.

Conclusion

The added risks and effects of deconditioning on people with dementia require considerable efforts from policy makers and clinicians to ensure that they initiate and maintain physical activity in prolonged periods of social distancing. Delivering rehabilitation in the same way as before the pandemic might not be feasible or sustainable and innovative approaches must be found. Digital support for this population has shown promising results but remains a challenge.

Trial registration

The PrAISED trial and process evaluation have received ethical approval number 18/YH/0059 from the Bradford/Leeds Ethics Committee. The ISRCTN Registration Number for PrAISED is 15320670.

Online Dance Therapy for People With Parkinson's Disease: Feasibility and Impact on Consumer Engagement

BACKGROUND

Therapeutic dancing can be beneficial for people living with Parkinson's disease (PD), yet community-based classes can be difficult to access.

OBJECTIVE

To evaluate the feasibility and impact of online therapeutic dancing classes for people in the early to mid-stages of PD.

METHODS

Co-produced with people living with PD, physiotherapists, dance teachers and the local PD association, the 'ParkinDANCE' program was adapted to enable online delivery during the COVID-19 pandemic. Participants completed 8 one-hour sessions of online therapeutic dancing. Each person was assigned their own dance teacher and together they selected music for the classes. A mixed-methods design enabled analysis of feasibility and impact. Feasibility was quantified by attendance and adverse events. Impact was determined from individual narratives pertaining to consumer experiences and engagement, analysed with qualitative methods through a phenomenological lens.

RESULTS

Attendance was high, with people attending 100% sessions. There were no adverse events. Impact was illustrated by the key themes from the in-depth interviews: (i) a sense of achievement, enjoyment and mastery occurred with online dance; (ii) project co-design facilitated participant engagement; (iii) dance instructor capabilities, knowledge and skills facilitated positive outcomes; (iv) music choices were key; and (v) participants were able to quickly adapt to online delivery with support and resources.

CONCLUSIONS

Online dance therapy was safe, feasible and perceived to be of benefit in this sample of early adopters. During the pandemic, it was a viable form of structured physical activity. For the future, online dance may afford benefits to health, well-being and social engagement.

The Effects of Physical Inactivity and Exercise at Home in Young Patients with Congenital Heart Disease during the COVID-19 Pandemic

Background: The COVID-19 pandemic had a significant impact on the population’s ability to be physically active. Purpose: Evaluate the effect of the COVID-19 mitigation measures on exercise tolerance in patients with congenital heart disease (CHD). Materials and methods: All subjects (880, 6–18 years old) who performed a stress test at our hospital from October 2020 to February 2021 and had a similar test one year earlier were enrolled. A questionnaire on the degree of physical activity carried out in 2020 concerning the period prior to the pandemic was compiled. Exercise tolerance and the main anthropometric parameters between the first and second tests were compared. Results: 110 subjects (11.9 ± 4.1 years) were included in the study. The percentage of patients engaged in regular physical activity (RPA) decreased significantly during the pandemic (p < 0.001), and BMI increased significantly (p < 0.001), except among the subjects who began RPA during the lockdown, whereas test duration did not decrease significantly overall but increased in this last subgroup (p < 0.05) Conclusions: The COVID-19 lockdown led to a less active lifestyle with a significant increase in BMI in our group of CHD. These data could have negative effects on the risk profile of this population. RPA practiced at home seems to be effective in counteracting such effects.

Impact of the COVID-19 pandemic on exercise habits among cancer patients

Purpose There is limited information on how the COVID-19 pandemic has changed health behaviors among cancer patients. We examined the impact of the pandemic on changes in exercise behaviors and identified characteristics associated with these changes among cancer patients. Methods Cancer patients (n  =  1,361) completed a survey from August-September 2020 to assess COVID-19 pandemic-related changes in health behaviors and psychosocial factors. Patients were categorized into 3 groups: exercising less, exercising did not change, and exercising more. Patient characteristics were compared by exercise groups. Results One-third of the patients reported a decreased amount of regular exercise, while 11% reported exercising more during the pandemic. Patients who exercised less were more likely to be unemployed/retired, undergoing active treatment, and had increased pandemic-related alcohol consumption and psychosocial stressors such as loneliness and financial stress (all p  < 0.05). In contrast, patients who exercised more were younger, female, full-time employed, did not consume alcohol, and had good health status and more social interactions (all p  < 0.05). Patients who were living in rural areas and did not experience changes in daily life, were also more likely not to experience changes in exercise habits (all p  < 0.05). Conclusion Our results indicate that a significant proportion of cancer patients experienced changes in exercise habits during the first 6 months of the COVID-19 pandemic. Age, sex, employment status, health status, alcohol consumption, and psychosocial factors were associated with changes in exercise behaviors. Providers should monitor for changes in health behaviors, such as exercise, because of their importance in improving cancer survivorship.

Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action

Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.

Eating habits and mental health among rugby players of the Peruvian pre-selection during the second quarantine due to the COVID-19 pandemic

Objectives:

Social isolation during the COVID-19 pandemic impacts the mental health and diet of populations.

Aim:

The aim of the study was to evaluate whether the eating habits and mental health status of the rugby players of the Peruvian pre-selection were affected by the second quarantine of the COVID-19 pandemic.

Methods:

A cross-sectional study was carried out through a pre-structured online survey in 74 players, 42 men (56.8%) and 32 women (43.2%). The mean age was 20.5 ± 4.4 years. Participants completed a validated food frequency questionnaire and depression, anxiety, and stress scale-21 (DASS-21).

Results:

58.1% of the respondents reported that their dietary intake remained the same or increased. 58.3% of the players experienced anxiety, among which 26.4% reported moderate and severe symptoms. A greater proportion of participants <20 years old reported depression compared to those ⩾20 years (68.6% vs 31.4%, p = 0.010). Those who reported inadequate food intake were more likely to report depressive symptoms (p = 0.006).

Conclusion:

These findings reaffirm the need to implement programs of psychological support and nutritional counseling among athletes to reduce negative symptoms and better face mental health and dietary challenges in these times of crisis.

Potential Physiological and Cellular Mechanisms of Exercise That Decrease the Risk of Severe Complications and Mortality Following SARS-CoV-2 Infection

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has unmasked mankind's vulnerability to biological threats. Although higher age is a major risk factor for disease severity in COVID-19, several predisposing risk factors for mortality are related to low cardiorespiratory and metabolic fitness, including obesity, cardiovascular disease, diabetes, and hypertension. Reaching physical activity (PA) guideline goals contribute to protect against numerous immune and inflammatory disorders, in addition to multi-morbidities and mortality. Elevated levels of cardiorespiratory fitness, being non-obese, and regular PA improves immunological function, mitigating sustained low-grade systemic inflammation and age-related deterioration of the immune system, or immunosenescence. Regular PA and being non-obese also improve the antibody response to vaccination. In this review, we highlight potential physiological, cellular, and molecular mechanisms that are affected by regular PA, increase the host antiviral defense, and may determine the course and outcome of COVID-19. Not only are the immune system and regular PA in relation to COVID-19 discussed, but also the cardiovascular, respiratory, renal, and hormonal systems, as well as skeletal muscle, epigenetics, and mitochondrial function.

Protecting Families: A Qualitative Study on the Implementation of Protective Measures to Prevent COVID-19 Transmission

BACKGROUND: Health protocol compliance among family members can help curb the spread of COVID-19. However, not all families or family members can easily navigate the changes brought about by the pandemic; hence, minimizing virus transmission remains a challenge. AIM: Therefore, observing how families implement health protocols in daily life will reveal the challenges and opportunities, and inform public health policies. METHODS: We conducted a qualitative study by collecting data through phone interviews from November 2020 to February 2021. Eighteen families with a total of 30 individuals participated in this study. The interview data were transcribed verbatim and analyzed using thematic analysis. RESULTS: The analysis shows that participants were actively involved in implementing protective measures to prevent transmission among their family members. Five themes emerged from the data, namely fundamental concerns, restraints and constraints, pandemic roles, compromises, and intergenerational attitudes. The themes described the families’ lives during the pandemic, their efforts in protecting family members, and the dynamic within the families related to the implementation of COVID-19 protective measures. CONCLUSION: This study indicates that families could play a key role in both protecting and compromising the health of their family members. Families respond to the health crisis actively, but at times increase the risk to virus exposure because they have to continue going about their daily lives.

The Aging Muscle in Experimental Bed Rest: A Systematic Review and Meta-Analysis

Background: Maintaining skeletal muscle mass and function in aging is crucial for preserving the quality of life and health. An experimental bed rest (BR) protocol is a suitable model to explore muscle decline on aging during inactivity. Objective: The purpose of this systematic review and meta-analysis was, therefore, to carry out an up-to-date evaluation of bed rest, with a specific focus on the magnitude of effects on muscle mass, strength, power, and functional capacity changes as well as the mechanisms, molecules, and pathways involved in muscle decay. Design: This was a systematic review and meta-analysis study. Data sources: We used PubMed, Medline; Web of Science, Google Scholar, and the Cochrane library, all of which were searched prior to April 23, 2020. A manual search was performed to cover bed rest experimental protocols using the following key terms, either singly or in combination: "Elderly Bed rest," "Older Bed rest," "Old Bed rest," "Aging Bed rest," "Aging Bed rest," "Bed-rest," and "Bedrest". Eligibility criteria for selecting studies: The inclusion criteria were divided into four sections: type of study, participants, interventions, and outcome measures. The primary outcome measures were: body mass index, fat mass, fat-free mass, leg lean mass, cross-sectional area, knee extension power, cytokine pattern, IGF signaling biomarkers, FOXO signaling biomarkers, mitochondrial modulation biomarkers, and muscle protein kinetics biomarkers. Results: A total of 25 studies were included in the qualitative synthesis, while 17 of them were included in the meta-analysis. In total, 118 healthy elderly volunteers underwent 5-, 7-, 10-, or 14-days of BR and provided a brief sketch on the possible mechanisms involved. In the very early phase of BR, important changes occurred in the skeletal muscle, with significant loss of performance associated with a lesser grade reduction of the total body and muscle mass. Meta-analysis of the effect of bed rest on total body mass was determined to be small but statistically significant (ES = -0.45, 95% CI: -0.72 to -0.19, P < 0.001). Moderate, statistically significant effects were observed for total lean body mass (ES = -0.67, 95% CI: -0.95 to -0.40, P < 0.001) after bed rest intervention. Overall, total lean body mass was decreased by 1.5 kg, while there was no relationship between bed rest duration and outcomes (Z = 0.423, p = 672). The meta-analyzed effect showed that bed rest produced large, statistically significant, effects (ES = -1.06, 95% CI: -1.37 to -0.75, P < 0.001) in terms of the knee extension power. Knee extension power was decreased by 14.65 N/s. In contrast, to other measures, meta-regression showed a significant relationship between bed rest duration and knee extension power (Z = 4.219, p < 0.001). Moderate, statistically significant, effects were observed after bed rest intervention for leg muscle mass in both old (ES = -0.68, 95% CI: -0.96 to -0.40, P < 0.001) and young (ES = -0.51, 95% CI: -0.80 to -0.22, P < 0.001) adults. However, the magnitude of change was higher in older (MD = -0.86 kg) compared to younger (MD = -0.24 kg) adults. Conclusion: Experimental BR is a suitable model to explore the detrimental effects of inactivity in young adults, old adults, and hospitalized people. Changes in muscle mass and function are the two most investigated variables, and they allow for a consistent trend in the BR-induced changes. Mechanisms underlying the greater loss of muscle mass and function in aging, following inactivity, need to be thoroughly investigated.

Physical inactivity and health inequality during coronavirus: a novel opportunity or total lockdown?

Government-restricted movement during the coronavirus pandemic in various countries around the world has led to rapid and fundamental changes in our health behaviour. As well as being at a higher risk of contracting and being hospitalised with COVID-19, the elderly, those with chronic disease and lower socioeconomic groups are also disproportionately affected by restriction of movement, further widening the physical activity health inequality. In this viewpoint we discuss the physiological sequelae of physical inactivity, and the additional burden of ageing and inflammation. We provide recommendations for public health promotion and interventions to try to mitigate the detrimental effects of physical inactivity and rebalance the health inequality.

Motivation and Intention Toward Physical Activity During the COVID-19 Pandemic: Perspectives From Integrated Model of Self-Determination and Planned Behavior Theories

Background: In attempts to hinder the spread of the Coronavirus disease 2019 (COVID-19), many countries have continued distancing, isolation, and quarantine measures, which has led to limited opportunity of physical activity. This study provides empirical support for a motivational process behind physical activity during the COVID-19 pandemic by testing the influence of psychosocial variables derived from the integrated model of self-determination theory (SDT) and the theory of planned behavior (TPB). Methods: A cross-sectional survey was conducted among Korean adults (N = 248). Participants completed the measures of SDT and TPB constructs modified to reflect their participation in physical activity during the COVID-19 pandemic. A sample size of 243 participants was employed, and the integrated model was tested using serial multiple mediation analysis to check the hypothesized relationships. Results: Findings indicated that in the COVID-19 context, the satisfaction of basic psychological needs positively predicts the level of self-determined motivations for physical activity, which is partially related to the level of social cognitive beliefs and intentions. The findings also demonstrated that attitude toward physical activity during COVID-19 was a major variable explaining the serial multiple relationships between the SDT and TPB constructs. The potential influence of demographics (gender, age, marital status, and past physical activity) was controlled as a covariate, and no significant effects were identified. Conclusion: The current study identified the psychosocial mechanisms of intention of South Koreans' physical activity during the COVID-19 pandemic, which could be used as an empirical basis for the development of interventions to maintain or strengthen physical activity in unprecedented situations.

COVEPIC (Cognitive and spOrt Virtual EPIC training) investigating the effects of home-based physical exercise and cognitive training on cognitive and physical functions in community-dwelling older adults: study protocol of a randomized single-blinded clinical trial

BACKGROUND

In the context of the COVID-19 pandemic, lockdown and social distancing measures are applied to prevent the spread of the virus. It is well known that confinement and social isolation can have a negative impact on physical and mental health, including cognition. Physical activity and cognitive training can help enhance older adults' cognitive and physical health and prevent the negative collateral impacts of social isolation and physical inactivity. The COVEPIC study aims to document the effects of 6 months of home-based physical exercise alone versus home-based physical exercise combined with cognitive training on cognitive and physical functions in adults 50 years and older.

METHODS

One hundred twenty-two healthy older adults (> 50 years old) will be recruited from the community and randomized to one of the two arms for 6 months: (1) home-based physical exercises monitoring alone and (2) combined physical exercises monitoring with home-based cognitive training. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as executive functions, processing speed, and episodic memory (composite Z-scores based on validated neuropsychological tests and computerized tasks). The secondary outcome is physical functions, including balance (one-leg stance test), gait and mobility performance (Timed Up and Go, 4-meter walk test), leg muscle strength (5-time sit-to-stand), and estimated cardiorespiratory fitness (Matthews' questionnaire). Exploratory outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported questionnaires (i.e., Geriatric depression scale-30 items, Perceived stress scale, State-trait anxiety inventory-36 items, Perseverative thinking questionnaire, Connor-Davidson Resilience Scale 10, and 12-item Short Form Survey).

DISCUSSION

This trial will document the remote monitoring of home-based physical exercise alone and home-based physical combined with cognitive training to enhance cognitive and physical health of older adults during the COVID-19 pandemic period. Remote interventions represent a promising strategy to help maintain or enhance health and cognition in seniors, and potentially an opportunity to reach older adults in remote areas, where access to such interventions is limited.

TRIAL REGISTRATION

Clinical trial Identifier NCT04635462 . COVEPIC was retrospectively registered on November 19, 2020.

Altered central and peripheral haemodynamics during rhythmic handgrip exercise in young adults with SARS-CoV-2

New Findings

What is the central question of this study?

Are central and peripheral haemodynamics during handgrip exercise different in young adults 3–4 weeks following infection with of SARS‐CoV‐2 compared with young healthy adults.

What is the main finding and its importance?

Exercising heart rate was higher while brachial artery blood flow and vascular conductance were lower in the SARS‐CoV‐2 compared with the control group. These findings provide evidence for peripheral impairments to exercise among adults with SARS‐CoV‐2, which may contribute to exercise limitations.

Abstract

The novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) can have a profound impact on vascular function. While exercise intolerance may accompany a variety of symptoms associated with SARS‐CoV‐2 infection, the impact of SARS‐CoV‐2 on exercising blood flow (BF) remains unclear. Central (photoplethysmography) and peripheral (Doppler ultrasound) haemodynamics were determined at rest and during rhythmic handgrip (HG) exercise at 30% and 45% of maximal voluntary contraction (MVC) in young adults with mild symptoms 25 days after testing positive for SARS‐CoV‐2 (SARS‐CoV‐2: n = 8M/5F; age: 21 ± 2 years; height: 176 ± 11 cm; mass: 71 ± 11 kg) and were cross‐sectionally compared with control subjects (Control: n = 8M/5F; age: 27 ± 6 years; height: 178 ± 8 cm; mass: 80 ± 25 kg). Systolic blood pressure, end systolic arterial pressure and rate pressure product were higher in the SARS‐CoV‐2 group during exercise at 45% MVC compared with controls. Brachial artery BF was lower in the SARS‐CoV‐2 group at both 30% MVC (Control: 384.8 ± 93.3 ml min^–1; SARS‐CoV‐2: 307.8 ± 105.0 ml min^–1; P = 0.041) and 45% MVC (Control: 507.4 ± 109.9 ml min^–1; SARS‐CoV‐2: 386.3 ± 132.5 ml min^–1; P = 0.002). Brachial artery vascular conductance was lower at both 30% MVC (Control: 3.93 ± 1.07 ml min^–1 mmHg^–1; SARS‐CoV‐2: 3.11 ± 0.98 ml min^–1 mmHg^–1; P = 0.022) and 45% MVC (Control: 4.74 ± 1.02 ml min^–1 mmHg^–1; SARS‐CoV‐2: 3.46 ± 1.10 ml min^–1 mmHg^–1; P < 0.001) in the SARS‐CoV‐2 group compared to control group. The shear‐induced dilatation of the brachial artery increased similarly across exercise intensities in the two groups, suggesting the decrease in exercising BF may be due to microvascular impairments. Brachial artery BF is attenuated during HG exercise in young adults recently diagnosed with mild SARS‐CoV‐2, which may contribute to diminished exercise capacity among those recovering from SARS‐CoV‐2 like that seen in severe cases.

Creativity and Leisure During COVID-19: Examining the Relationship Between Leisure Activities, Motivations, and Psychological Well-Being

Social distancing policies have been implemented around the world to reduce the spread of coronavirus disease 2019 (COVID-19). These measures have included temporary restrictions on mass gatherings and the closure of public facilities, limiting the pursuit of leisure activities such as travel while allowing more time for at-home pursuits, including creative activities such as gardening and painting. Previous research has demonstrated the benefits of physical activity for psychological well-being during COVID-19, but less attention has been given to the potential benefits of creative pursuits, such as arts and music. The present study investigated changes in the pursuit of creative, non-creative, and physical leisure activities and the relationship between engaging in leisure, the motivations for and barriers to pursuing these activities, and psychological well-being during COVID-19. A total of 3,827 participants from 74 countries completed an online leisure activities questionnaire and the World Health Organization Five Well-Being Index. Logistic regression indicated that gender, age, social distancing adherence, and employment status significantly predicted leisure engagement during COVID-19. Compared to sports and outdoor pursuits, participation in creative activities was generally more likely to increase during this period, while participation in non-creative activities was less likely to increase. Multiple linear regression indicated that maintaining or increasing time on leisure activities significantly predicted well-being during COVID-19, with increased time spent on home crafts and artisanship, fine arts, musical and performing arts engagement, sports and outdoor pursuits, niche and IT interests, and language activities each predicting higher well-being outcomes. Motivations such as seeking creative expression and mental stimulation, keeping fit, and maintaining social connections also predicted higher well-being. These findings suggest that participation in both physical and creative leisure activities may offer protective benefits for well-being during COVID-19, and that strategies to promote engagement in creative activities should also be considered in future guidance for mental health during periods of lockdown or isolation.

Age-related changes in muscle architecture and metabolism in humans: The likely contribution of physical inactivity to age-related functional decline

In the United Kingdom (UK), it is projected that by 2035 people aged >65 years will make up 23 % of the population, with those aged >85 years accounting for 5% of the total population. Ageing is associated with progressive changes in muscle metabolism and a decline in functional capacity, leading to a loss of independence. Muscle metabolic changes associated with ageing have been linked to alterations in muscle architecture and declines in muscle mass and insulin sensitivity. However, the biological features often attributed to muscle ageing are also seen in controlled studies of physical inactivity (e.g. reduced step-count and bed-rest), and it is currently unclear how many of these ageing features are due to ageing per se or sedentarism. This is particularly relevant at a time of home confinements reducing physical activity levels during the Covid-19 pandemic. Current knowledge gaps include the relative contribution that physical inactivity plays in the development of many of the negative features associated with muscle decline in older age. Similarly, data demonstrating positive effects of government recommended physical activity guidelines on muscle health are largely non-existent. It is imperative therefore that research examining interactions between ageing, physical activity and muscle mass and metabolic health is prioritised so that it can inform on the "normal" muscle ageing process and on strategies for improving health span and well-being. This review will focus on important changes in muscle architecture and metabolism that accompany ageing and highlight the likely contribution of physical inactivity to these changes.

Effects of a Home-Based Lifestyle Intervention Program on Cardiometabolic Health in Breast Cancer Survivors during the COVID-19 Lockdown

This study aimed to evaluate the cardiometabolic effects of a home-based lifestyle intervention (LI) in breast cancer survivors (BCSs) during the COVID-19 lockdown. In total, 30 BCSs (women; stages 0-II; non-metastatic; aged 53.5 ± 7.6 years; non-physically active; normal left ventricular systolic function) with a risk factor for recurrence underwent a 3-month LI based on nutrition and exercise. Anthropometrics, Mediterranean diet adherence, physical activity level (PAL), cardiorespiratory fitness (VO2max), echocardiographic parameters, heart rate variability (average standard deviation of NN intervals (ASDNN/5 min) and 24 h very- (24 hVLF) and low-frequency (24 hLF)), and metabolic, endocrine, and inflammatory serum biomarkers (glycemia, insulin resistance, progesterone, testosterone, and high-sensitivity C-reactive protein (hs-CRP)) were evaluated before (T0) and after (T1) the LI. After the LI, there were improvements in: body mass index (kg/m2: T0 = 26.0 ± 5.0, T1 = 25.5 ± 4.7; p = 0.035); diet (Mediet score: T0 = 6.9 ± 2.3, T1 = 8.8 ± 2.2; p < 0.001); PAL (MET-min/week: T0 = 647 ± 547, T1 = 1043 ± 564; p < 0.001); VO2max (mL·min-1·kg-1: T0 = 30.5 ± 5.8, T1 = 33.4 ± 6.8; p < 0.001); signs of diastolic dysfunction (participants: T0 = 15, T1 = 10; p = 0.007); AS-DNN/5 min (ms: T0 = 50.6 ± 14.4, T1 = 55.3 ± 16.7; p = 0.032); 24 hLF (ms2: T0 = 589 ± 391, T1 = 732 ± 542; p = 0.014); glycemia (mg/dL: T0 = 100.8 ± 11.4, T1 = 91.7 ± 11.0; p < 0.001); insulin resistance (HOMA-IR score: T0 = 2.07 ± 1.54, T1 = 1.53 ± 1.11; p = 0.005); testosterone (ng/mL: T0 = 0.34 ± 0.27, T1 = 0.24 ± 0.20; p = 0.003); hs-CRP (mg/L: T0 = 2.18 ± 2.14, T1 = 1.75 ± 1.74; p = 0.027). The other parameters did not change. Despite the home-confinement, LI based on exercise and nutrition improved cardiometabolic health in BCSs.

Impact of the COVID-19 pandemic on orthopedic fracture characteristics in three hospitals in Turkey: A multi-center epidemiological study

Objectives

In this study, we present the use of case specific three- dimensional (3D) printed plastic models and custom-made acetabular implants in orthopedic surgery.

Materials and methods

Between March 2018 and September 2020, surgeries were simulated using plastic models manufactured by 3D printers on the two patients with pilon fractures. Also, custom-made acetabular implants were used on two patients with an acetabular bone defect for the revision of total hip arthroplasty (THA).

Results

More comfortable surgeries were experienced in pilon fractures using preoperative plastic models. Similarly, during the follow-up period, the patients that applied custom-made acetabular implants showed a fixed and well-positioning in radiographic examination. These patients did not experience any surgical complications and achieved an excellent recovery.

Conclusion

Preoperative surgical simulation with 3D printed models can increase the comfort of fracture surgeries. Also, custom-made 3D printed acetabular implants can perform an important task in patients treated with revision THA surgery due to severe acetabular defects.