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

Associations between sociodemographic factors and physical activity and sedentary behaviors in adults with chronic diseases during COVID-19 pandemic

The pandemic of the new coronavirus (COVID-19) may be affecting the physical activity (PA) level in much of the population. This study aimed to investigate the prevalence of physical inactivity and sedentary behavior (SB) among adults with chronic diseases and their associations with sociodemographic factors during the COVID-19 pandemic. This cross-sectional study included 249 participants (age: 18–91 years; 61.4% female) with chronic conditions and attended the Family Health Strategy program in a small town in Brazil. Data were collected between 2020-07–13 and 2020-07-24 by face-to-face interviews. Self-reported PA, sitting time, chronic diseases, medication use, sociodemographic data, and self-isolation adherence were obtained by questionnaire. During this specific time point of the COVID-19 pandemic, 71.5% of participants did not meet the PA recommendations (≥500 METs-min/week), and the prevalence of SB risk (≥4 h sitting) was 62.7%. Adjusted logistic regression indicated that male participants (odds ratio [OR]: 1.89 [95% CI 1.02–3.53]), living alone (OR: 2.92 [95% CI 1.03–8.30]) or in a two-person household (OR: 2.32 [95% CI 1.16–4.63]), and those who reported sometimes performing self-isolation (OR: 3.07 [95% CI 1.47–6.40]) were more likely to meet the minimum PA recommendations. Current smokers had a lower odds (OR: 0.36 [95% CI 0.14–0.95]) of meeting the PA recommendations. Older participants (OR: 2.18 [95% CI 1.06–4.50]) and those who had multimorbidity (OR: 1.92 [95% CI 1.07–3.44]) were more likely to have a higher degree of SB. There is an urgent need to mitigate physical inactivity and SB, and public health interventions must take into account sociodemographic status.

The Influence of COVID-19 Lockdown Restrictions on Perceived Nutrition Habits in Rugby Union Players

The global outbreak of COVID-19 has led to governments and local authorities implementing nationwide lockdowns in an attempt to encourage social distancing and minimize the spread of the virus. Only essential businesses have been able to remain open, with non-essential businesses and activities either closing or restricting services. With no group training sessions allowed, canceled matches, an inability to work and the closure of eating establishments, Rugby Union players have experienced disruption to their daily lives. Two surveys were distributed among Rugby Union athletes to explore (1) the influence of COVID-19 lockdown restrictions on Rugby Union players' nutrition and training habits and (2) how nutrition habits in New Zealand Rugby Union players change after lockdown restrictions were lifted. In total, 258 respondents completed Survey 1 (84.1% male, 26.4% professional/semi-professional). Of the respondents, 58% indicated they lived with family during lockdown. Total food intake was reported to be higher in 36% of respondents. Fruit and vegetable intake was lower (17%) and packaged/convenience food intake higher (26%) in a minority of respondents. In total, 106 respondents completed Survey 2 (84.9% male, 34.0% professional/semi-professional). Of the respondents, 72% prepared and 67% purchased their own food. Less than half of respondents consumed high-protein food more than twice daily either during or following lockdown. Compared to during lockdown, motivation to train and exercise was greater in 58% of respondents following lockdown. Dieticians and nutritionists within clubs provided most of the nutrition knowledge to athletes however other unreliable sources were identified, such as social media and family members. The ongoing pandemic has presented significant challenges for athletes concerning training and nutrition habits and the current study provides some insight into these. Coaches and performance staff should ensure athletes receive appropriate nutritional and training support whilst being aware of the unique demands the individuals' may face.

Psychological Pathways Linking Public Trust During the Coronavirus Pandemic to Mental and Physical Well-being

The well-being of the public during the 2019 coronavirus (COVID-19) pandemic is deeply rooted in institutional trust in the government's risk communication effort. The objective of this study was to examine the psychological pathway through which public trust in the government is associated with mental and physical well-being. We collected cross-sectional data from 501 participants aged ≥18 years using an online panel. Public trust in the government was assessed as our exposure variable. We screened for psychological distress by combining the Patient Health Questionnaire and the General Anxiety Disorder scale. Physical well-being was examined using self-rated health. We further assessed the roles of risk perceptions. The author conducted a one-way analysis of variance (ANOVA), Pearson's correlations, multivariable regressions, and mediation analyses (using the Preachers and Hayes' approach). Participants were 55.29% female, 67.86% Caucasian/white with a mean age of 32.44 ± 11.94 years. Public trust in the government regarding COVID-19 was negatively correlated with psychological distress (r = -0.20; p < 0.001) and positively associated with physical well-being (r = 0.13; p < 0.001). After adjusting for sociodemographic and socioeconomic factors, public trust remained negatively associated with psychological distress (β = -0.19; 95% confidence intervals, [CI] -0.30, -0.09) and positively associated with physical well-being (β = 0.26; 95% CI [0.16, -0.37]). Perceived self-efficacy to practice COVID-19 protective behavior partially mediated the relationship between public trust and psychological distress (13.07%); and physical well-being (28.02%). Perceived self-efficacy to protect self against COVID-19 infection can serve as a psychological pathway through which public trust may be associated with mental and physical health.

Brazil before and during COVID-19 pandemic: Impact on the practice and habits of physical exercise

INTRODUCTION

The goal of this study was to investigate the practice and habits of physical exercise impact due to COVID-19 social isolation before and during the outbreak in Brazil and its mains macro-regions, which have social and economic disparities.

METHODS

This is an observational cross-sectional study through an online questionnaire survey. A self-administered survey (PEF-COVID19) was applied in the Brazilian general population, age ≥ 18 years. T-test for independent samples and Chi-square tests were used to compare Brazil and different macro-regions, p˂0.05.

RESULTS

1,977 participants filled the survey and 1,845 were included; 80% of the included ones were in social isolation. In general, the self-related physical exercise practice before and during the COVID-19 pandemic and exercise characteristics were highly affected by the pandemic (p˂0.05). Sedentary behavior increased significantly (14.9 vs. 29.8%) and between the active ones, the frequency of PEx per week and duration of the PEx practice decreased significantly. The motivation to exercise also changed considering performance and health before and during the pandemic, respectively (10 vs. 5.6% and 72.4 vs. 79.1%). Also, the sample started to exercise less in the night and more in the afternoon, respectively (33.7 vs. 25.3% and 19.1 vs. 31.5%).

CONCLUSIONS

The COVID-19 pandemic highly influenced the physical exercise practice and habits (frequency, duration, motivation, period to exercise) in Brazil and its main macro-regions. These results can be used to create measures, as home-based exercise programs, to avoid the harm of sedentary behaviors and mental health impact during and after the pandemic.

Environmental Issues and Neurological Manifestations Associated with COVID-19 Pandemic: New Aspects of the Disease?

Coronavirus (SARS-CoV-2) emerged in China in December 2019 and rapidly caused a global health pandemic. Current evidence seems to suggest a possible link with ecosystem disequilibrium and even air pollution. The primary manifestations affect respiratory and circulatory systems, but neurological features are also being reported through case reports and case series. We summarize neurological symptoms and complications associated with COVID-19. We have searched for original articles published in PubMed/Medline, PubMed Central and Google Scholar using the following keywords: "COVID-19", "Coronavirus", "pandemic", "SARS-COV-2", "neurology", "neurological", "complications" and "manifestations". We found around 1000 publications addressing the issue of neurological conditions associated with COVID-19 infection. Amongst those, headache and dizziness are the most common reported symptoms followed by encephalopathy and delirium, while the most frequent complications are cerebrovascular accidents, Guillain-Barré syndrome, acute transverse myelitis, and acute encephalitis. Specific symptoms affecting the peripheral nervous system such as hyposmia and dysgeusia are the most common manifestations recorded in the selected studies. Interestingly, it was noted that these kinds of neurological symptoms might precede the typical features, such as fever and cough, in COVID patients. Neurological symptoms and complications associated with COVID-19 should be considered as a part of the clinical features of this novel global pandemic.

Smart technology for physical activity and health assessment during COVID-19 lockdown

BACKGROUND

The worldwide lockdown in response to COVID-19 pandemics has often led to physical inactivity and social distancing. When combined, these factors may affect quality and life and increase the risk of different diseases. Therefore, assessment of physical activity levels should be encouraged to monitor and identify those at a higher risk of inactivity. Smart technology is a promising tool to assess physical activity and health and may be particularly useful during a period of general lockdown.

METHODS

An online survey was developed and shared among the Italian general population to collect data about physical activity and daily routine changes between January 2020 and the lockdown period from March 23 to March 29. Participants were asked to provide data such as daily step count (Steps) or heart rate (HR) measured and collected by their smart technology devices.

RESULTS

Four hundred participants were included in the final analysis. During the lockdown, the number of steps dropped from 8284±4390 to 3294±3994 steps (P<0.001), while mean peak HR decreased from 61.3±18.2% to 55.9±17.3% (P<0.001).

CONCLUSIONS

These findings provide objective data about the effects of the COVID-19 lockdown on physical activity, thus encouraging the use of smart devices to monitor and promote healthy lifestyles while faced with a confinement condition.

Managing the combined consequences of COVID-19 infection and lock-down policies on athletes: narrative review and guidelines proposal for a safe return to sport

COVID-19 pandemic is a global health matter. The disease spread rapidly across the globe and brought the world of sports to an unprecedented stoppage. Usual symptoms of the disease are fever, cough, myalgia, fatigue, slight dyspnoea, sore throat and headache. In more severe cases, dyspnoea, hypoxaemia, respiratory failure, shock and multiorgan failure occur. This appears to be a self-limiting phenomenon related to individuals with coexisting medical conditions, such as hypertension, diabetes and cardiovascular disorders. Nevertheless, cases have been reported in professional soccer players in extremely good fitness condition, demonstrating that athletes are not spared by the disease. Despite COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported, leading to acute myocarditis. One difficulty is that symptoms of COVID-19 vary among individuals, with athletes being affected with no apparent sign of the disease. This could be a real danger for amateur or professional athletes when returning to their usual training and thus to play. Another threat is that the lock-down policies did not allow most athletes to follow their usual training routines. There is thus a need for a careful approach by the sports medicine community to ensure safety of all athletes before they return to sport. Here, we propose evaluation guidelines of fitness and health of athletes to (1) reduce any lethal risk of practice, especially myocarditis and sudden cardiac death; (2) evaluate the combined consequences of the disease and detraining on the physical abilities and biological profile of athletes; and (3) monitor postinfection fatigue symptoms.

Impact of COVID-19 on lifestyle-related behaviours- a cross-sectional audit of responses from nine hundred and ninety-five participants from India

BACKGROUND AND AIMS

The impact of measures taken to contain COVID-19 on lifestyle-related behaviour is undefined in Indian population. The current study was undertaken to assess the impact of COVID-19 on lifestyle-related behaviours: eating, physical activity and sleep behaviour.

METHODS

The study is a cross-sectional web-based survey. A validated questionnaire to assess the changes in lifestyle-related behaviour was administered on adults across India using a Google online survey platform.

RESULTS

A total of 995 responses (58.5% male, mean age 33.3 years) were collected. An improvement in healthy meal consumption pattern and a restriction of unhealthy food items was observed, especially in the younger population (age <30 years). A reduction in physical activity coupled with an increase in daily screen time was found especially among men and in upper-socio-economic strata. Quarantine induced stress and anxiety showed an increase by a unit in nearly one-fourth of the participants.

CONCLUSIONS

COVID-19 marginally improved the eating behaviour, yet one-third of participants gained weight as physical activity declined significantly coupled with an increase in screen and sitting time. Mental health was also adversely affected. A detailed understanding of these factors can help to develop interventions to mitigate the negative lifestyle behaviours that have manifested during COVID-19.

Prevention and Management of Type 2 Diabetes and Metabolic Syndrome in the Time of COVID-19: Should We Add a Cup of Coffee?

Recent evidence shows that COVID-19 patients with existing metabolic disorders, such as diabetes and metabolic syndrome, are exposed to a high risk of morbidity and mortality. At the same time, in order to manage the pandemic, the health authorities around the world are advising people to stay at home. This results in decreased physical activity and an increased consumption of an unhealthy diet, which often leads to an increase in body weight, risk for diabetes, insulin resistance, and metabolic syndrome, and thus, paradoxically, to a high risk of morbidity and mortality due to COVID-19 complications. Here we summarize the evidence demonstrating that the promotion of a healthy life style, including physical activity and a dietary intake of natural polyphenols present in coffee and tea, has the potential to improve the prevention and management of insulin resistance and diabetes in the time of COVID-19 pandemic. Particularly, it would be pertinent to evaluate further the potential positive effects of coffee beverages, rich in natural polyphenols, as an adjuvant therapy for COVID-19, which appear not to be studied sufficiently.

Changes in Physical Activity and Sedentary Behavior Amid Confinement: The BKSQ-COVID-19 Project

BACKGROUND

Coronavirus disease 19 (COVID-19) has compelled implementing confinement measure across the globe. These measures can potentially lead to many changes in lifestyle. However, no studies examined the effect of COVID-19-induced confinement on physical activity (PA) and sedentary behavior (SB).

METHODS

During April and May of 2020, the current study surveyed changes in PA and SB induced by COVID-19 confinement.

RESULTS

The participants of the study were 1844. Among the participants who were regularly involved in PA, the majority (41.8-42.2%) of the participants reported a "decrease" (p<0.05) in walking, jogging, and sports while the majority (46.3-53.1%) reported a "no change" (p<0.05) in swimming, cycling, and weight lifting. With regard to the SB, most of the participants reported an "increase" in watching TV (72.3%), using electronics (82.7%), and logging to social media (81.9%). Additionally, gender, job type, obesity, and being worried to contract the disease were associated (p<0.05) with changes in PA. On the other hand, age, gender, obesity, job type and income were related (p<0.05) to changes in SB.

CONCLUSION

Results of the current study might enhance knowledge about the impact of COVID-19 on lifestyle, particularly PA and SB. Subsequently, it can also be used to establish strategies to enhance engagement in activities during the current and future pandemics.

Resistance Training Safety during and after the SARS-Cov-2 Outbreak: Practical Recommendations

In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.

The COVID-19 Pandemic Lockdowns and Changes in Body Weight among Polish Women. A Cross-Sectional Online Survey PLifeCOVID-19 Study

There is limited information on the relationships between restrictions linked to COVID-19 and changes in body weight. The aim of the study was to identify the body weight changes and their determinants in the nutritional and socio-demographic context during the COVID-19 pandemic in Polish women. During lockdown in Poland, 34% of women gained weight, while 18% of women reduced weight. As many as 44% of women with obesity before the pandemic increased their body weight, and 74% of women that were underweight reduced their body weight. In a group with weight gain, women increased their body weight by 2.8 kg on average and around 65% of them increased their total food intake. Unhealthy dietary changes and the negative lifestyle changes that comprised of an increase in screen time and a decrease in physical activity were found as key factors associated with weight gain. A higher risk of weight gain was associated with being obese before the pandemic or living in a macroeconomic region >50% of EU-28 GDP, while those younger in age and carrying out remote work had a higher chance of weight loss. Concluding, the specific conditions during lockdown worsened the nutritional status, which may increase the risk of complicatedness and mortality from COVID-19. It seems advisable to create dietary and lifestyle recommendations tailored to the individual needs of women who are underweight or have excessive body weight. More attention should be paid also to environmental impacts. Both, the reduction of excessive body weight and the maintenance of a normal weight should be based on the principle to eat and live sustainably and healthily.

Eating Habits and Physical Activity of the Spanish Population during the COVID-19 Pandemic Period

Due to the pandemic situation caused by the COVID-19 infection, some governments have implemented house confinement measures. The objective of our study is to learn the dietary patterns, consumption, and physical activity of the Spanish population before and during the period of confinement by COVID-19. A cross-sectional descriptive study based on a questionnaire during May 2020, coinciding with the period of confinement and the step forward into Phase 1, is carried out. During confinement, the adherence to the Mediterranean Diet increases (8.0% versus 4.7%; p < 0.001). No socio-demographic variables show statistical significance (p < 0.05) regarding good adherence to the Mediterranean Diet (MD) before and during confinement. During confinement, consumption of homemade baking shows a higher increase (0.28% versus 4.60%; p = 0.004). During confinement, the number of subjects that practice exercise decreases (29.4% versus 28.8%; p = 0.004), as well as the time spent exercising (more than an hour, 26.6% versus 14.7%, p = 0.001). Mediterranean Diet adherence slightly increases during confinement, although consumption of ‘unhealthy’ food also increases. Moreover, the number of subjects that practice physical activity, as well as the time spent on it weekly, decreases.

The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study

Aim

To investigate the effect of the coronavirus 2019 (COVID-19) lockdown on lifestyle behaviors and mood changes in the Croatian general population.

Methods

During ten days of the COVID-19 lockdown in Croatia, 3027 respondents (70.3% female) from the general population completed an online, self-report questionnaire. Demographic data and data on lifestyle habits and mood changes before and during the COVID-19 lockdown were collected.

Results

A total of 95.64% of respondents reported to follow most or all restrictions, with female sex (P < 0.001) and higher education level (P < 0.001) being associated with higher restriction compliance. Women smoked an increased number of cigarettes (P < 0.001). The proportion of respondents of both sexes who did not drink or drank 7 drinks per week or more increased (P < 0.001). Women also reported lower frequency (P = 0.001) and duration of physical exercise (P < 0.001). In total, 30.7% of respondents gained weight, with female sex (OR, 2.726) and higher BMI (OR, 1.116; both P < 0.001) being associated with an increased likelihood of gaining weight. Both men and women felt more frequently afraid (P < 0.001), discouraged (P < 0.001), and sad (P < 0.001).

Conclusion

Public health authorities should promote the adoption of healthy lifestyles in order to reduce long-term negative effects of the lockdown.

Molecular mechanisms involved in the positive effects of physical activity on coping with COVID-19

PURPOSE

Physical activity (PA) represents the first line of defence against diseases characterised by increased inflammation status, such as metabolic and infectious diseases. Conversely, a sedentary lifestyle-associated with obesity, type 2 diabetes and cardiovascular disorders-negatively impacts on general health status, including susceptibility to infections. At a time of a pandemic SARS-CoV2 infection, and in the context of the multiorgan crosstalk (widely accepted as a mechanism participating in the pathophysiology of all organs and systems), we examine the complex interplay mediated by skeletal muscle contraction involving the immune system and how this contributes to control health status and to counteract viral infections. In so doing, we review the molecular mechanisms and expression of molecules modulated by PA, able to provide the proper molecular equipment against viral infections such as the current SARS-CoV2.

METHODS

A critical review of the literature was performed to elucidate the molecular mechanisms and mediators induced by PA that potentially impact on viral infections such as SARS-CoV2.

RESULTS

We showed the effects mediated by regular moderate PA on viral adverse effects through the regulation of biological processes involving the crosstalk between skeletal muscle, the immune system and adipose tissue. Evidence was provided of the effects mediated by modulation of the expression of inflammation markers.

CONCLUSION

A tigth association between PA and reduction in inflammation status allows effective counteracting of SARS-CoV2 infection. It is therefore essential to persuade people to keep active.

Practical Recommendations for Maintaining Active Lifestyle during the COVID-19 Pandemic: A Systematic Literature Review

Diminished volumes of habitual physical activity and increased sedentary levels have been observed as a result of COVID-19 home-confinement. Consequences of inactivity, including a higher mortality rate and poorer general health and fitness, have been reported. This systematic review aimed to provide practical recommendations for maintaining active lifestyles during pandemics. In May 2020, two electronic databases (PubMed; Web of Science) were used to search for relevant studies. A total of 1206 records were screened by two researchers. Thirty-one relevant studies were included in this systematic review, in which the methodological quality was assessed. With regard to six studies, which explicitly dealt with physical activity during COVID-19, the evidence level is classified by three articles to level II, and in the other three to level VI. Regarding the physical activity recommendations in these papers, three of them were classified to a medium, and the same number to a weak evidence base. Of the 25 papers which refer to other pandemics and/or isolation situations, one was classified to evidence level I, four were ranged to level II, three to level III, one to level V, and the others to level VI. This systematic review revealed that reduced physical activity levels are of serious concern during home confinement in pandemic times. The recommendations provided by many international organizations to maintain active lifestyles during these times mainly target the general population, with less consideration for vulnerable populations (e.g., older adults, people with health issues). Therefore, personalized and supervised physical activity programs are urgently needed, with the option to group-play physical activity programs (e.g., exergames). These can be assisted, delivered, and disseminated worldwide through information and communication technology solutions. If it is permitted and safe, being active outside in daylight is advised, with an effort level of mild to moderate using the rating of perceived exertion scale. Relaxation techniques should be integrated into the daily routine to reduce stress levels. On the evidence base and levels of the included articles in this review, the results need to be interpreted with caution. Given that policies are different across regions and countries, further research is needed to categorize recommendations according to different social-distancing scenarios.

Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic

Background: From March to May 2020, lockdown measures were adopted in Italy to contain the epidemic of the novel Coronavirus. People were forced to restrict their movement and social contacts, therefore having a higher risk of inactivity. This study, carried out among Italian undergraduates, explored their sedentary and physical activities (PA) during the lockdown with respect to their previous habits. Methods: An electronic questionnaire was administered once to students attending three Italian universities after the end of lockdown. Results: A total of 1430 students (mean age 22.9 ± 3.5 years, 65.5% females) completed the questionnaire. All the sedentary behaviors increased significantly, and all the physical activities decreased significantly during the lockdown. Time spent using electronic devices showed the highest increase (+52.4 min/day), and walking the greatest decrease (-365.5 min/week). Being younger than 22 years old, female, and previously active, attending the universities of Naples and Rome and having at least one graduate parent were associated with the achievement of recommended levels of PA even during the lockdown. Conclusions: This study highlights the reduction of PA among Italian undergraduates in the course of home-confinement due to the CoViD-19 pandemic. The practice of adequate PA during the lockdown was mainly associated with the previous adoption of an active lifestyle. Promoting active lifestyles during the non-pandemic period may have had positive effects also in case of lockdown.

H″IT″ting the Barriers for Exercising during Social Isolation

Aerobic exercise is traditionally recommended to improve general health and prevent many non-communicable diseases. However, the measures adopted to control the novel Coronavirus (COVID-19) outbreak culminated with closing of exercise facilities and fitness centers and, as a primary consequence, impaired aerobic exercise practice. This contributed to an increase in risk factors associated with physical inactivity such as insulin resistance, high blood pressure, low-grade inflammation, weight gain, and mental health problems. The scenario is worrisome, and it is important to propose alternatives for exercise practice during the COVID-19 pandemic. Interval training (IT) emerges as an exercise mode that might be feasible, low-cost, and potentially safe to be performed in many different places. IT consists of interspersing relative brief bouts of high-intensity exercise with recovery periods and promotes similar or greater health benefits when compared to moderate-intensity continuous exercise. Among the different types of IT, sprint interval training and "Tabata protocols" might be particularly useful during social isolation. These protocols can be controlled and performed without the need of complex equipment and can be adapted to different places, including domestic environments. In this article, we present variations of IT as possible alternatives to cope physical inactivity during COVID-19 pandemics with a focus on its practical applications. The protocols suggested can be performed without the need of specialized equipment or facilities, in a time-efficient manner, and aiming to prevent detraining or even improve physical fitness and general health.

Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs

Background

Physical distancing and other COVID-19 pandemic mitigation strategies may have unintended consequences on a number of health behaviors and health outcomes. The purpose of this study was to investigate the association between perceived change in physical activity or exercise and mental health outcomes over the short-term in response to COVID-19 mitigation strategies in a sample of adult twins.

Methods

This was a cross-sectional study of 3,971 identical and same-sex fraternal adult twins (909 pairs, 77% identical) from the community-based Washington State Twin Registry. Participants in this study completed an online survey examining the impact of COVID-19 mitigation on a number of health-related behaviors and outcomes, administered between March 26 and April 5, 2020. In the present study, the exposure was perceived change in physical activity or exercise. The outcomes were levels of perceived anxiety and stress.

Results

More twin pairs reported a decrease in physical activity levels (42%) than those reporting no change (31%) or increased physical activity levels (27%). A perceived decrease in physical activity or exercise was associated with higher stress and anxiety levels. However, the physical activity–stress relationship was confounded by genetic and shared environmental factors. On the other hand, the physical activity–anxiety relationship held after controlling for genetic and shared environmental factors, although it was no longer significant after further controlling for age and sex, with older twins more likely to report lower levels of anxiety and females more likely to report higher levels of anxiety.

Conclusions

Strategies to mitigate the COVID-19 pandemic may be impacting physical activity and mental health, with those experiencing a decrease in physical activity also having higher levels of stress and anxiety. These relationships are confounded by genetic and shared environmental factors, in the case of stress, and age and sex, in the case of anxiety.

Moderators of Change in Physical Activity Levels during Restrictions Due to COVID-19 Pandemic in Young Urban Adults

This study aimed to investigate moderators of change in physical activity (PA) levels after 30 days (30-d) of restrictions due to the COVID-19 pandemic in young adults. This research is an extension of the CRO-PALS study and analyses for this study were performed on young adults (20–21 y.o., n = 91). Moderate-to-vigorous physical activity (MVPA), sport participation, student and socioeconomic status were assessed pre- and post-30-d restrictions. Differences in MVPA levels were examined using repeated-measures ANOVAs. After 30-d of restrictions, the drop in MVPA in females (−64.8 min/day, p = 0.006) and males was shown (−57.7 min/day, p < 0.00). However, active participants decreased, while non-active peers increased their MVPA level (−100.7 min/day, p < 0.00, and +48.9 min/day, p = 0.051, respectively). Moreover, students and non-students decreased their MVPA level (−69.0 min/day, p < 0.00, and −35.0 min/day, p = 0.22, respectively) as well as sport participants and non-sport participants (−95.3 min/day, p < 0.001, and −53.9 min/day, p < 0.00, respectively). Our results suggest that 30-d of restrictions equally affect females and males where the evident drop in MVPA is seen in both genders. However, active people decreased their PA level during lockdown and the opposite pattern was seen in non-active peers, where restrictions for them can represent an opportunity to change their behavior in a positive direction in order to gain better health status.

Community nursing services during the COVID-19 pandemic: the Singapore experience

Community nurses in Singapore support vulnerable older persons with chronic health condition(s). In the situation of scaled-down community health and social services during the COVID-19 outbreak, the community nursing team adopted measures for pandemic preparedness. This report is to share the Singapore General Hospital community nursing experience, preparation and transforming efforts during the pandemic. Team segregation, active screening and triage before visits and other precautionary measures were executed to minimise the risk of exposure to COVID-19. There was a shift from face-to-face to teleconsultation to meet the requirement of safe social-distancing. Community nursing teams continued to play an active role in supporting older persons during the pandemic, despite the challenges. Moving to the lockdown phase ('circuit breaker'), teleconsultation, virtual meetings and integrated partnerships were essential to ensure healthcare accessibility and continuity of care. The experience gleaned was valuable to advance future community nursing services in the evolving healthcare landscape. Structured teleconsultation and technology advancement are useful to complement the service.

IMPACTS OF COVID-19 ON THE IMMUNE, NEUROMUSCULAR, AND MUSCULOSKELETAL SYSTEMS AND REHABILITATION

ABSTRACT The new coronavirus, which causes the infectious disease named COVID-19 by the World Health Organization (WHO), was notified in 2020 in China. The main clinical manifestations in infected patients are fever, cough and dyspnoea. These patients are prone to developing cardiac changes, diffuse myopathy, decreased pulmonary function, decreased inspiratory muscle strength, and a deterioration in functional capacity. Thus, it is expected that patients affected by COVID-19 will suffer musculoskeletal consequences as a result of the inflammatory process and loss of muscle mass caused by immobility, generating motor incapacities that are not yet quantifiable. It is important to understand the clinical implications caused by COVID-19, in order to have better rehabilitation strategies for these patients. The aim of this study was to conduct a reflective analysis of the impact of COVID-19 on the immune, neuromuscular and musculoskeletal systems, and its rehabilitation process. This is a reflexive analysis, developed in the Laboratory for the Study of Movement of the Institute of Orthopaedics’ and Traumatology, at the Universidade de São Paulo School of Medicine, SP, Brazil. In this analysis, we reflect on the following topics related to COVID-19: immunological mechanisms, impact on the neuromuscular and musculoskeletal systems, and the rehabilitation of patients. Level of evidence V; Opinion of the specialist.

Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020

INTRODUCTION

This paper adds to the series of systematic rapid living reviews, started in April 2020, to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to the COVID-19 pandemic. The aim of this study was to present the results of a systematic search performed on papers published from May 1st to May 31st, 2020.

EVIDENCE ACQUISITION

An extensive search on the main medical literature databases for articles published (including Epub), in English, from May 1st to May 31st, 2020 was performed, according to the methodology already described in the previous 2 rapid reviews, with 2 important improvements: first, we made the search string more comprehensive; second, we relied on accredited terminologies to describe the study designs and report the rehabilitation settings.

EVIDENCE SYNTHESIS

Fifty-eight out of 618 articles were finally included for qualitative analysis. The number of primary studies has increased, with respect to the previous months, although still around 60% papers are just expert opinions. Six papers report on the prevalence and /or characteristics of emerging disability after COVID-19, 12 on rehabilitation approaches to COVID-19 patients, up to 25 on the organization of rehabilitation services after COVID-19, 13 papers on the impact of COVID-19 on health conditions of rehabilitative interest and only 2 on late complications due to COVID-19 that may be of rehabilitative interest.

CONCLUSIONS

Nowadays, all patients with disability, regardless of COVID-19 infection, are suffering because of restrictions imposed to rehabilitation service delivery. Neurological involvement is often present during acute and postacute stage, conveying the risk of a long-lasting disability. Accordingly, careful neurological monitoring should be granted. Although new therapies are under development, the main gap in the available scientific literature is the lack of high-quality primary studies, so experimental studies on the effects of rehabilitation are still warranted.

When COVID-19 affects muscle: effects of quarantine in older adults

At the beginning of 2020 a respiratory diseased named COVID-19 rapidly spread worldwide. Due to the presence of comorbidities and a greater susceptibility to infections, older adults are the population most affected by this pandemic. An efficient pharmacological treatment for COVID-19 is not ready yet; in the meanwhile, a general quarantine has been initiated as a preventive action against the spread of the disease. If on one side this countermeasure is slowing the spread of the virus, on the other side is also reducing the amount of physical activity. Sedentariness is associated with numerous negative health outcomes and increase risk of fall, fractures and disabilities in older adults. Models of physical inactivity have been widely studied in the past decades, and most studies agreed that is necessary to implement physical exercise (such as walking, low load resistance or in bed exercise) during periods of disuse to protect muscle mass and function from catabolic crisis. Moreover, older adults have a blunted response to physical rehabilitation, and a combination of intense resistance training and nutrition are necessary to overcome the loss of in skeletal muscle due to disuse.

Significant reduction of physical activity in patients with neuromuscular disease during COVID-19 pandemic: the long-term consequences of quarantine

Background

Quarantine was the measure taken by governments to control the rapid spread of COVID-19. This restriction resulted in a sudden change in people’s lifestyle, leading to an increase in sedentary behavior and a related decrease in the practice of physical activity (PA). However, in neuromuscular diseases patients need to perform regular PA to counteract the negative consequences of the disease. Hence, the aim of this study was to estimate the levels of PA, measured as energy expenditure (MET–minute/week), among patients with neuromuscular disease (NMD) before and during the last week of quarantine.

Methods

A total of 268 Italian subjects, living in Sicily, completed an adapted version of the IPAQ-SF. Participants comprised 149 NMD, enrolled at the Neuromuscular Clinic of Palermo and 119 healthy subjects (control group). The SF-12 questionnaire was also administered to NMD. The Mann–Whitney U and the Kruskal–Wallis rank-sum tests were used for statistical analyses.

Results

We observed a significant decrease of the total weekly PA level during COVID-19 quarantine in both patients and controls. Moreover, a significant difference in the total weekly PA level was found depending on the presence of neuromuscular disease, impaired walking, gender and BMI. Finally, we found a correlation between SF-12 scores and the entity of the reduction of PA level during quarantine, thus confirming a relevant association with the quality of life in NMD.

Conclusion

Our study confirmed that COVID-19 quarantine has affected the practice of PA among both NMD and healthy controls.

Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 h and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey

BACKGROUND

Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours.

METHODS

Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions.

RESULTS

1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly.

CONCLUSION

While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey

BACKGROUND

Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours.

METHODS

Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions.

RESULTS

1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly.

CONCLUSION

While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

Effects of COVID-19 Home Confinement on Eating Behaviour and Physical Activity: Results of the ECLB-COVID19 International Online Survey

BACKGROUND

Public health recommendations and governmental measures during the COVID-19 pandemic have resulted in numerous restrictions on daily living including social distancing, isolation and home confinement. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on health behaviours and lifestyles at home is undefined. Therefore, an international online survey was launched in April 2020, in seven languages, to elucidate the behavioural and lifestyle consequences of COVID-19 restrictions. This report presents the results from the first thousand responders on physical activity (PA) and nutrition behaviours.

METHODS

Following a structured review of the literature, the "Effects of home Confinement on multiple Lifestyle Behaviours during the COVID-19 outbreak (ECLB-COVID19)" Electronic survey was designed by a steering group of multidisciplinary scientists and academics. The survey was uploaded and shared on the Google online survey platform. Thirty-five research organisations from Europe, North-Africa, Western Asia and the Americas promoted the survey in English, German, French, Arabic, Spanish, Portuguese and Slovenian languages. Questions were presented in a differential format, with questions related to responses "before" and "during" confinement conditions.

RESULTS

1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%) were included in the analysis. The COVID-19 home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall). Additionally, daily sitting time increased from 5 to 8 h per day. Food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of main meals) were more unhealthy during confinement, with only alcohol binge drinking decreasing significantly.

CONCLUSION

While isolation is a necessary measure to protect public health, results indicate that it alters physical activity and eating behaviours in a health compromising direction. A more detailed analysis of survey data will allow for a segregation of these responses in different age groups, countries and other subgroups, which will help develop interventions to mitigate the negative lifestyle behaviours that have manifested during the COVID-19 confinement.

The Effects of COVID-19 and Quarantine Measures on the Lifestyles and Mental Health of People Over 60 at Increased Risk of Dementia

Background: The lockdown strategies adopted to limit the spread of COVID-19 infection may lead to adopt unhealthy lifestyles which may impact on the mental well-being and future risk of dementia. Older adults with mild cognitive impairment (MCI) or subjective cognitive decline (SCD) may suffer important mental health consequences from measures of quarantine and confinement. Aims: The study aimed to explore the effects of COVID-19 and quarantine measures on lifestyles and mental health of elderly at increased risk of dementia. Methods: One hundred and twenty six community-dwelling seniors with MCI or SCD were phone-interviewed and assessed with questions regarding variables related to COVID-19 pandemic, lifestyle changes and scales validated for the assessment of depression, anxiety, and apathy. Results: The sample included 55.6% patients with MCI and 56 people with SCD. Over 1/3 of the sample reduced their physical activity and nearly 70% reported an increase in idle time. Adherence to the Mediterranean diet decreased in almost 1/3 of respondents and over 35% reported weight gain. Social activities were abolished and 1/6 of participants also decreased productive and mental-stimulating activities. 19.8% were depressed, 9.5% anxious, and 9.5% apathetic. A significant association existed between depression and living alone or having a poor relation with cohabitants and between anxiety and SCD, cold or flu symptoms, and reduction in productive leisure activities. Conclusions: Seniors with SCD and MCI underwent lifestyle changes that are potentially harmful to their future cognitive decline, even if, with the exception of leisure activities, they do not appear to be cross-sectionally associated with psychiatric symptoms.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.