Baseline physical activity is associated with reduced mortality and disease outcomes in COVID-19: A systematic review and meta-analysis

The dose-response relationship between physical activity and the risk of death from pneumonia in middle-aged and older adults: A meta-analysis

BACKGROUND

Deaths from COVID-19 are concentrated in older adults, and studies have reported that physical activity (PA) can reduce the risk of death from pneumonia.

METHODS

Eight cohort studies and 2 case-control studies were included according to the inclusion and exclusion criteria established in this meta-analysis study followed the PRISMA guideline, 8 cohort studies and 2 case-control studies were finally included. Then, the research objects in these studies were classified to further study the dose-response relationship and non-dose-response relationship.

RESULTS

The highest dose of PA reduced the risk of death by 59% (risk ratio = 0.41; 95% confidence interval: 0.23-0.58) compared with the lowest dose of PA in middle-aged and elderly people. Furthermore, when the PA level was <10 m/wk, the risk of death from pneumonia was reduced by 6% every 4.5 MET-h/wk increase. At a PA level > 10 m/wk, the risk of death from pneumonia increased by 5% every 4.5 MET-h/wk increase. At a PA level > 30 m/wk, PA is a risk factor for pneumonia-related death in middle-aged and elderly people.

CONCLUSIONS

This meta-analysis showed that PA was associated with a reduced risk of dying from pneumonia in middle-aged and older adults, and that there was a significant nonlinear negative dose-response relationship between PA levels and the risk of dying from pneumonia. Therefore, moderate exercise was recommended.

The Role of Diet and Physical Activity in Shaping COVID-19 Severity: Design, Validation, and Application of a Retrospective Questionnaire

After the global challenges posed by COVID-19, researchers strived to identify risk factors for severe cases, which lead to various complications-including death. Lifestyle modifications, such as implementing a healthy diet and recommended physical activity, have been shown to be protective against severe COVID-19 cases. Despite an association of a plant-based diet with reduced COVID-19 severity, specific dietary characteristics have not been identified. Also, the methodology for measuring physical activity is variable, with studies overlooking the intensity or the habit components of physical activity. To bridge this gap, our study designed, validated, and applied a retrospective questionnaire with aims of exploring the relationship between lifestyle factors, specifically diet and physical activity, and severe COVID-19. We considered the intensity and years of physical activity habit, which is a limitation of other questionnaires. Results reveal associations of age and BMI with severe COVID-19. An excessive sugar diet was found to be associated with severe COVID-19 and increased symptom duration. We also observed an inverse relationship pattern of moderate- and vigorous-intensity physical activity across case severity, which is absent in walking physical activity. This study lays a foundation for research aiming to identify lifestyle factors that prevent severe COVID-19 cases.

The efficacy of extracorporeal shock wave therapy for knee osteoarthritis : an umbrella review

BACKGROUND

An umbrella review was conducted to compare the effectiveness of extracorporeal shock wave therapy (ESWT) versus non-ESWT in the treatment of knee osteoarthritis (KOA).

MATERIALS AND METHODS

Three databases including PubMed, Embase and Web of science were searched up to September 2023. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Meta-analysis of outcome indicators was performed using Revman 5.4 software.

RESULTS

A total of eight meta-analysis were included in this umbrella review. All meta-analysis were graded against a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and scored between 8 and 11. Compared to the sham group, the ESWT group showed better results in WOMAC (Western Ontario and McMaster Universities Arthritis Index) [mean difference (MD)=-2.94, 95% CI: -5.52, -0.37, P=0.03, I²=60%], Visual Analog Scale (VAS) (MD=-2.0, 95% CI: -2.5, -1.5, P<0.01, I²=0%), range of motion (ROM) (MD=17.55, 95% CI: 13.49, 21.61, P<0.00001, I²=0%), and Lequesne index (MD=-2.85, 95% CI: -3.64, -2.07, P<0.00001, I²=48%).

CONCLUSION

Based on the results of our analysis, ESWT is now an effective therapy for improving pain and function in patients with KOA.

The effects of the first wave of COVID-19 restrictions on physical activity: a longitudinal study from "step into health" program in Qatar

Introduction

The COVID-19 pandemic led to restrictions that prevented physical activity in public places. This study sought to conduct a comprehensive longitudinal analysis of how lockdown policies in an Arabian Gulf country influenced the patterns of physical activity during first wave.

Methods

In a longitudinal study design, members of the ongoing "Step into health" community-based health promotion program who provided valid pedometer data from January to August 2020, covering pre, during and post-covid first wave period met the inclusion criteria.

Results

420 (76.7% men, 13.8% ≤40 years) were included in the study. Overall, significant decline in daily step counts was recorded (-1,130 ± SE302) after the implementation of lockdown policies (p < 0.001). When the restrictions were removed, the steps per day were still lower compared to pre-covid for men (-910 ± SE610, p = 0.017) and among individuals with normal BMI (-1,304 ± SE409, p = 0.004). The lockdown in Qatar did not significantly affect women and individuals with obesity who already had lower daily steps pre-covid.

Discussion

The present study confirms immediate decline in daily steps imposed indirectly through the COVID-19 lockdown measures. Participants with higher physical activity levels pre-covid experienced significant decline in step count during and even after restrictions were uplifted.

The intervention design to promote active travel mode among children and adolescents: A systematic review

Background

Walking and cycling are examples of active travel modes or nonmotorized modes that rely on human physical power rather than fossil fuel consumption. In the context of short-distance journeys, active travel modes are advocated as feeder modes to reduce energy consumption and CO2 emissions. However, in Thailand and many other developing countries, these modes of transportation have not been widely adopted or effectively promoted. The absence of comprehensive campaigns and interventions to promote and facilitate the use of active travel modes has become a major barrier to their adoption, particularly among adolescents who will be future global citizens. Therefore, a campaign or intervention targeting adolescents is imperative to introduce and persuade them to adopt active travel modes. This study aims to provide guidelines for developing a robust intervention strategy to promote active travel modes among adolescents.

Methods

This study performed a systematic review to achieve the research goal using a particular search and selection approach. The search strategy has focused on published studies in the English language since 2014 to highlight the most recent trends. The selection process focused on articles relevant to promoting active travel mode among children and adolescents (up to 18 years old) through intervention.

Conclusions

A total of 16 studies were included. The findings reveal that successful interventions to promote active travel modes consist of an educational program and activities incorporating gamification to encourage their use. Furthermore, the intervention should last longer than one month to be effective.

The effect of SARS-CoV-2 on the development of Parkinson's disease: the role of α-synuclein

The current coronavirus disease 2019 (COVID-19) can lead to various neurological complications in infected people. These neurological effects include problems in both central nervous system (CNS) and peripheral nervous system (PNS). Hyposmia, a PNS symptom of COVID-19, frequently manifests in the early stages of Parkinson's disease (PD) and serves as an early warning sign of the condition. In addition, the olfactory system is recognized as an early site for the onset of α-synuclein pathology, the pathological hallmark of PD. PD is characterized by accumulation and aggregation of misfolded α-synuclein (α-Syn) into Lewy bodies and Lewy neurites, resulting in the degeneration of dopaminergic neurons in substantia nigra pars compacta (SNpc). Previous research has also shown the involvement of α-Syn in the innate immune response following viral infections. Consequently, the potential link between viral infections and development of PD has gained attention in recent years. However, it's still too early to definitively conclude whether COVID-19 can cause Parkinsonism. Nevertheless, we can explore the likelihood of this connection by examining past studies and possible mechanisms to better understand how COVID-19 might potentially lead to PD following the infection. Based on the various pieces of evidence discussed in this review, we can infer that SARS-CoV-2 promotes the aggregation of α-Syn and, ultimately, leads to PD through at least two mechanisms: the stable binding of the S1 protein to proteins prone to aggregation like α-Syn, and the upregulation of α-Syn as part of the immune response to the infection.

Socioeconomic and clinical risk factors associated with moderate intensity physical activity before and during the COVID-19 pandemic

Although moderate intensity physical activity (MIPA) improves general mental health, morbidity, and mortality, the COVID-19 pandemic may have adversely impacted individuals' ability to engage in MIPA. We examined the extent of socioeconomic factors, body mass index, anxiety/depression, and cancer diagnosis associated with MIPA before and during the COVID-19 pandemic. Multivariable logistic regression models were conducted on 4,551 U.S. adults aged 18-64 years using nationally representative samples from the 2019 and 2020 Health Information National Trends Survey datasets. The prevalence of MIPA before the pandemic was higher (77.07%) than during the pandemic (76.21%). Before the COVID-19 pandemic, lower odds of MIPA were observed for individuals with fair/poor health (OR = 0.24, 95% CI = 0.27, 0.63), obesity (OR = 0.51, 95% CI = 0.33, 0.79), anxiety/depression (OR = 0.60, 95% CI = 0.42, 0.85), or a cancer diagnosis (OR = 0.56, 95% CI = 0.32, 0.98). During the pandemic, lower odds were observed among those with obesity (OR = 0.44, 95% CI = 0.28, 0.70), anxiety/depression (OR = 0.61, 95% CI = 0.43, 0.86), less than high school education (OR = 0.33, 95% CI = 0.16, 0.70), or family income of $20,000 - $34,999 (OR = 0.42, 95% CI = 0.24, 0.74). There was a decline in MIPA during the pandemic, with certain subgroups, such as individuals of lower socioeconomic and physical and mental health status, less likely to engage in MIPA. This study highlights the need for concerted physical activity educational strategies aimed at improving access to and utilization of MIPA within subgroups to reduce MIPA disparities, particularly among disadvantaged groups during pandemics.

Physical fitness level and the risk of severe COVID-19: A systematic review

To verify systematically the association between the status of physical fitness and the risk of severe Coronavirus disease 2019 (COVID-19). This systematic review is in accordance with the Preferred Reporting Items for Systematic Review and Meta Analyses (PRISMA) statement and the eligibility criteria followed the Population, Intervention, Comparison, Outcomes and Study (PICOS) recommendation. PubMed, Embase, SciELO and Cochrane electronic databases were searched. All studies that explored the relationship between the pattern of physical fitness and COVID-19 adverse outcomes (hospitalization, intensive care unit admission, intubation, or mortality), were selected. The quality of the studies was assessed by the specific scale of the Newcastle-Ottawa Scale. A total of seven observational studies were identified in this systematic review; 13 ​468 patients were included in one case-control study, two cohort studies, and four cross-sectional studies. All studies reported an inverse association between high physical fitness and severe COVID-19 (hospitalization, intensive care admission, or mortality). Only some studies reported comorbidities, especially obesity and cardiovascular disorders, but the results remained unchanged after controlling for comorbidities. The quality of the seven studies included was moderate according to the Newcastle-Ottawa Quality Assessment Scale. The methodological heterogeneity of the studies included did not allow a meta-analysis of the findings. In conclusion, higher physical fitness levels were associated with lower risk of hospitalization, intensive care admissions, and mortality rates among patients with COVID-19.

Exercise is the Most Important Medicine for COVID-19

ABSTRACT

COVID-19 infection and long COVID affect multiple organ systems, including the respiratory, cardiovascular, renal, digestive, neuroendocrine, musculoskeletal systems, and sensory organs. Exerkines, released during exercise, have a potent crosstalk effect between multiple body systems. This review describes the evidence of how exerkines can mitigate the effects of COVID-19 in each organ system that the virus affects. The evidence presented in the review suggests that exercise should be considered a first-line strategy in the prevention and treatment of COVID-19 infection and long COVID disease.

Effects of COVID-19 vaccination during pregnancy on SARS-CoV-2 infection and maternal and neonatal outcomes: A systematic review and meta-analysis

SARS-CoV-2 infection during pregnancy is associated with adverse maternal and neonatal outcomes, but no systematic synthesis of evidence on COVID-19 vaccination during pregnancy against these outcomes has been undertaken. Thus, we aimed to assess the collective evidence on the effects of COVID-19 vaccination during pregnancy on maternal and neonatal outcomes. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1 November 2022. A systematic review and meta-analysis were performed to calculate pooled effects size and 95% confidence interval (CI). We evaluated 30 studies involving 862,272 individuals (308,428 vaccinated and 553,844 unvaccinated). Overall pooled analyses in pregnant women during pregnancy showed reduced risks of SARS-CoV-2 infection by 60% (41%-73%), COVID-19 hospitalisation during pregnancy by 53% (31%-69%), and COVID-19 intensive care unit (ICU) admission by 82% (12%-99%). Neonates of vaccinated women were 1.78 folds more likely to acquire SARS-CoV-2 infection during the first 2, 4 and 6 months of life during the Omicron period. The risk of stillbirth was reduced by 45% (17%-63%) in association with vaccination (vs. no vaccination) in pregnancy. A decrease of 15% (3%-25%), 33% (14%-48%), and 33% (17%-46%) in the odds of preterm births before 37, 32 and 28 weeks' gestation were associated with vaccination (vs. no vaccination) in pregnancy, respectively. The risk of neonatal ICU admission was significantly lower by 20% following COVID-19 vaccination in pregnancy (16%-24%). There was no evidence of a higher risk of adverse outcomes including miscarriage, gestational diabetes, gestational hypertension, cardiac problems, oligohydramnios, polyhydramnios, unassisted vaginal delivery, cesarean delivery, postpartum haemorrhage, gestational age at delivery, placental abruption, Apgar score at 5 min below 7, low birthweight (<2500 g), very low birthweight (<1500 g), small for gestational age, and neonatal foetal abnormalities. COVID-19 vaccination during pregnancy is safe and highly effective in preventing maternal SARS-CoV-2 infection in pregnancy, without increasing the risk of adverse maternal and neonatal outcomes, and is associated with a reduction in stillbirth, preterm births, and neonatal ICU admission. Importantly, maternal vaccination did not reduce the risk of neonatal SARS-CoV-2 infection during the first 6 months of life during the Omicron period.

Impact of COVID-19 Infection on Cardiorespiratory Fitness, Sleep, and Psychology of Endurance Athletes-CAESAR Study

COVID-19 has a deteriorating impact on health which is especially important for endurance athletes (EAs) who need to maintain continuity of training. The illness affects sleep and psychology, which influence sport performance. The aims of this study were: (1) to assess the consequences of mild COVID-19 on sleep and psychology and (2) to assess the consequences of mild COVID-19 on cardiopulmonary exercise test (CPET) results. A total of 49 EAs (males = 43, 87.76%; females = 6, 12.24%; age = 39.9 ± 7.8 years; height = 178.4 ± 6.8 cm; weight = 76.3 ± 10.4 kg; BMI = 24.0 ± 2.6 kg·m^-2) underwent a maximal cycling or running CPET pre- and post-COVID-19 and completed an original survey. Exercise performance deteriorated after COVID-19 (maximal oxygen uptake, VO_2max = 47.81 ± 7.81 vs. 44.97 ± 7.00 mL·kg·min^-1 pre- and post-infection, respectively; p < 0.001). Waking up at night affected the heart rate (HR) at the respiratory compensation point (RCP) (p = 0.028). Sleep time influenced pulmonary ventilation (p = 0.013), breathing frequency (p = 0.010), and blood lactate concentration (Lac) (p = 0.013) at the RCP. The maximal power/speed (p = 0.046) and HR (p = 0.070) were linked to the quality of sleep. Stress management and relaxation techniques were linked with VO_2max (p = 0.046), maximal power/speed (p = 0.033), and maximal Lac (p = 0.045). Cardiorespiratory fitness deteriorated after mild COVID-19 and was correlated with sleep and psychological indices. Medical professionals should encourage EAs to maintain proper mental health and sleep after COVID-19 infection to facilitate recovery.

Interferon-lambda: New role in intestinal symptoms of COVID-19

The tremendous public health and economic impact of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a huge challenge globally. There is increasing evidence that SARS-CoV-2 induces intestinal infections. Type III interferon (IFN-λ) has an antiviral role in intestinal infection, with focused, long-lasting, and non-inflammatory characteristics. This review presents a summary of the structure of SARS-CoV-2, including its invasion and immune escape mechanisms. Emphasis was placed on the gastrointestinal impact of SARS-CoV-2, including changes to the intestinal microbiome, activation of immune cells, and inflammatory responses. We also describe the comprehensive functions of IFN-λ in anti-enteric SARS-CoV-2 infection, and discuss the potential application of IFN-λ as a therapeutic agent for COVID-19 with intestinal symptoms.

Baseline physical activity and the risk of severe illness and mortality from COVID-19: A dose-response meta-analysis

To provide a scientific basis for improved exercise-based immunity, a meta-analysis was used to explore the dose-response relationship between physical activity (PA) and the risk of severe illness and mortality related to COVID-19 (coronavirus disease 2019). To this end, we searched PubMed, Web of Science databases from January 2020 through April 2022. 14 observational studies met the criteria for inclusion in the meta-analysis, including 2840 cases of severe illness and death from COVID-19. Categorical dose-relationship analysis showed that the risks of severe illness and mortality from COVID-19 were, respectively, 46% (risk ratio (RR): 0.54; confidence intervals (CIs): 0.41-0.68) and 59% (RR = 0.41; 95%CI: 0.23-0.58) lower for the highest dose of PA compared with the lowest dose of PA. The results of the continuous dose-response analysis show an inverse nonlinear relationship (P_{non-linearity} < 0.05) between PA and both the risk of severe illness and mortality from COVID-19. For PA below 10 MET-h/week (MET-h/week: metabolic equivalent of task-hours/week), an increase of 4 MET-h/week (1 h of moderate-intensity or 0.5 h of high-intensity PA) was associated with 8% and 11% reductions in the risk of severe illness and mortality from COVID-19. PA above 10 MET-h/week lowered the risk of severe illness and mortality from COVID-19 by 7% and 9%, respectively, for each 4 MET-h/week increase. Doses of WHO-recommended PA levels (10 MET-h/week) may be required for more substantial reductions in the risk of severe illness and mortality from COVID-19.

Association of physical activity and the risk of COVID-19 hospitalization: A dose-response meta-analysis

BACKGROUND

Many people have experienced a high burden due to the spread of the coronavirus disease (COVID-19) and its serious consequences for health and everyday life. Prior studies have reported that physical activity (PA) may lower the risk of COVID-19 hospitalization. The present meta-analysis explored the dose-response relationship between PA and the risk of COVID-19 hospitalization.

METHODS

Epidemiological observational studies on the relationship between PA and the risk of COVID-19 hospitalization were included. Categorical dose-response relationships between PA and the risk of COVID-19 hospitalization were assessed using random effect models. Robust error meta-regression models assessed the continuous relationship between PA (metabolic equivalent [Met]-h/wk) and COVID-19 hospitalization risk across studies reporting quantitative PA estimates.

RESULTS

Seventeen observational studies (cohort\case-control\cross-section) met the criteria for inclusion in the meta-analysis. Categorical dose-relationship analysis showed a 40% (risk ratio [RR] 0.60, 95% confidence interval [CI]: 0.48-0.71) reduction in the risk of COVID-19 hospitalization compared to the lowest dose of PA. The results of the continuous dose-response relationship showed a non-linear inverse relationship (Pnon-linearity < .05) between PA and the risk of COVID-19 hospitalization. When total PA was < or >10 Met-h/wk, an increase of 4 Met-h/wk was associated with a 14% (RR = 0.83, 95% CI: 0.85-0.87) and 11% (RR = 0.89, 95% CI: 0.87-0.90) reduction in the risk of COVID-19 hospitalization, respectively.

CONCLUSIONS

There was an inverse non-linear dose-response relationship between PA level and the risk of COVID-19 hospitalization. Doses of the guideline-recommended minimum PA levels by the World Health Organization may be required for more substantial reductions in the COVID-19 hospitalization risk.

Effects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review

BACKGROUND

Hospitalized patients recovering from coronavirus disease 2019 (COVID-19) may experience disability and suffer from significant physical and mental impairment requiring physical rehabilitation following their discharge. However, to date, no attempt has been made to collate and synthesize literature in this area.

OBJECTIVE

This systematic review examines the outcomes of different physical rehabilitation interventions tested in COVID-19 patients who were discharged from hospital.

SEARCH STRATEGY

A systematic search of MEDLINE/PubMed, CINAHL, Scopus and medRxiv was conducted to identify articles published up to March 2022.

INCLUSION CRITERIA

This systematic review included studies of outpatient rehabilitation programs for people recovering from COVID-19 who received physical activity, exercise, or breathing training to enhance or restore functional capacity, pulmonary function, quality of life, and mental health or function.

DATA EXTRACTION AND ANALYSIS

Selection of included articles, data extraction, and methodological quality assessments were conducted by two review authors respectively, and consensus was reached through discussion and consultation with a third reviewer. Finally, we review the outcomes of studies based on four categories including: (1) functional capacity, (2) pulmonary function, (3) quality of life, and (4) mental health status.

RESULTS

A total of 7534 titles and abstracts were screened; 10 cohort studies, 4 randomized controlled trials and 13 other prospective studies involving 1583 patients were included in our review. Early physical rehabilitation interventions applied in COVID-19 patients who were discharged from the hospital improved multiple parameters related to functional capacity, pulmonary function, quality of life and mental health status.

CONCLUSION

Physical rehabilitation interventions may be safe, feasible and effective in COVID-19 patients discharged from the hospital, and can improve a variety of clinically relevant outcomes. Further studies are warranted to determine the underlying mechanisms. Please cite this article as: Rahmati M, Shamsi MM, Woo W, Koyanagi A, Lee SW, Yon DK, Shin JI, Smith L. Effects of physical rehabilitation interventions in COVID-19 patients following discharge from hospital: A systematic review. J Integr Med. 2023; Epub ahead of print.

Acute liver injury in a COVID-19 infected woman with mild symptoms: A case report

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread rapidly, resulting in a pandemic in January 2020. Few studies have focused on the natural history and consequences of acute liver injury (ALI) in mild or asymptomatic COVID-19 patients, manifested by elevated aminotransferase levels. ALI is usually expected for severe COVID-19 cases. Here, we present a COVID-19 case with mild respiratory symptoms and significantly elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels.

CASE SUMMARY

A 60-year-old woman without medical history or chronic illness received three COVID-19 vaccinations since the start of the pandemic. The patient was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presented with mild symptoms on July 12^th, 2022. Post-recovery, she underwent an examination at our hospital on August 30^th, 2022. AST and ALT levels in the liver function test were 207 U/L (normal value < 39, 5.3-fold increase) and 570 U/L (normal value < 52, 10.9-fold increase), respectively. The patient was diagnosed with ALI, and no treatment was prescribed. The following week, blood tests showed a reduction in both levels (ALT 124 U/L, AST 318 U/L). Two weeks later, AST and ALT levels had decreased to near the expected upper limits (ALT 40 U/L, AST 76 U/L).

CONCLUSION

Clinicians should pay attention to liver function testing during COVID-19 recovery regardless of the disease’s severity.

Physical activities pre- and post-COVID-19 vaccination and its implementations: A narrative review

Coronavirus disease 2019 is a severe communicable pulmonary medical problem that has been a challenging disease for everyone in the globe, but vaccines development and administration against this severe acute respiratory syndrome-inducing disease (coronavirus disease 2019) are currently yielding fabulous results. The mean duration of the coronavirus disease 2019 pandemic for this study spanned from 2020 until 2022. These manifestations are accompanied by symptoms of respiratory tract illnesses such as non-productive cough, sore throat, and nasal discharge. Relevant reviews on coronavirus disease 2019 manifestations and outcomes, consisting mainly of the infections/outbreaks, experimental information, and pre- and post-serovaccination details that occurred, were described. After a typical vaccination course, the study aims to summarize and understand more about the effectiveness of exercise on the pre-and post-coronavirus disease 2019 vaccination and its implementations. Physical activity is an immunological function adjuvant to decrease communicable disease risk and enhance immunity post-viral infection vaccination. Moderate-intensity resistance exercisesession directly before getting the influenza vaccine decreases vaccine responses in older adults, such as redness, pain, or inflammation at the injection spot or other adverse consequences compared to the inactive circumstance. However, it was reported that exercise after a shot is generally safe as long as vaccinated people feel well enough. Though exercise before or after vaccination has no negative impact on the protection afforded by the vaccine, people can exercise immediately after receiving the vaccine, as any changes in blood flow will not affect the vaccine's response. One episode of light-to-moderate-intensifying exercise after vaccination may improve the antibody reactions to influenza or the coronavirus disease 2019 vaccine. Vaccination administered pre- and post-regular exercise is an effective approach for boosting antibody responses due to its immunostimulant effects. Future research should investigate how different vaccine antibodies respond to low, moderate, and high physical activity levels.

The effect of SARS-CoV-2 infection on cardiac function in post-COVID-19 survivors: A systematic review and meta-analysis

The longitudinal trajectories of cardiac structure and function following SARS-CoV-2 infection are unclear. Therefore, this meta-analysis aims to elucidate the effect of SARS-CoV-2 infection on cardiac function in coronavirus disease 2019 (COVID-19) survivors after recovery. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1st August 2022. A systematic review and meta-analysis were performed to calculate the pooled effects size and 95% confidence interval of each outcome. A total of 21 studies including 2394 individuals (1436 post-COVID-19 cases and 958 controls) were included in the present meta-analysis. The pooled analyses compared with control groups showed a significant association between post-COVID-19 and reduced left ventricular ejection fraction (LV EF), LV end-diastolic volume (LV EDV), LV stroke volume (LV SV), mitral annular plane systolic excursion (MAPSE), global longitudinal strain, right ventricular EF (RV EF), RV EDV, RV ESV, RV SV, tricuspid annular plane systolic excursion, and increased LV mass. Subgroup analysis based on the severity of COVID-19 in the acute phase and subsequent chronic outcomes revealed that LV EF, MAPSE, RV EF, and RV ESV only decreased in studies including patients with a history of intensive care unit admission. Cardiac impairment after SARS-CoV-2 infection persisted in recovered COVID-19 patients even after 1 year. Future studies are warranted to determine the biological mechanisms underlying the long-term cardiovascular consequences of COVID-19.

The effect of adherence to high-quality dietary pattern on COVID-19 outcomes: A systematic review and meta-analysis

Dietary quality and patterns may influence SARS-CoV-2 infection and outcomes, but scientific data and evidence to support such a role are lacking. Therefore, this meta-analysis aims to elucidate the effect of prepandemic diet quality on the risk of COVID-19 infection and hospitalization. PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE were systematically searched for articles published up to September 1, 2022. A systematic review and meta-analysis were performed to calculate each outcome's risk ratio (RR) and 95% confidence interval (CI). Five studies including 4 023 663 individuals (3 149 784 high-quality diet individuals and 873 881 controls) were included in the present meta-analysis. The effectiveness of high-quality dietary pattern against SARS-CoV-2 infection and hospitalization was 28% (95% CI 19%-36%) and 62% (95% CI 25%-80%); respectively. Subgroup analysis based on different levels of diet quality showed no difference between middle and high levels of diet quality in reducing the risk of COVID-19 infection. Interestingly, subgroup analysis based on the different types of high-quality diets and the risk of COVID-19 infection revealed that the effectiveness of plant-based diet against SARS-CoV-2 infection was 50% (95% CI 30%-65%); while the effectiveness of Mediterranean diet against SARS-CoV-2 infection was 22% (95% CI 12%-31%). Adherence to a high-quality dietary pattern is associated with a lower risk of COVID-19 infection and hospitalization. More studies are required to confirm these findings, and future studies should determine the biological mechanisms underlying the association between diet quality and risk of COVID-19 infection.

The Key Drivers of Brain Injury by Systemic Inflammatory Responses after Sepsis: Microglia and Neuroinflammation

Sepsis is a leading cause of intensive care unit admission and death worldwide. Most surviving patients show acute or chronic mental disorders, which are known as sepsis-associated encephalopathy (SAE). Although accumulating studies in the past two decades focused on the pathogenesis of SAE, a systematic review of retrospective studies which exclusively focuses on the inflammatory mechanisms of SAE has been lacking yet. This review summarizes the recent advance in the field of neuroinflammation and sheds light on the activation of microglia in SAE. Activation of microglia predominates neuroinflammation. As the gene expression profile changes, microglia show heterogeneous characterizations throughout all stages of SAE. Here, we summarize the systemic inflammation following sepsis and also the relationship of microglial diversity and neuroinflammation. Moreover, a collection of neuroinflammation-related dysfunction has also been reviewed to illustrate the possible mechanisms for SAE. In addition, promising pharmacological or non-pharmacological therapeutic strategies, especially those which target neuroinflammation or microglia, are also concluded in the final part of this review. Collectively, clarification of the vital relationship between neuroinflammation and SAE-related mental disorders would significantly improve our understanding of the pathophysiological mechanisms in SAE and therefore provide potential targets for therapies of SAE aimed at inhibiting neuroinflammation.

Physical activity pattern before and during the COVID-19 pandemic and association with contextual variables of the pandemic in adults and older adults in southern Brazil

Aim

To compare the physical activity pattern before and during the COVID-19 pandemic and verify the association with contextual, behavioral, and health variables related to the pandemic in adults and older adults from southern Brazil.

Subject and methods

This is a panel-type, population-based study in Rio Grande-RS and Criciúma-SC, with 4290 individuals. The physical activity pattern (dependent variable) was measured using the International Physical Activity Questionnaire-IPAQ. In addition, contextual, behavioral, and health aspects related to the pandemic (independent variables) were assessed by questionnaires. Fisher's exact test was used for bivariate analyses and Poisson regression with robust variance to calculate crude and adjusted prevalence, with their respective 95% confidence intervals.

Results

There was a 72% reduction in commuting physical activity and a 145% increase in physical inactivity when compared before and during the pandemic. Social distancing, excessive search for information about COVID-19, fear of the pandemic, and COVID-19 infection were all factors that contributed to the decline in physical activity during the pandemic. The home office was a protective factor for physical inactivity.

Conclusion

The COVID-19 pandemic has negatively affected the pattern of physical activity in the general population, except for those who switched to working from home.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01789-x.

Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis

BACKGROUND

There is growing evidence that patients recovering after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have a variety of acute sequelae including newly diagnosed diabetes. However, the risk of diabetes in the post-acute phase is unclear. To solve this question, we aimed to determine if there was any association between status post-coronavirus disease (COVID-19) infection and a new diagnosis of diabetes.

METHODS

We performed a systematic review and meta-analysis of cohort studies assessing new-onset diabetes after COVID-19. PubMed, Embase, Web of Science, and Cochrane databases were all searched from inception to June 10, 2022. Three evaluators independently extracted individual study data and assessed the risk of bias. Random-effects models estimated the pooled incidence and relative risk (RR) of diabetes compared to non-COVID-19 after COVID-19.

RESULTS

Nine studies with nearly 40 million participants were included. Overall, the incidence of diabetes after COVID-19 was 15.53 (7.91-25.64) per 1000 person-years, and the relative risk of diabetes after COVID-19 infection was elevated (RR 1.62 [1.45-1.80]). The relative risk of type 1 diabetes was RR=1.48 (1.26-1.75) and type 2 diabetes was RR=1.70 (1.32-2.19), compared to non-COVID-19 patients. At all ages, there was a statistically significant positive association between infection with COVID-19 and the risk of diabetes: <18 years: RR=1.72 (1.19-2.49), ≥18 years: RR=1.63 (1.26-2.11), and >65 years: RR=1.68 (1.22-2.30). The relative risk of diabetes in different gender groups was about 2 (males: RR=2.08 [1.27-3.40]; females: RR=1.99 [1.47-2.80]). The risk of diabetes increased 1.17-fold (1.02-1.34) after COVID-19 infection compared to patients with general upper respiratory tract infections. Patients with severe COVID-19 were at higher risk (RR=1.67 [1.25-2.23]) of diabetes after COVID-19. The risk (RR=1.95 [1.85-2.06]) of diabetes was highest in the first 3 months after COVID-19. These results remained after taking confounding factors into account.

CONCLUSIONS

After COVID-19, patients of all ages and genders had an elevated incidence and relative risk for a new diagnosis of diabetes. Particular attention should be paid during the first 3 months of follow-up after COVID-19 for new-onset diabetes.

Effects of physical activity on the severity of illness and mortality in COVID-19 patients: A systematic review and meta-analysis

Purpose: This systematic review and meta-analysis investigated the association between Physical activity (PA) before Coronavirus Disease 2019 (COVID-19) infection and the severity of illness and mortality in COVID-19 patients.

Methods: A comprehensive search was undertaken to identify retrospective and nonrandomized controlled trial studies comparing the severity and mortality of COVID-19 infection among COVID-19 patients who had previously reported their participation in PA with those who had not. The databases searched were PubMed, Cochrane Library, Scopus, Science Direct, EMBASE, OPENGREY.EU, and ClinicalTrials.gov. The risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects model was used for determining pairwise meta-analyses. The protocol was registered with PROSPERO (CRD42021262548).

Results: Eighteen studies met the inclusion criteria (5 cross-sectional, 12 cohort, and 1 case-control studies). All 1 618 680 subjects were adults. PA significantly decreased the risk of death in COVID-19 patients (odds ratio [OR] 0.34; 95% confidence interval [CI], 0.19–0.62; p < 0.001) and the risk of severe outcomes (OR 0.60; 95% CI, 0.48–0.76; p < 0.001). Subgroup analysis showed that PA for ≥150 min/wk at a moderate intensity or ≥75 min/wk at a vigorous intensity reduced the risks of severity and mortality. Vigorous PA reduced mortality risk, whereas moderate to vigorous PA reduced the risks of severity and mortality.

Conclusion: PA before infection might reduce severity and mortality in COVID-19 patients, especially PA ≥ 150 min/wk of moderate activity or ≥75 min/wk of vigorous activity. However, careful interpretations should be considered due to the difference in PA patterns and severity definitions among included studies. This finding implies that engaging in regular PA, even in different patterns, has beneficial effects on the severity and mortality of COVID-19 patients.

Physical activity lowers the risk for acute respiratory infections: Time for recognition

Physical inactivity is a well-established risk factor for chronic diseases, such as cardiovascular disease, cancer, and diabetes mellitus. There is a growing awareness that physical inactivity should also be regarded as a risk factor for acute respiratory infections (ARIs). ARIs, such as the common cold, influenza, pneumonia, and coronavirus disease 2019 (COVID-19), are among the most pervasive diseases on earth and cause widespread morbidity and mortality. Evidence in support of the linkage between ARIs and physical inactivity has been strengthened during the COVID-19 pandemic because of increased scientific scrutiny. Large-scale studies have consistently reported that the risk for severe COVID-19 outcomes is elevated in cohorts with low physical activity and/or physical fitness, even after adjusting for other risk factors. The lowered risk for severe COVID-19 and other ARIs in physically active groups is attributed to exercise-induced immunoprotective effects, including enhanced surveillance of key immune cells and reduced chronic inflammation. Scientific consensus groups, including those who submitted the Physical Activity Guidelines for Americans, have not yet given this area of research the respect that is due. It is time to add "reduced risk for ARIs" to the "Exercise is Medicine" list of physical activity-related health benefits.

The global impact of COVID-19 pandemic on the incidence of pediatric new-onset type 1 diabetes and ketoacidosis: A systematic review and meta-analysis

Viral infections may increase the risk of developing type 1 diabetes (T1D), and recent reports suggest that Coronavirus Disease 2019 (COVID-19) might have increased the incidence of pediatric T1D and/or diabetic ketoacidosis (DKA). Therefore, this meta-analysis aims to estimate the risk of global pediatric new-onset T1D, DKA, and severe DKA before and after the COVID-19 pandemic. A systematic search of MEDLINE/PubMed, CINAHL, Scopus, and EMBASE was conducted for articles published up to March 2022. A random-effects meta-analysis was performed to compare the relative risk of T1D and DKA among pediatric patients with T1D between the COVID-19 pre-pandemic and pandemic periods. We also compared glucose and HbA1c values in children who were newly diagnosed with T1D before and after the COVID-19 pandemic. The global incidence rate of T1D in the 2019 period was 19.73 per 100 000 children and 32.39 per 100 000 in the 2020 period. Compared with pre-COVID-19 pandemic, the number of worldwide pediatric new-onset T1D, DKA, and severe DKA during the first year of the COVID-19 pandemic increased by 9.5%, 25%, and 19.5%, respectively. Compared with pre-COVID-19 pandemic levels, the median glucose, and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic increased by 6.43% and 6.42%, respectively. The COVID-19 pandemic has significantly increased the risk of global pediatric new-onset T1D, DKA, and severe DKA. Moreover, higher glucose and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic mandates targeted measures to raise public and physician awareness.

Australian University Nursing and Allied Health Students' and Staff Physical Activity Promotion Preparedness and Knowledge: A Pre-Post Study Using an Educational Intervention

The promotion of physical activity (PA) by health professionals is a key strategy to increase PA levels in the population. In this study, we investigated PA promotion, preparedness, and knowledge among university nursing and allied health students and staff, as well as PA resource usage within curricula, before and after an educational intervention. Students and staff from 13 health disciplines at one Australian university were invited to complete an online survey, and a curriculum audits were conducted before and after PA teaching resources were promoted by academic PA champions (n = 14). A total of 299 students and 43 staff responded to the survey pre-intervention, and 363 and 32 responded to the post-intervention, respectively. PA promotion role perception (≥93%) and confidence to provide general PA advice (≥70%) were high throughout the study. Knowledge of PA guidelines was poor (3−10%). Students of physiotherapy, sport and exercise science, as well as more active students, were more likely to be aware of the PA guidelines (p < 0.05). Over 12 months, PA promotion preparedness and knowledge did not change significantly, nor was there a change in the amount of PA content delivered, despite a significant increase in the use of the teaching resources across a number of disciplines (p = 0.007). Future research should be carried out to investigate the implementation of the resources over time and to develop additional strategies for PA promotion and education scaffolded across curricula.