Even patients with mild COVID-19 symptoms after SARS-CoV-2 infection show prolonged altered red blood cell morphology and rheological parameters.

Infection with the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the associated coronavirus disease-19 (COVID-19) might affect red blood cells (RBC); possibly altering oxygen supply. However, investigations of cell morphology and RBC rheological parameters during a mild disease course are lacking and thus, the aim of the study. Fifty individuals with mild COVID-19 disease process were tested after the acute phase of SARS-CoV-2 infection (37males/13 females), and the data were compared to n = 42 healthy controls (30 males/12 females). Analysis of venous blood samples, taken at rest, revealed a higher percentage of permanently elongated RBC and membrane extensions in COVID-19 patients. Haematological parameters and haemoglobin concentration, MCH and MCV in particular, were highly altered in COVID-19. RBC deformability and deformability under an osmotic gradient were significantly reduced in COVID-19 patients. Higher RBC-NOS activation was not capable to at least in part counteract these reductions. Impaired RBC deformability might also be related to morphological changes and/or increased oxidative state. RBC aggregation index remained unaffected. However, higher shear rates were necessary to balance the aggregation-disaggregation in COVID-19 patients which might be, among others, related to morphological changes. The data suggest prolonged modifications of the RBC system even during a mild COVID-19 disease course.

Sports, Myocarditis and COVID-19: Diagnostics, Prevention and Return-to-play Strategies.

Myocarditis is an umbrella term for non-ischemic myocardial inflammation and remains a leading cause of sudden cardiac death in active individuals and athletes. Accurate diagnosing is challenging and diseases could often remain undetected. In the majority of cases, acute myocarditis resolves favourably. However, a relevant proportion of patients may have an increased risk of prognostically relevant cardiac arrhythmias and/or the development and progression of maladaptive myocardial remodelling (dilated cardiomyopathy). This review provides current knowledge on myocarditis and sports with special regard to the COVID-19 pandemic. Possible causes, common symptoms and proposed diagnostics are summarized. The relevance of temporary avoidance of intensive sports activities for both the prevention and therapy of acute myocarditis is discussed. Risk stratification, specific return-to-play recommendations and proposed follow-up diagnostics (also after COVID-19 infection) are presented.

[Effects of surgical face masks on exercise performance and perceived exertion of exercise in well-trained healthy boys]. / Einfluss einer Mund-Nase-Maske auf die objektive körperliche Leistungsfähigkeit sowie das subjektive Belastungsempfinden bei gut-trainierten, gesunden Jungen.

This study investigated the effects of surgical "everday" face masks on the physical performance and perceived exertion in trained eleven-year-old boys.No decrease in objective performance parameters was found in the aerobic and aerobic-anaerobic transition zones. However, at the maximum performance level with surgical face mask, there was a significant reduction in running time as well as a significant increase in the subjective perception of exertion with otherwise unchanged performance parameters. In summary, the use of surgical face masks in trained children does not affect athletic activities as long as the loads are performed primarily in the aerobic intensity range.

Brachial and central blood pressure and arterial stiffness in adult elite athletes.

PURPOSE: Measures of arterial stiffness (AS) and central blood pressure (BP) are indicators for cardiovascular health and possess a high prognostic value in the prediction of cardiovascular events. The effects of physical training are widely unexplored in the context of competitive, high-performance sports. Therefore, we aimed to present possible reference values of brachial and central BP and of AS of adult elite athletes compared to a control group. METHODS: A total of 189 subjects participated in this cross-sectional study. Of these were 139 adult elite athletes (70 male, 69 female) performing on top-national and international level, and 50 control subjects (26 male, 24 female). Resting brachial and central BP and aortic pulse wave velocity (PWV) were measured and were compared in terms of sex, sport category, and age of the athletes. RESULTS: Results show no difference between athletes and controls in any parameter. Women exhibit lower brachial and central BP and AS values compared to men. PWV is positively correlated with age. Evaluation of the parameters according to the different sport categories showed that endurance athletes exhibit lower BP and PWV compared to other athletes. CONCLUSIONS: This study presents brachial and central BP and PWV values of athletes, suggesting that high-performance sport does not negatively impact AS. The proposed reference values might support a more detailed evaluation of elite athlete's cardiovascular and hemodynamic system and a better assignment to possible risk groups.

Exercise after Heart Transplantation: Typical Alterations, Diagnostics and Interventions.

For the treatment of terminal heart failure, heart transplantation is considered to be the gold standard, leading to significantly improved quality of life and long-time survival. For heart transplant recipients, the development and maintenance of good functional performance and adequate exercise capacity is crucial for renewed participation and integration in self-determined live. In this respect, typical transplant-related alterations must be noted that play a significant role, leading to restrictions both centrally and peripherally. Before patients begin intensive and structured exercise training, a comprehensive diagnosis of their exercise capacity should take place in order to stratify the risks involved and to plan the training units accordingly. Particularly endurance sports and resistance exercises are recommended to counter the effects of the underlying disease and the immunosuppressive medication. The performance level achieved can vary considerably depending on their individual condition, from gentle activity through a non-competitive-level to intensive competitive sports. This paper includes an overview of the current literature on heart transplant recipients, their specific characteristics, as well as typical cardiovascular and musculoskeletal alterations. It also discusses suitable tools for measuring exercise capacity, recommendations for exercise training, required precautions and the performance level usually achieved.

Moderate Postmeal Walking Has No Beneficial Effects Over Resting on Postprandial Lipemia, Glycemia, Insulinemia, and Selected Oxidative and Inflammatory Parameters in Older Adults with a Cardiovascular Disease Risk Phenotype: A Randomized Crossover Trial.

BACKGROUND: Research suggests that postprandial events, as risk factors for cardiovascular diseases (CVDs), are influenced by meal composition and exercise. OBJECTIVES: We investigated the effect of walking versus rest on postprandial metabolic, inflammatory, and oxidative events following the consumption of test meals reflecting 2 different dietary patterns in older adults with an increased CVD risk. METHODS: A randomized crossover trial was conducted in 26 men and women (aged 70 ± 5 y; BMI 30.3 ± 2.3 kg/m2). Each adult participated in 4 treatments combining 1 of 2 iso-energetic (4300 kJ) meals [Western diet high-fat meal (WD): total fat, 59.4 g; saturated fatty acids, 32.0 g, dietary fiber, 4.2 g; or Mediterranean-type diet meal (MD): total fat, 40.1 g; saturated fatty acids, 5.1 g; dietary fiber, 14.5 g] with 30 min walking (4.6 ± 0.1 km/h) or rest. Primary (serum triglycerides) and secondary [serum nonesterified fatty acids (NEFAs); parameters of glucose metabolism, inflammation, endothelial activation, oxidation; blood pressure/heart rate] outcomes were measured at fasting and 1.5, 3.0, and 4.5 h postprandially. Data were analyzed by linear mixed models. RESULTS: Triglycerides were higher after the WD than after the MD [AUC in mmol/L × min: Western diet high-fat meal plus postprandial walking (WD-W), 218 ± 15.2; Western diet high-fat meal plus postprandial resting (WD-R), 207 ± 12.6; Mediterranean-type diet meal plus postprandial walking (MD-W), 139 ± 9.83; Mediterranean-type diet meal plus postprandial resting (MD-R), 149 ± 8.15; P  < 0.001]. No meal or activity effect was observed for NEFAs based on AUC data (WD-W, -43.5 ± 7.08; WD-R, -49.2 ± 6.94; MD-W, -48.0 ± 11.6; MD-R, -67.6 ± 7.58). Plasma glucose was higher after the MD than after the WD (WD-W, 222 ± 34.9; WD-R, 177 ± 32.8; MD-W, 314 ± 44.4; MD-R, 275 ± 57.8; P  < 0.001), as was serum insulin (AUC in nmol/L × min: WD-W, 82.0 ± 10.3; WD-R, 88.6 ± 12.8; MD-W, 129 ± 14.7; MD-R, 138 ± 20.5; P < 0.001). Plasma IL-6 was higher after walking than after resting (AUC in pg/mL × min: WD-W, 72.0 ± 34.0; WD-R, 14.3 ± 38.8; MD-W, 70.8 ± 39.4; MD-R, 5.60 ± 26.0; P < 0.05). Plasma vitamin C was higher after the MD than after the WD (P < 0.001) and after walking than after resting (P < 0.05; AUC in mg/L × min: WD-W, -305 ± 59.6; WD-R, -396 ± 84.0; MD-W, 113 ± 56.4; MD-R, -44.5 ± 48.1). We observed no meal or activity effects on parameters of oxidation and endothelial adhesion molecules. Our data revealed no significant meal × activity effects on all outcomes. CONCLUSIONS: In older adults with an increased CVD risk, the MD was associated with superior effects on several postprandial parameters (e.g., triglycerides), in comparison to the WD. Data revealed no relevant differences regarding the effects of postmeal walking and resting. None of the 4 treatments can be rated as superior regarding their acute effects on the shown postprandial metabolic, oxidative, and inflammatory parameters. The trial was registered at German Clinical Trials Register (DRKS; http://www.germanctr.de and http://www.drks.de) under identifier DRKS00012409.

Physical versus psychosocial stress: effects on hormonal, autonomic, and psychological parameters in healthy young men.

As a time-efficient training system, high intensity interval training (HIIT) is well known for several beneficial effects. However, the literature on the stress-generating effects of HIIT shows a research deficit. A standardized comparable stressor and different kinds of stress-parameters are needed for quantifying the results. The present study examined the hormonal, autonomic, and psychological stress outcomes of HIIT compared to a standardized psychosocial stressor and tested the cross-stressor-adaptation (CSA) hypothesis which implies a stress-buffering effect at a good fitness level. In a sample of 32 healthy young males (24.31 ± 3.35 years of age) stress was induced with a multiple Wingate (WG), as a HIIT all-out performance test, involving four 30 sec all-out exercise bouts. In addition, the Trier Social Stress Test (TSST), which consists of a mock job interview and mental arithmetic performance, was used for stress induction. Cortisol, heart rate variability (HRV), and stress-related questionnaires were assessed before, during, and after stress induction. Both the Wingate as well as the TSST led to a highly significant change in time and stressor for cortisol and HRV. Furthermore, a significantly higher delta during Wingate was identified. In part, the TSST had a significantly higher impact on the psychological measurements than the WG. In contrast to the literature, this study was not able to confirm the stress-buffering effect of the CSA hypothesis. These findings prove the stressful effect of HIIT. The prevention of negative health effects needs to be taken into consideration in sports training methods and programs as well as in stress-related research Lay summary By using a well-estimated psychosocial stressor for comparison and several stress parameters, this study is able to show the strong stress-generating effect of high intensity interval training (HIIT). Interestingly, subjective stress perception differed from objective stress response. This research is an important step towards understanding stress-related disorders in elite sport and making recommendations for reducing autonomic as well as hormonal stress in high intensity sport.

Effects of exercising before breakfast on the health of T2DM patients-A randomized controlled trial.

This is the first study to examine whether training before breakfast in the overnight-fasted state is more effective in improving the health of patients with type 2 diabetes mellitus (T2DM) than after breakfast in the fed state. Thirty T2DM patients (60 ± 8 years, 33.7 ± 4.6 kg/m2 ) were randomly assigned to the F group (training in the overnight-fasted state (n = 15)) and to the C group (training in the fed state (control group, n = 15)). All patients completed an 8-week combined endurance/strength training program. Physical training significantly increased time to physical exhaustion during an endurance test (+10.4%), power output during strength tests (chest presses: +36.7% and seated rows: +37.8%), and fat-free mass (+1.7 kg). Body fat mass (-1.9 kg), glycated hemoglobin (HbA1c) values (absolute change: -0.3%), serum insulin values (-2.5 microU/mL), the homeostatic model assessment for insulin resistance (HOMA-IR) index (-1.1), and circulating triglyceride levels (-31 mg/dL) decreased significantly from pre- to post-training. The training had no effect on body mass index, serum fasting glucose, total cholesterol, low-density lipoprotein/high-density lipoprotein ratio or interleukin (IL)-6, IL-10 and tumor necrosis factor (TNF)α levels. Analyses of variance revealed no time × group interaction for any variable (P > .05). The training was effective in improving the health of T2DM patients. However, the preliminary study's data do not provide any evidence that the nutritional state (overnight-fasted or fed) in regular physical training plays a significant role for training-induced adaptations in T2DM patients. Full trials (using other training protocols as well) should be conducted to gain further knowledge about the relevance of pre-exercise breakfast ingestion.

Endurance training alters YKL40, PERM1, and HSP70 skeletal muscle protein contents in men with type 2 diabetes mellitus.

BACKGROUND: The fight against type 2 diabetes mellitus (T2DM) is tremendously challenging. This pilot study investigates whether endurance training (3 times per week for 3 months, moderate intensity) can change the skeletal muscle protein contents of chitinase-3-like protein-1 (YKL40), peroxisome proliferator-activated receptor y coactivator-1 and estrogen-related receptor-induced regulator in muscle-1 (PERM1) and heat-shock protein-70 (HSP70), which have been discussed as novel therapeutically relevant targets. METHODS: Muscle biopsies were obtained from overweight/obese men with T2DM (n = 7, years = 63 ± 9) at T1 (6 weeks pre-training), T2 (1 week pre-training) and T3 (3 to 4 days post-training). The protein levels of YKL40, PERM1, and HSP70 were determined by immunohistochemistry. RESULTS: YKL40, PERM1, and HSP70 were significantly upregulated following endurance training (T2-T3: +103%, +61%, +89%, p = 0.012, p = 0.010, p = 0.028). There was a fiber type-specific distribution of HSP70 with increased protein contents in type I fibers. A significant change in the fiber type distribution with an increase in type I fibers and a decrease in type II fibers was observed post-training. There were no significant differences for YKL40, PERM1, HSP70, or the fiber type distribution between T1 and T2. CONCLUSION: The training-induced upregulation of YKL40, PERM1, and HSP70 could help manage the diabetic disease and reduce its complications.

[Neuronal Blood Pressure Regulation]. / Neuronale Kontrolle des Blutdrucks.

Neuronal blood pressure control is mediated by the autonomic nervous system. In this article, physiological and pathophysiological mechanisms will be recapitulated. Blood pressure regulation aims at maintaining adequate cardiac output and a sufficient perfusion pressure for the organs. In glaucoma, ocular perfusion pressure is defined as the difference between systemic blood pressure and intraocular pressure and is crucial for the supply of the optic nerve. Patients who suffer from normal-tension glaucoma and low blood pressure are at risk of glaucoma progression. In primary open-angle glaucoma, blood pressure is also of importance. A 24-h ambulatory blood pressure monitoring with particular attention to the nocturnal dipping is recommended for all glaucoma patients. Internal medicine specialists and ophthalmologists should be aware of the mutual influence of the two diseases and take this it into account for the choice of an individual therapeutic strategy and target level.

Ischemic Preconditioning Enhances Performance and Erythrocyte Deformability of Responders.

This pilot study aimed to evaluate the differential effects of a remote ischemic preconditioning (rIPC) manoeuvre on performance and red blood cell (RBC) deformability compared to a sham control and a placebo setting. Ten male subjects performed three test settings in a single-blind, crossover, and randomized control design. All settings started with 20 min of rest and were followed by 4 cycles of occlusion/reperfusion consisting of 5 min each. During rIPC and placebo, the cuff pressure was inflated to 200 mmHg and 120 mmHg, respectively. During the sham control setting, 10 mmHg pressure was applied. All tests were followed by a cycle exercise with lactate diagnostics. Power at 2 and 4 mmol/l lactate thresholds were calculated. RBC deformability was measured before and after the respective manoeuvre. Results showed that no effect resulted from any manoeuvre on performance values or RBC deformability. But 6 subjects showed a higher power at the 2 mmol/l threshold, and 5 subjects exerted higher power at the 4 mmol/l threshold when the rIPC manoeuvre preceded the exercise. In these responsive subjects, RBC deformability also improved. Hence, rIPC effects are much influenced by the subjects' responsiveness, and improved RBC deformability might contribute to enhanced performance in responsive subjects.

Long-term follow-up of former world-class swimmers: evaluation of cardiovascular function.

There is some evidence that long-term high-intensity endurance training might be associated with deterioration in cardiac function and might impose a potential risk for cardiovascular events. Thus, the intention was to retrospectively evaluate the cardiac status in former endurance athletes, particularly right ventricular (RV) dimension and function, to reveal potential cardiac damage. A group of 12 former world-class swimmers (45 ± 1.5 years) was examined 24.9 ± 4.3 years after cessation of high-intensity endurance training. They underwent history taking, physical examination, ECG, exercise testing and echocardiography. Furthermore, functional and echocardiography data that were also available from former evaluations were included in the analysis. There was a significant decline in exercise capacity. LV function was normal with a decrease in septal thickness to 9.1 ± 1.3 (p < 0.05) and LV diastolic diameter to 48.9 ± 5.6 (p < 0.05). Still, there was a remaining septal hypertrophy. RV function was 55.3 ± 4.2% and there were normal RV dimensions adjusted for body surface area. 25 years after the cessation of endurance training there was a normal RV and LV function with a normalization of almost all diameters, still there was a mild LV hypertrophy in some athletes. Consequently, no relevant long-term cardiac remodeling after intensive endurance training was depicted in this group of athletes.

Marathon run: cardiovascular adaptation and cardiovascular risk.

The first marathon run as an athletic event took place in the context of the Olympic Games in 1896 in Athens, Greece. Today, participation in a 'marathon run' has become a global phenomenon attracting young professional athletes as well as millions of mainly middle-aged amateur athletes worldwide each year. One of the main motives for these amateur marathon runners is the expectation that endurance exercise (EE) delivers profound beneficial health effects. However, with respect to the cardiovascular system, a controversial debate has emerged whether the marathon run itself is healthy or potentially harmful to the cardiovascular system, especially in middle-aged non-elite male amateur runners. In this cohort, exercise-induced increases in cardiac biomarkers-troponin and brain natriuretic peptide-and acute functional cardiac alterations have been observed and interpreted as potential cardiac damage. Furthermore, in the cohort of 40- to 65-year-old males engaged in intensive EE, a significant risk for the development of atrial fibrillation has been identified. Fortunately, recent studies demonstrated a normalization of the cardiac biomarkers and the functional alterations within a short time frame. Therefore, these alterations may be perceived as physiological myocardial reactions to the strenuous exercise and the term 'cardiac fatigue' has been coined. This interpretation is supported by a recent analysis of 10.9 million marathon runners demonstrating that there was no significantly increased overall risk of cardiac arrest during long-distance running races. In conclusion, intensive and long-lasting EE, e.g. running a full-distance Marathon, results in high cardiovascular strain whose clinical relevance especially for middle-aged and older athletes is unclear and remains a matter of controversy. Furthermore, there is a need for evidence-based recommendations with respect to medical screening and training strategies especially in male amateur runners over the age of 35 years engaged in regular and intensive EE.

The Influence of Acute and Chronic Exercise on Appetite and Appetite Regulation in Patients with Prediabetes or Type 2 Diabetes Mellitus-A Systematic Review.

This systematic review aims to analyze the effects of acute and chronic exercise on appetite and appetite regulation in patients with abnormal glycemic control. PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for eligible studies. The included studies had to report assessments of appetite (primary outcome). Levels of appetite-regulating hormones were analyzed as secondary outcomes (considered, if additionally reported). Seven studies with a total number of 211 patients with prediabetes or type 2 diabetes mellitus (T2DM) met the inclusion criteria. Ratings of hunger, satiety, fullness, prospective food consumption, nausea, and desire to eat, as well as levels of (des-)acylated ghrelin, glucagon-like peptide 1, glucose-dependent insulinotropic peptide, pancreatic polypeptide, peptide tyrosine tyrosine, leptin, and spexin were considered. Following acute exercise, the effects on appetite (measured up to one day post-exercise) varied, while there were either no changes or a decrease in appetite ratings following chronic exercise, both compared to control conditions (without exercise). These results were accompanied by inconsistent changes in appetite-regulating hormone levels. The overall risk of bias was low. The present results provide more evidence for an appetite-reducing rather than an appetite-increasing effect of (chronic) exercise on patients with prediabetes or T2DM. PROSPERO ID: CRD42023459322.

Efficacy and safety of diclofenac diethylamine 1.16% gel in acute neck pain: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Neck pain (NP) is a common musculoskeletal disorder in primary care that frequently causes discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce neck pain and associated inflammation and facilitate earlier recovery. Topical diclofenac diethylamine (DDEA) 1.16% gel is clinically proven to be effective and well tolerated in acute and chronic musculoskeletal conditions, but until now no clinical data existed for its use in acute NP. The aim of this study was to assess the efficacy and safety of DDEA 1.16% gel compared with placebo gel in acute NP. METHODS: In a randomized, double-blind, placebo-controlled study, patients with acute NP (n = 72) were treated with DDEA 1.16% gel (2 g, 4x/day, for 5 days) or placebo. Efficacy assessments included pain-on-movement (POM), pain-at-rest (PAR), functional neck disability index (NDI) and response to treatment (decrease in POM by 50% after 48 h). Adverse events (AEs) were recorded throughout the study. RESULTS: The primary outcome, POM at 48 h, was statistically significantly lower with DDEA gel (19.5 mm) vs. placebo (56.9 mm) (p < 0.0001), representing a clinically relevant decrease from baseline (75% vs. 23%, respectively). All POM scores were significantly lower with DDEA gel vs. placebo from 1 h, as were PAR and NDI scores from first assessment (24 h) onwards (all p < 0.0001). Response to treatment was significantly higher with DDEA gel (94.4%) vs. placebo (8.3%) (p < 0.0001). There were no AEs with DDEA gel. CONCLUSIONS: DDEA 1.16% gel, which is available over-the-counter, was effective and well tolerated in the treatment of acute neck pain. The tools used to assess efficacy suggest that it quickly reduced neck pain and improved neck function. However, questions remain regarding the comparability and validity of such tools. Further studies will help ascertain whether DDEA 1.16% gel offers an alternative treatment option in this common, often debilitating condition. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01335724.

Combination of comfrey root extract plus methyl nicotinate in patients with conditions of acute upper or low back pain: a multicentre randomised controlled trial.

This randomised, multicentre, double-blind, three-arm, placebo-controlled trial compared a topical combination of 35% comfrey root extract plus 1.2% methyl nicotinate versus a single preparation of methyl nicotinate or placebo cream for relief of acute upper or low back pain. 379 patients were randomly assigned to three groups (combination, n = 163; methyl nicotinate, n = 164; placebo, n = 52). They applied a 12 cm layer of cream three times daily for 5 days. The primary efficacy variable was the area under the curve (AUC) of the visual analogue scale (VAS) on active standardised movement values at visits 1 to 4. Secondary measures included back pain at rest, pressure algometry, consumption of analgesic medication, functional impairment measured with Oswestry Disability Index, and global assessment of response. The AUC of the VAS on active standardised movement was markedly smaller in the combination treatment group than in the methyl nicotinate and in the placebo group (ANOVA: p < 0.0001). The combination demonstrated superiority to the two other treatment arms, while methyl nicotinate displayed a considerable effect as well.

Effects of Covid-19 on the autonomic nervous system in elite athletes assessed by heart rate variability.

Introduction: Covid-19 is a viral airway and systemic infection which can negatively affect the function of the autonomic nervous system. Cardiovascular autonomic function is essential for peak athletic performance. The aim of this study was to assess the effects of a Covid-19 disease on the autonomic nervous system of German elite athletes using heart rate variability (HRV). Methods: 60 elite athletes (aged 22.88 ± 4.71 years) were recruited, 30 of whom had undergone a Covid-19 disease. Heart rate (HR), blood pressure (BP) and heart rate variability (HRV) were measured during rest and during an orthostatic challenge. Results: At rest and after orthostatic stress blood pressure and the root mean square of successive differences (RMSDD) were significantly lower in Covid-19 athletes (COV) than in control athletes (CON) (p = 0.002 and p = 0.004, respectively); heart rate was significantly higher (p = 0.001). COV showed a significantly greater reduction in blood pressure and elevation of heart rate than CON, but the change in RMSSD did not differ significantly during the orthostatic challenge. Conclusion: These results show a change in cardiac parasympathetic activity and cardiovascular autonomic function in German elite athletes after Covid-19. These findings further the understanding of effects of the Covid-19 disease on the cardiovascular physiology in athletes. Heart rate variability may be a helpful tool in the return-to-play assessment of elite athletes. Supplementary Information: The online version contains supplementary material available at 10.1007/s11332-023-01067-7.

Feasibility, Usability, and Safety of ParaGym, an Intelligent Mobile Exercise App for Individuals With Paraplegia: Protocol for a Pilot Block-Randomized Controlled Trial.

BACKGROUND: Exercise is crucial for individuals with paraplegia to reduce the risk of secondary diseases and improve independence and quality of life. However, numerous barriers such as inadequate accessibility restrict their participation in exercise programs. Digital exercise apps can help overcome these barriers. Personalization is considered a crucial feature of mobile exercise apps, as people with paraplegia have individual requirements regarding exercise programs depending on their level of impairment. Despite the increasing popularity of mobile exercise apps, there are none available that target the individual needs of this cohort. The ParaGym mobile exercise app prototype was designed to automatically tailor exercise sessions to the individual needs of users with paraplegia. OBJECTIVE: This study aims to evaluate the feasibility, usability, safety, and preliminary effectiveness of the ParaGym mobile exercise app prototype. METHODS: This pilot block-randomized controlled feasibility trial will include 45 adult participants with paraplegia. Eligible participants will be block randomized to either the intervention or waitlist control group. The intervention group will perform a 6-week exercise program using the ParaGym mobile exercise app, comprising three 35-minute exercise sessions per week. The waitlist control group will continue their usual care and receive access to the app after study completion. Participants will record all exercise sessions conducted with the app as well as additional exercise sessions conducted during the study period using exercise diaries. The primary outcomes include feasibility, usability, and safety. Feasibility will be assessed through semistructured interviews, study adherence, and retention rates. Usability will be measured using the System Usability Scale. Safety will be determined by the occurrence of adverse events. Secondary outcomes include the effects of the intervention on peak exercise capacity (VO2 peak); handgrip strength; independence, which will be measured using the Spinal Cord Independence Measure III (SCIM III); and health-related quality of life, which will be measured using the Short Form-36 Health Survey (SF-36). RESULTS: Recruitment commenced in November 2022. Overall, 12 participants were enrolled at the time of submission. Data collection commenced in January 2023, with completion expected in April 2023. CONCLUSIONS: To the best of our knowledge, this is the first study to assess the feasibility, usability, and safety of an intelligent mobile exercise app for individuals with paraplegia. Thereafter, the app should be adapted according to the findings of this trial. Future trials with an updated version of the app should aim for a larger sample size, longer intervention duration, and more diverse target group. In the long term, a fully marketable version of the ParaGym app should be implemented. This would increase the access to personalized, independent, and evidence-based exercise training for this cohort and, in the future, other people who use wheelchairs. TRIAL REGISTRATION: German Clinical Trials Register DRKS00030370; https://drks.de/search/de/trial/DRKS00030370. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45652.

Mid- to long-term cardiac magnetic resonance findings in elite athletes recovered from COVID-19: results from an ongoing observational COVID-19 study at a German Olympic medical centre.

INTRODUCTION: The cardiac magnetic resonance (CMR) data on mid- to long-term myocardial damage due to COVID-19 infections in elite athletes are scarce. Therefore, this study investigated the mid -to long-term consequences of myocardial involvement after a COVID-19 infection in elite athletes. MATERIALS AND METHODS: This study included 27 athletes at the German Olympic Centre North Rhine-Westphalia (NRW)/Rhineland with a confirmed previous COVID-19 infection between January 2020 and October 2021. The athletes were part of an ongoing observational COVID-19 study at the Institute of Cardiology and Sports Medicine Cologne at the German Sport University (DSHS).Nine healthy non-athletes with no prior COVID-19 illness served as controls. CMR was performed within a mean of 182 days (standard deviation [SD] 99) of the initial positive test result. RESULTS: CMR did not reveal any signs of acute myocarditis (according to the current Lake Louise criteria) or myocardial damage in any of the 26 elite athletes with previous COVID-19 infection. Of these athletes, 92% experienced a symptomatic course, and 54% reported symptoms lasting for more than 4 weeks. One male athlete was excluded from the analysis because CMR revealed an arrhythmogenic right ventricular cardiomyopathy (ARVC). Athletes had significantly enlarged left and right ventricle volumes and increased left ventricular myocardial mass in comparison to the healthy control group (LVEDVi 103.4 vs 91.1 ml/m2, p = 0.031; RVEDVi 104.1 vs 86.6 ml/m2, p = 0.007; LVMi 59.0 vs 46.2 g/m2, p = 0.002). Only two cases of elevated high-sensitivity-Troponin were documented; in one, the participant had previously engaged in high-intensity training, and in the other, CMR revealed a diagnosis of an arrhythmogenic cardiomyopathy. CONCLUSION: Our findings suggest that the risk for mid- to long-term myocardial damage is very low to negligible in elite athletes. Our results do not allow conclusions to be drawn regarding myocardial injury in the acute phase of infection nor about possible long-term myocardial effects in the general population.

Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study.

BACKGROUND: Single-pill combination improves adherence and persistence to medication in hypertension. It remains unclear whether this also reduces cardiovascular outcomes and all-cause mortality. We analyzed whether single-pill combinations are superior to identical multiple pills on persistence to medication, cardiovascular outcomes, and all-cause mortality. METHODS: This was a retrospective claims data (German AOK PLUS) analysis. Data from hypertensive patients ≥18 years treated with renin-angiotensin system combinations given as single pill or identical multipills covering the years 2012 to 2018 were analyzed and followed up to at least 1 year. After 1:1 propensity score matching, persistence to medication, cardiovascular events, and all-cause mortality were compared using non-parametric tests. Results were reported as incidence rate ratios and hazard ratios. RESULTS: After propensity score matching data from 57 998 patients were analyzed: 10 801 patients received valsartan/amlodipine, 1026 candesartan/amlodipine, 15 349 ramipril/amlodipine, and 1823 amlodipine/valsartan/hydrochlorothiazide as single pill or identical multipill. No relevant differences in patient characteristics were observed within the 4 groups. In all groups, a significant lower all-cause mortality, a significant a higher persistence to medication, a significant lower event rate in 15 out of 20 comparisons, and a tendency in the remaining 5 comparisons was observed under single pills compared with multipill combinations. CONCLUSIONS: Antihypertensive combination therapy reduces all-cause mortality and cardiovascular events when provided as single pill compared to identical drugs as multipills. This strongly supports the European Society of Cardiology/European Society of Hypertension and International Society of Hypertension guidelines recommending the use of a single-pill combination and thus should be more rigorously implemented into daily clinical practice.