Effects of Aerobic Exercise Therapy through Nordic Walking Program in Lactate Concentrations, Fatigue and Quality-of-Life in Patients with Long-COVID Syndrome: A Non-Randomized Parallel Controlled Trial.

BACKGROUND: Long-COVID syndrome comprises a variety of signs and symptoms that develop during or after infection with COVID-19 which may affect the physical capabilities. However, there is a lack of studies investigating the effects of Long-COVID syndrome in sport capabilities after suffering from COVID-19 infection. The purpose of the study was to evaluate and compare lactate concentration and quality of life (QoL) in patients with Long-COVID with those who have not developed non-Long-COVID during Nordic walking exercise therapy. METHODS: Twenty-nine patients (25.5 ± 7.1 years) took part in a non-randomized controlled trial, divided into two groups: a Long-COVID group (n = 16) and a non-Long-COVID control (n = 13). Patients were confirmed as having Long-COVID syndrome if they experienced fatigue or tiredness when performing daily activities and worsening of symptoms after vigorous physical or mental activity. All participants underwent a 12-week Nordic Walking program. Lactate concentration after exercise and distance covered during all sessions were measured. Pre- and Long-Nordic Walking program, the Modified Fatigue Impact Scale (MFIS), the Short Form 36 Health Survey (SF-36), and EURO QoL-5D (EQ-ED) were administered to assess fatigue and quality of life, respectively. RESULTS: There was a lactate concentration effect between groups (F = 5.604; p = 0.024). However, there was no significant effect as a result of the session (F = 3.521; p = 0.121) with no interaction of group × session (F = 1.345; p = 0.414). The group main effect (F = 23.088; p < 0.001), time effect (F = 6.625; p = 0.026), and group × time (F = 4.632; p = 0.002) interaction on the SF-36 scale were noted. Also, there were a significant group main effect (F = 38.372; p < 0.001), time effect (F = 12.424; p = 0.005), and group × time interaction (F = 4.340; p = 0.014) on EQ-5D. However, there was only a significant group main effect (F = 26.235; p < 0.001) with no effect on time (F = 2.265; p = 0.160) and group × time (F = 1.584; p = 0.234) interaction on the MFIS scale. CONCLUSIONS: The Long-COVID group showed higher lactate concentration compared with the control group during the 12 weeks of the Nordic Walking program. The Long-COVID group presented a decrease in fatigue with respect to the control group according to the MFIS scale, as well as improvement in quality of life after aerobic exercise therapy.

Predictive Factors and ACE-2 Gene Polymorphisms in Susceptibility to Long COVID-19 Syndrome.

Long COVID-19 syndrome is present in 5-10% of patients infected with SARS-CoV-2, and there is still little information on the predisposing factors that lead to its development. The purpose of the study was to evaluate the predictive factors in early symptoms, clinical features and the role of Angiotensin-Converting Enzyme-2 (ACE-2) c.513-1451G>A (rs2106806) and c.15643279T>C (rs6629110) polymorphisms in the susceptibility to developing Long COVID-19 syndrome subsequent to COVID-19 infectionA total of 29 patients who suffered COVID-19 were recruited in a descriptive longitudinal study of two groups: Long COVID-19 (n = 16) and non-Long COVID-19 (n = 13). Early symptoms and clinical features during COVID-19 were classified by a medical service. ACE-2 polymorphisms were genotyped by using a Single Nucleotide Primer Extension (SNPE). Of the early symptoms, fatigue, myalgia and headache showed a high risk of increasing Long COVID-19 susceptibility. Clinical features such as emergency care, SARS-CoV-2 reinfection, previous diseases, respiratory disease and brain fog also had a high risk of increasing Long COVID-19 susceptibility. The A allele in the rs2106806 variant was associated with an odds ratio (OR) of 4.214 (95% CI 2.521-8.853; p < 0.001), and the T allele in the rs6629110 variant was associated with an OR of 3.754 (95% CI 1.785-6.105; p = 0.002) of increasing Long COVID-19 susceptibility. This study shows the risk of ACE-2 polymorphisms, different early symptoms and clinical features during SARS-CoV-2 infection in susceptibility to Long COVID-19.

Construct Validity and Test-Retest Reliability of a Free Mobile Application to Evaluate Aerobic Capacity and Endurance in Post-COVID-19 Syndrome Patients-A Pilot Study.

Introduction: Disability associated with the symptoms of post-COVID-19 syndrome is one of its main features and can have a considerable impact on care and rehabilitation units. This, linked to a decreased aerobic capacity and endurance in post-COVID-19 syndrome patients, increases interest in studying the potential of mobile applications to assess performance capacity. The purpose of this research was to study how a free mobile application assesses aerobic capacity and endurance and its relationship with aerobic capacity, test-retest reliability, and endurance evaluated by a conventional test, along with fatigue and health-related quality of life. Methods: An observational study was conducted. RUNZI®, a free mobile application, was used by mounting a Samsung Galaxy S8 smartphone using a strap on the right forearm while all participants simultaneously performed a 6-Minute Walking Test (6MWT). Construct validity between the 6MWT and the total distance performed evaluated by RUNZI® was explored. Additionally, evaluation scales to assess fatigue (MFIS) and health-related quality of life (SF-36) were used to analyze the construct validity of RUNZI®. For test−retest reliability of the app, the same instructions about the 6MWT and procedure with the app were given to all participants at two different time periods. Results: A total of 16 post-COVID-19 syndrome patients (15 females and 1 male) completed the procedure. Distance measured with the RUNZI® showed an excellent correlation with the 6MWT assessed conventionally (p < 0.0001; r = 0.851). No statistical correlations were found between the distance assessed by the RUNZI® app with MFIS and the SF-36. Test−retest reliability was found to be close to statistical significance (p = 0.058) for distance (m) measured by RUNZI® with an ICC of 0.482. Conclusions: Instrumental 6MWT assessed by the RUNZI® app for the Android® operating system showed an excellent correlation with conventional 6MWT, indicating its construct validity in post-COVID-19 syndrome patients. Further, values for the test−retest reliability for the free mobile application were close to statistical significance with a reliability considered poor in an indoor setting.

Neuroplasticity Modifications Following a Lower-Limb Amputation: A Systematic Review.

BACKGROUND: Although there are studies that have examined brain functional reorganization following upper-limb amputation, understanding of the brain changes that occur in people with lower-limb amputation is limited. OBJECTIVE: To investigate modifications in the brain following lower-limb amputation. METHODS: We included case-control studies that evaluate neuroplasticity in the central nervous system using neuroimaging techniques. A literature search was conducted using MEDLINE, CINAHL, Web of Science, Scopus, and Cochrane. RESULTS: Eleven articles were included (total n = 204 people with unilateral lower-limb amputation). These studies showed an increase in cerebellar gray matter volume in prosthesis users, as well as a decrease in thickness of the premotor cortex, orbitofrontal cortex, temporo-occipital junction, precentral gyrus, visual areas, and somatosensory cortex. Regarding white matter, the trials observed a decrease in the integrity at the corona radiata, the connections between the premotor areas, the fronto-occipital fasciculus and the corpus callosum. In addition, a decreased functional connectivity between cortical and subcortical areas has been described. CONCLUSIONS: Lower-limb amputation causes changes in several brain structures that may occur in the absence of pain and regardless of prosthesis use. The modifications observed include thinning or loss of gray matter volume, decrease in the integrity of the white matter connections between brain structures and changes in the functional connectivity between cortical and subcortical areas. LEVEL OF EVIDENCE: I.

Limits of stability in patients with vascular (due to diabetes) and nonvascular unilateral transtibial amputation: a cross-sectional study.

The aim of the study was to investigate the differences in the stability limits between patients with vascular and nonvascular unilateral transtibial amputation (UTA) and patients without amputation. Eighteen patients with UTA who used a prosthesis were divided into two groups: vascular (n=9) and nonvascular (n=9). Twenty-four patients without amputation served as the control group. Computerized dynamic posturography Smart EquiTest System, version 8.0 was used for measuring stability limits. The limits of stability test was used to assess the participants' ability to voluntarily sway to various locations in space. The measured parameters were maximum centre of gravity (COG) excursion, endpoint COG excursion and directional control. Single-factor analysis of variance and Bonferroni adjustment a posteriori tests was performed to investigate the differences between groups. The patients with vascular UTA had significantly lower endpoint COG excursion to oblique and forward direction compared with controls (P=0.017). In addition, the patients with vascular UTA had significantly lower maximum COG excursion to oblique and forward and to oblique and backward directions (P=0.031; 0.019). Patients with vascular UTA had significantly lower endpoint and maximum COG excursion to oblique and backward direction compared with patients with nonvascular UTA (P=0.30; 0.029). To summarize, patients with vascular UTA have substantially reduced limits of stability compared with patients without amputation and the patients with nonvascular UTA.

Weight Symmetry and Latency Scores for Unexpected Surface Perturbations in Subjects With Traumatic and Vascular Unilateral Transtibial Amputation.

BACKGROUND: Subjects with lower limb amputation develop new motor control strategies to preserve balance when they experience unexpected perturbations. Most studies performed thus far have not aimed to discuss the possible differences in postural control between subjects with vascular unilateral transtibial amputation (UTA) and subjects with traumatic UTA. OBJECTIVE: To analyze the automatic postural reaction in response to unexpected surface perturbations in a sample of subjects with traumatic and vascular UTA and to compare these observations with those for a group of healthy subjects. SETTING: University department. DESIGN: Observational study. PARTICIPANTS: A total of 9 men with traumatic UTA, 7 men with vascular UTA, and 10 control subjects without amputation. INTERVENTION: Computerized dynamic posturography Smart EquiTest System version 8.0 was used to measure automatic postural responses in both groups. MAIN OUTCOME MEASURES: The motor control test was used to assess the participants' automatic postural responses to unexpected surface perturbations. RESULTS: Latency scores showed that subjects with traumatic UTA coped with faster latencies under their sound limb than did the subjects with vascular UTA in medium backward and forward perturbations (medium-backward: P = .004; medium-forward: P = .037). In addition, the subjects with traumatic UTA also managed faster responses to medium-backward (P = .017 versus right control limb; P = .046 versus left control limb) and large-backward (P = .021 versus right control limb) and medium-forward (P = .012 versus right control limb; P = .043 versus left control limb) perturbations in their sound limb in contrast to control subjects. Weight symmetry showed that the subjects with traumatic UTA bore significantly more weight through their sound limb compared with the control subjects during medium and large backward translations (P = .028 and P = .045, respectively). CONCLUSIONS: The subjects with traumatic UTA had a greater reliance on their sound limb, and they had faster latencies and more weight in the sound limb upon experiencing unexpected perturbations compared with the control subjects. Conversely, persons with vascular UTA experienced slower latency responses in the sound limb compared with persons with traumatic UTA.

Comparison of stability limits in men with traumatic transtibial amputation and a nonamputee control group.

BACKGROUND: Currently, knowledge is lacking about whether subjects with traumatic unilateral transtibial amputation (UTA) have a compromised ability to voluntarily move their center of gravity (COG) to positions within the limits of stability. OBJECTIVE: To analyze the ability to voluntarily move the COG to positions within the limits of stability in a sample of subjects with traumatic UTA. DESIGN: Observational, case-control study. SETTING: University department. PARTICIPANTS: Ten men with traumatic UTA and 10 control subjects without amputation. MAIN OUTCOME MEASURES: Computerized dynamic posturography SMART EquiTEST System version 8.0 was used for measuring stability limits in both groups. The Limits of Stability test was used to assess the participants' ability to voluntarily sway to various locations in space (8 predetermined target positions). RESULTS: End point excursion achieved statistically significant differences in the prosthetic (P = .02) and backward (P = .03) directions in the subjects with UTA. A statistically significant decrease was observed in the maximum excursion to backward direction (P = .05) in the subjects with UTA. Directional control only reached statistically significant differences in the prosthetic backward direction (P = .05) compared with the control group. Movement velocity was statistically significantly lower in the subjects with UTA toward prosthetic (P = .03), backward (P = .05), sound (P = .01), and sound forward (P = .03) directions in relation to the control group. CONCLUSIONS: Persons with traumatic UTA have a reduced ability to move their COG within stability limits (restricted displacement, inadequate directional control, and reduced velocity). These findings should be considered when developing rehabilitation programs for these persons.

Knee and hip internal moments and upper-body kinematics in the frontal plane in unilateral transtibial amputees.

OBJECTIVE: The aim of this study was to quantify the motor adaptations in the frontal plane made by unilateral transtibial amputees (UTAs), with special regard to: (1) abduction/adduction moment at the hip and knee valgus moment in the frontal plane; (2) pelvic and thorax obliquity; and (3) stride length and gait speed. METHODS: 15 Males with unilateral transtibial amputation comprised the subject group and 15 non-disabled individuals served as control group. Gait analysis was performed using the VICON MOTION SYSTEM(®) (Oxford Metrics, Oxford, UK). RESULTS: In this study, UTAs walked with a reduced hip abductor moment during the stance phase. At the knee joint, the valgus moment was reduced in the prosthetic limb compared to the sound and the control limb. The thorax range of motion in the frontal plane was increased on the prosthetic side, compared with the non amputee subjects. CONCLUSION: Our findings suggest that unilateral transtibial amputation patients walk with different motor control strategies in the frontal plane compared with the non-disabled subjects. These results suggest the need for specific training for this group of UTAs, focusing on exercises to stabilize and strengthen the proximal muscles as well as practicing balance and coordination in the coronal plane.

Cardiac rehabilitation programs and health-related quality of life. State of the art.

Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature.

Performance of the craniocervical flexion test, forward head posture, and headache clinical parameters in patients with chronic tension-type headache: a pilot study.

DESIGN: Case-control, descriptive pilot study. OBJECTIVE: To describe the differences in the performance of the craniocervical flexion test (CCFT) between individuals with chronic tension-type headache (CTTH) and healthy controls. To assess the relationship between the CCFT, forward head posture, and several clinical variables related to the intensity and temporal profile of headache. BACKGROUND: Musculoskeletal impairments of the craniocervical region might play an important role on the pathogenesis of CTTH. Deficits in the performance of the CCFT have been reported in patients with cervicogenic headache, nonspecific neck pain, and whiplash injury, but not in individuals with CTTH. MATERIAL AND METHODS: Ten patients with CTTH and 10 comparable controls without headache were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and to record the pain history. The CCFT was performed with the subject supine and required performing a gentle head-nodding action of craniocervical flexion. The activation pressure score (pressure that the subject can achieve and hold for 10 seconds), the performance pressure index (calculated by multiplying the activation pressure score by the number of successful repetitions), and the highest pressure score (the highest level that each subject was able to hold for 10 seconds from 20 to 30 mm Hg) were measured. Side-view pictures of each subject were taken in both sitting and standing positions to assess forward head posture (FHP) by measuring the craniovertebral angle. All measures were taken by an assessor blinded to the subject's condition. RESULTS: Patients with CTTH had significantly lower values in both active pressure score and performance pressure index (P < .001), but not in the highest pressure score (P = .057), compared to controls. Patients with CTTH had a smaller craniovertebral angle (mean +/- SD, 42.0 degrees +/- 6.6 degrees), indicating a more FHP than controls (48.8 degrees +/- 2.5 degrees), in the standing position (P < .01); but not in the sitting position (CTTH, 39 degrees +/- 8.9 degrees; controls, 42.8 degrees +/- 8.9 degrees, P = .10). No association between FHP and any of the CCFT variables was found (P >.05). Headache intensity and frequency did not seem to be related to the CCFT variables, but there was a positive association between headache duration and activation pressure score (r(s), = 0.746, P = .02) and highest pressure score (r(s), = 0.743, P = .02). CONCLUSIONS: These findings suggest possible impairments of the musculoskeletal system in individuals with CTTH, although it is not possible to determine if these impairments contributed to the etiology of CTTH or are as a result of the chronic headache condition.