Feasibility and Effect of Implementing Physical Activity Program Implementation during Covid-19 in Hospitalized Positive Covid-19 Older Adults

An Exercise Immune Fitness test to unravel mechanisms of post-acute sequelae of COVID-19

The Post-Acute Sequelae of COVID-19 (PASC) Syndrome is a debilitating syndrome with onset three months post COVID-19 infection, marked by the presence of fatigue, headache, cognitive dysfunction, post-exertional malaise, orthostatic intolerance, and dyspnea that is clinically relevant and is at least as severe as fatigue in several other clinical conditions, including cancer. The onset, progression, and symptom profile of PASC patients have considerable overlap with Myalgic-Encephalopathy/Chronic Fatigue Syndrome (ME/CFS). In people with ME/CFS, exercise (and other types of exertion) can cause serious setbacks and deterioration in function. Post-exertional malaise (PEM) appears to be a common and a significant challenge for the majority of this patient group. Of the nearly 24 million adults in the U.S. who currently have long COVID, more than 80% are having some trouble carrying out daily activities. Mechanisms of PACS remain poorly understood. While multi-omic information gathered at the time of acute COVID-19 onset may help predict long COVID outcomes, we here propose to test the hypothesis that additional molecular immunological information collected during standardized exercise-testing for cardio-respiratory fitness after recovery from acute COVID-19 can be used to improve the understanding of mechanisms of PASC.

Implementation, Feasibility, and Acceptability of MATCH to Prevent Iatrogenic Disability in Hospitalized Older Adults: A Question of Geriatric Care Program?

Senior adults (>age 65) represent almost 20% of the population but account for 48% of hospital bed occupancy. In older adults, hospitalization often results in functional decline (i.e., iatrogenic disability) and, consequently, the loss of autonomy. Physical activity (PA) has been shown to counteract these declines effectively. Nevertheless, PA is not implemented in standard clinical practice. We previously showed that MATCH, a pragmatic, specific, adapted, and unsupervised PA program, was feasible and acceptable in a geriatric assessment unit (GAU) and a COVID-19 geriatric unit. This feasibility study aims to confirm that this tool could be implemented in other geriatric care programs, notably a geriatric rehabilitation unit (GRU) and a post-acute care unit (PACU), in order to reach the maximum number of older patients. Eligibility and consent were assessed by the physician for all the patients admitted to the three units (GAU, GRU, and PACU). The rehabilitation therapist taught each participant one of the five PA programs based on their mobility score on the decisional tree. Implementation (eligibility (%): patients eligible/number admitted and delay of implementation: number of days until prescription); feasibility (adherence (%): number sessions completed/number sessions prescribed and walking time (%): total walking time/time prescribed time); and acceptability (healthcare team (%): tool adequacy (yes/no) and patient: System Usability Scale questionnaire (SUS: x/100)) were evaluated and analyzed using a Kruskal-Wallis ANOVA or Fisher's exact test. Eligibility was different between the units (GRU = 32.5% vs. PACU = 26.6% vs. GAU = 56.0%; p < 0.001), but the time before implementation was similar (days: GRU = 5.91 vs. PACU = 5.88 vs. GAU = 4.78; p > 0.05). PA adherence (GRU = 83.5% vs. PACU = 71.9% vs. GAU = 74.3%) and walking time (100% in all units) were similar (p > 0.05). Patients (SUS: GRU = 74.6 vs. PACU = 77.2 vs. GAU = 77.2; p > 0.05) and clinicians (adequacy (yes; %): GRU = 78.3%; PACU = 76.0%; GAU = 72.2%; p > 0.05) found MATCH acceptable. Overall, MATCH was implementable, feasible, and acceptable in a GAU, GRU, and PACU. Randomized controlled trials are needed to confirm our results and evaluate the health benefits of MATCH compared with usual care.

The effect of exercise rehabilitation on COVID-19 outcomes: a systematic review of observational and intervention studies

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Testing Function Focused Care for Acute Care using the Evidence Integration Triangle: Protocol description

This manuscript provides the protocol for a National Institute of Aging-funded cluster randomized clinical trial that focuses on helping nurses in acute care to engage patients with dementia in physical activity while hospitalized using an approach referred to as function-focused care. Physical activity is defined as bodily movement produced by skeletal muscles resulting in the expenditure of energy and includes functional tasks such as bathing and dressing, leisure activity, ambulation, and moderate and vigorous intensity physical activity such as dancing, bike riding, or walking upstairs. The development of Function Focused Care for Acute Care (FFC-AC) was based on the Social Ecological Model and Social Cognitive Theory and includes four steps: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Patient Goals; and (4) Mentoring and Motivating of Staff (all levels of nursing staff), Patients, and Families. Function-focused care activities include motivating older patients to participate in bed mobility; personal care activities such as bathing, dressing, ambulating as they are able; and other types of physical activities. The integration of the intervention among the nurses on the units is guided by the Evidence Integration Triangle (EIT), which includes the participation of a stakeholder team and practical outcome measures. The intervention is therefore referred to as FFC-AC-EIT. In addition to describing the protocol developed to test the effectiveness and feasibility of FFC-AC-EIT, a description of ways to overcome some of the barriers and challenges that can be encountered with this study is provided.

Mental health of older people in social isolation: the role of physical activity at home during the COVID-19 pandemic

The COVID-19 pandemic involves a new coronavirus characterized by a respiratory disease resulting from an infection with severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2). The severity and fatality of COVID-19 are directly related to age and immunocompromised states, with older adults making up the vast majority of cases. The elderly with a higher risk of serious complications due to COVID-19 and deaths are also the group most susceptible to the damage of social isolation, impacting on mental health, resulting in a more sedentary lifestyle, and health problems due to several causes, implying need for greater attention, care and protection. Physical activity has shown excellent results for mental health, being used in different treatments and populations, when considering the elderly, one of the ways to mitigate this impact on mental health is the practice of physical activity. Here, we discuss the impacts of social isolation on mental health and the role of physical activity and exercise in the homes of the elderly as a way to protect the spread of other diseases from all causes during the COVID-19 pandemic period. To this end, we discuss some possibilities that can be used by the elderly in the period of social isolation, to the point of remaining active within their homes.