Exercise modifies hypothalamic connectivity and brain functional networks in women after bariatric surgery: a randomized clinical trial.

BACKGROUND: Obesity is a disease that may involve disrupted connectivity of brain networks. Bariatric surgery is an effective treatment for obesity, and the positive effects on obesity-related conditions may be enhanced by exercise. Herein, we aimed to investigate the possible synergistic effects of Roux-en-Y Gastric Bypass (RYGB) and exercise training on brain functional networks. METHODS: Thirty women eligible for bariatric surgery were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n = 15, age = 41.0 ± 7.3 years) or RYGB plus Exercise Training (RYGB + ET: n = 15, age = 41.9 ± 7.2 years). Clinical, laboratory, and brain functional connectivity parameters were assessed at baseline, and 3 (POST3) and 9 months (POST9) after surgery. The 6-month, three-times-a-week, exercise intervention (resistance plus aerobic exercise) was initiated 3 months post-surgery (for RYGB + ET). RESULTS: Exercise superimposed on bariatric surgery (RYGB + ET) increased connectivity between hypothalamus and sensorial regions (seed-to-voxel analyses of hypothalamic connectivity), and decreased default mode network (DMN) and posterior salience (pSAL) network connectivity (ROI-to-ROI analyses of brain networks connectivity) when compared to RYGB alone (all p-FDR < 0.05). Increases in basal ganglia (BG) network connectivity were only observed in the exercised training group (within-group analyses). CONCLUSION: Exercise training is an important component in the management of post-bariatric patients and may improve the hypothalamic connectivity and brain functional networks that are involved in controlling food intake. TRIAL REGISTRATION: Clinicaltrial.gov: NCT02441361.

Effects of a 16-week home-based exercise training programme on health-related quality of life, functional capacity, and persistent symptoms in survivors of severe/critical COVID-19: a randomised controlled trial.

BACKGROUND: Long-lasting effects of COVID-19 may include cardiovascular, respiratory, skeletal muscle, metabolic, psychological disorders and persistent symptoms that can impair health-related quality of life (HRQoL). We investigated the effects of a home-based exercise training (HBET) programme on HRQoL and health-related outcomes in survivors of severe/critical COVID-19. METHODS: This was a single-centre, single-blinded, parallel-group, randomised controlled trial. Fifty survivors of severe/critical COVID-19 (5±1 months after intensive care unit discharge) were randomly allocated (1:1) to either a 3 times a week (~60-80 min/session), semi-supervised, individualised, HBET programme or standard of care (CONTROL). Changes in HRQoL were evaluated through the 36-Item Short-Form Health Survey, and physical component summary was predetermined as the primary outcome. Secondary outcomes included cardiorespiratory fitness, pulmonary function, functional capacity, body composition and persistent symptoms. Assessments were performed at baseline and after 16 weeks of intervention. Statistical analysis followed intention-to-treat principles. RESULTS: After the intervention, HBET showed greater HRQoL score than CONTROL in the physical component summary (estimated mean difference, EMD: 16.8 points; 95% CI 5.8 to 27.9; effect size, ES: 0.74), physical functioning (EMD: 22.5 points, 95% CI 6.1 to 42.9, ES: 0.83), general health (EMD: 17.4 points, 95% CI 1.8 to 33.1, ES: 0.73) and vitality (EMD: 15.1 points, 95% CI 0.2 to 30.1, ES: 0.49) domains. 30-second sit-to-stand (EMD: 2.38 reps, 95% CI 0.01 to 4.76, ES: 0.86), and muscle weakness and myalgia were also improved in HBET compared with CONTROL (p<0.05). No significant differences were seen in the remaining variables. There were no adverse events. CONCLUSION: HBET is an effective and safe intervention to improve physical domains of HRQoL, functional capacity and persistent symptoms in survivors of severe/critical COVID-19. TRIAL REGISTRATION NUMBER: NCT04615052.

Carotid intima-media thickness and flow-mediated dilation do not predict acute in-hospital outcomes in patients hospitalized with COVID-19.

Studies have suggested a potential role of endothelial dysfunction and atherosclerosis in the pathophysiology of COVID-19. Herein, we tested whether brachial flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) measured upon hospital admission are associated with acute in-hospital outcomes in patients hospitalized with COVID-19. A total of 211 patients hospitalized with COVID-19 were submitted to assessments of FMD and mean and maximum cIMT (cIMTmean and cIMTmax) within the first 72 h of hospital admission. Study primary outcome was a composite of intensive care unit admission, mechanical ventilation, or death during the hospitalization. These outcomes were also considered independently. Thrombotic events were included as a secondary outcome. Odds ratios (ORs) and confidence intervals (CIs) were calculated using unadjusted and adjusted multivariable logistic regression models. Eighty-eight (42%) participants demonstrated at least one of the composite outcomes. cIMTmean and cIMTmax were predictors of mortality and thrombotic events in the univariate analysis (cIMTmean and mortality: unadjusted OR 12.71 [95% CI 1.71-94.48]; P = 0.014; cIMTmean and thrombotic events: unadjusted OR 11.94 [95% CI 1.64-86.79]; P = 0.015; cIMTmax and mortality: unadjusted OR 8.47 [95% CI 1.41-51.05]; P = 0.021; cIMTmax and thrombotic events: unadjusted OR 12.19 [95% CI 2.03-73.09]; P = 0.007). However, these associations were no longer present after adjustment for potential confounders (P > 0.05). In addition, FMD% was not associated with any outcome. In conclusion, cIMT and FMD are not independent predictors of clinical outcomes in patients hospitalized with COVID-19. These results suggest that subclinical atherosclerosis and endothelial dysfunction may not be the main drivers of COVID-19 complications in patients hospitalized with COVID-19.NEW & NOTEWORTHY Studies have suggested a role of endothelial dysfunction and atherosclerosis in COVID-19 pathophysiology. In this prospective cohort study, we assessed the prognostic value of carotid intima-media thickness (IMT) and flow-mediated dilation (FMD) in patients with COVID-19. Carotid IMT and FMD were not independent predictors of major outcomes. These results suggest that other risk factors may be the main drivers of clinical outcomes in patients with COVID-19.

Self-selected Rest Interval Improves Vertical Jump Postactivation Potentiation.

ABSTRACT: do Carmo, EC, De Souza, EO, Roschel, H, Kobal, R, Ramos, H, Gil, S, and Tricoli, V. Self-selected rest interval improves vertical jump postactivation potentiation. J Strength Cond Res 35(1): 91-96, 2021-This study compared the effects of self-selected rest interval (SSRI) and fixed rest interval (FRI) strategies on postactivation potentiation (PAP) in countermovement jump (CMJ) performance. Twelve strength-trained men (age: 25.4 ± 3.6 years; body mass: 78.8 ± 10.5 kg; height: 175 ± 7.0 cm; half-squat 1 repetition maximum: 188.7 ± 33.4 kg) performed 3 experimental conditions: (a) FRI: CMJ test; 4-minute rest interval; 5 repetition maximum (5RM) back squat; 4-minute rest interval; and CMJ test, (b) SSRI: CMJ test; 4-minute rest interval; 5RM back squat; SSRI; and CMJ test, and (c) control: CMJ test; 8-minute rest interval and CMJ test. In SSRI, subjects were instructed to rest until they felt fully recovered and able to exercise at maximal intensity based on the perceived readiness scale. Significant changes in pre-post CMJ performance were observed in the SSRI condition (38.2 ± 4.6 cm vs. 40.5 ± 4.4 cm; p = 0.08; confidence interval [CI]: 0.72-3.82 cm; effect size [ES] = 0.93). There were significant differences in post-CMJ performance when SSRI was compared with FRI (40.5 ± 4.4 cm vs. 37.7 ± 5.1 cm; p = 0.02; CI: 0.43-5.08; ES = 1.13) and control (40.5 ± 4.4 cm vs. 37.4 ± 5.7 cm; p = 0.01; CI: 0.66-5.61; ES = 1.35). The average rest interval length for the SSRI condition was 5:57 ± 2:44 min:sec (CI: 4:24-7:30). Our results suggest that the use of SSRI was an efficient and practical strategy to elicit PAP on CMJ height in strength-trained individuals.

Exercise-induced anti-inflammatory effects in overweight/obese women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is characterized by exacerbated inflammation, which is implicated in cardiometabolic dysfunction. This study aimed to examine the potential effects of acute exercise on inflammatory responses in obese/overweight PCOS women and their controls. Participants underwent a single bout of moderate-intensity aerobic exercise (30 min at ∼65% of VO2peak). Blood and muscle samples were collected immediately before (PRE) and 60 min after the exercise session. Cytokines (i.e., IL-1ß, IL-6, IL-4, IL-10, TNF-α) were measured both in plasma and in skeletal muscle, and proteins related to inflammatory signaling (IKKα/ß and JNK) were assessed in skeletal muscle. At PRE, PCOS showed elevated muscle TNF-α (+62%, p = 0.0012) and plasma IL-1ß (+76%, p = 0.0010) compared to controls. In PCOS, exercise decreased plasma and muscle TNF-α (-14%, p = 0.0003 and -46%, p = 0.0003), as well as increased plasma and muscle IL-4 (+147%, p = 0.0018 and +62%, p = 0.0474) and plasma IL-10 (+38%, p = 0.0029). Additionally, IKKα/ß and JNK phosphorylation in skeletal muscle, which was higher in PCOS at PRE, was significantly reduced by exercise (-58%, p < 0.0001 and -46%, p < 0.0001, respectively), approaching control levels. Person's correlations between PRE values and delta changes (i.e., exercise effect) showed significant, negative associations for plasma IL-1ß (r = -0.92, p < 0.0001), TNF-α (r = -0.72, p = 0.0100) and IL-6 (r = -0.58, p = 0.05), and muscle TNF-α (r = -0.95, p < 0.0001), IKKα/ß (r = -0.75, p = 0.005), and JNK (r = -0.94, p < 0.0001) in PCOS. In conclusion, exercise can mitigate the inflammatory milieu in women with PCOS. The anti-inflammatory role of exercise could underlie its cardiometabolic protection in PCOS.

Effects of resisted sprint training on sprinting ability and change of direction speed in professional soccer players.

Resisted sprint training consists of performing overloaded sprints, which may produce greater effects than traditional sprint training. We compared a resisted sprint training with overload control versus an unresisted sprint training program on performance in soccer players. Eighteen elite athletes were randomly assigned to resisted (RST) or unresisted sprint training protocol (UR). Before and after a 6-week training period, sprinting ability, change of direction speed (COD), vertical jumps (SJ and CMJ), mean power (MP) and mean propulsive power (MPP) at distinct loads were assessed. Both groups improved sprinting ability at all distances evaluated (5m: UR = 8%, RST = 7%; 10m: UR = 5%, RST = 5%; 15m: UR = 4%, RST = 4%; 20m: UR = 3%, RST = 3%; 25m: UR = 2%, RST = 3%;), COD (UR = 6%; RST = 6%), SJ (UR = 15%; RST = 13%) and CMJ (UR = 15%; RST = 15%). Additionally, both groups increased MP and MPP at all loads evaluated. The between-group magnitude-based inference analysis demonstrated comparable improvement ("trivial" effect) in all variables tested. Finally, our findings support the effectiveness of a short-term training program involving squat jump exercise plus sprinting exercises to improve the performance of soccer players.

Effects of Different Combinations of Strength, Power, and Plyometric Training on the Physical Performance of Elite Young Soccer Players.

The combination of strength (ST) and plyometric training (PT) has been shown to be effective for improving sport-specific performance. However, there is no consensus about the most effective way to combine these methods in the same training session to produce greater improvements in neuromuscular performance of soccer players. Thus, the purpose of this study was to compare the effects of different combinations of ST and PT sequences on strength, jump, speed, and agility capacities of elite young soccer players. Twenty-seven soccer players (age: 18.9 ± 0.6 years) participated in an 8-week resistance training program and were divided into 3 groups: complex training (CP) (ST before PT), traditional training (TD) (PT before ST), and contrast training (CT) (ST and PT performed alternately, set by set). The experimental design took place during the competitive period of the season. The ST composed of half-squat exercises performed at 60-80% of 1 repetition maximum (1RM); the PT composed of drop jump exercises executed in a range from 30 to 45 cm. After the experimental period, the maximum dynamic strength (half-squat 1RM) and vertical jump ability (countermovement jump height) increased similarly and significantly in the CP, TD, and CT (48.6, 46.3, and 53% and 13, 14.2, and 14.7%, respectively). Importantly, whereas the TD group presented a significant decrease in sprinting speed in 10 (7%) and 20 m (6%), the other groups did not show this response. Furthermore, no significant alterations were observed in agility performance in any experimental group. In conclusion, in young soccer players, different combinations and sequences of ST and PT sets result in similar performance improvements in muscle strength and jump ability. However, it is suggested that the use of the CP and CT methods is more indicated to maintain/maximize the sprint performance of these athletes.

Half-squat or jump squat training under optimum power load conditions to counteract power and speed decrements in Brazilian elite soccer players during the preseason.

The purpose of this study was to test which specific type of exercise (i.e., jump squat (JS) or half-squat (HS)) is more effective at maintaining speed and power abilities throughout a preseason in soccer players. Twenty-three male soccer players were randomly allocated into two groups: JS and HS. The mean propulsive power, vertical jumping ability, and sprinting performance were evaluated before and after 4 weeks of a preseason period. The optimum power loads for the JS and HS exercises were assessed and were used as load-references. The soccer players performed 10 power oriented training sessions in total. Both JS and HS maintained power in JS and speed abilities (P > 0.05, for main effects and interaction effect) as indicated by ANCOVA. Both groups demonstrated reduced power during HS (ES = -0.76 vs. -0.78, for JS and HS, respectively); both groups improved acceleration (ACC) from 5 to 10 m (ES = 0.52). JS was more effective at reducing the ACC decrements over 0-5 m (ES = -0.38 vs. -0.58, for JS and HS, respectively). The HS group increased squat jump height (ES = 0.76 vs. 0.11, for HS and JS, respectively). In summary, JS is more effective in reducing the ACC capacity over very short sprints while HS is more effective in improving squat jump performance. Both strategies improve ACC over longer distances. New training strategies should be implemented/developed to avoid concurrent training effects between power and endurance adaptations during professional soccer preseasons.

Relationship between sprint ability and loaded/unloaded jump tests in elite sprinters.

The neuromechanical determinants of sprint running performance have been investigated in team sports athletes and non-elite sprinters. The aim of this study was to quantify the relationships between kinetic and performance parameters, obtained in loaded and unloaded vertical and horizontal jumps, and sprinting in elite athletes. Twenty-two sprinters performed squat jumps, countermovement jumps, horizontal jumps, and jump squats with different loads on a force platform, in addition to a 50-m sprint. Results indicated that jumping height and distance in vertical and horizontal jumps are more strongly correlated (R ≈ 0.81) to sprinting speed than the respective peak forces (R ≈ 0.36). Furthermore, the optimum load generating the maximum power in the jump squat is also highly correlated to sprint performance (R ≈ 0.72). These results reveal that vertical and horizontal jump tests may be used by coaches for assessing and monitoring qualities related to sprinting performance in elite sprinters.

Differences in muscle mechanical properties between elite power and endurance athletes: a comparative study.

The aim of this study was to compare muscle mechanical properties (using tensiomyography-TMG) and jumping performance of endurance and power athletes and to quantify the associations between TMG parameters and jumping performance indices. Forty-one high-level track and field athletes from power (n = 22; mean ± SD age, height, and weight were 27.2 ± 3.6 years; 180.2 ± 5.4 cm; and 79.4 ± 8.6 kg, respectively) and endurance (endurance runners and triathletes; n = 19; mean ± SD age, height, and weight were 27.1 ± 6.9 years; 169.6 ± 9.8 cm; 62.2 ± 13.1 kg, respectively) specialties had the mechanical properties of their rectus femoris (RF) and biceps femoris (BF) assessed by TMG. Muscle displacement (Dm), contraction time (Tc), and delay time (Td) were retained for analyses. Furthermore, they performed squat jumps (SJs), countermovement jumps (CMJs), and drop jumps to assess reactive strength index (RSI), using a contact platform. Comparisons between groups were performed using differences based on magnitudes, and associations were quantified by the Spearman's ρ correlation. Power athletes showed almost certain higher performance in all jumping performance indices when compared with endurance athletes (SJ = 44.9 ± 4.1 vs. 30.7 ± 6.8 cm; CMJ = 48.9 ± 4.5 vs. 33.6 ± 7.2 cm; RSI = 2.19 ± 0.58 vs. 0.84 ± 0.39, for power and endurance athletes, mean ± SD, respectively; 00/00/100, almost certain, p ≤ 0.05), along with better contractile indices reflected by lower Dm, Tc, and Td (Tc BF = 14.3 ± 2.3 vs. 19.4 ± 3.3 milliseconds; Dm BF = 1.67 ± 1.05 vs. 4.23 ± 1.75 mm; Td BF = 16.8 ± 1.6 vs. 19.6 ± 1.3 milliseconds; Tc RF = 18.3 ± 2.8 vs. 22.9 ± 4.0 milliseconds; Dm RF = 4.98 ± 3.71 vs. 8.88 ± 3.45 mm; Td RF = 17.5 ± 1.0 vs. 20.9 ± 1.6 milliseconds, for power and endurance athletes, mean ± SD, respectively; 00/00/100, almost certain, p ≤ 0.05). Moderate correlations (Spearman's ρ between -0.61 and -0.72) were found between TMG and jumping performance. The power group presented better performance in vertical jumps, supporting the validity of these tests to distinguish between endurance and power athletes. Furthermore, TMG can discriminate the "athlete-type" using noninvasive indices moderately correlated with explosive lower-body performance. In summary, both vertical jump and TMG assessments could be useful in identifying and selecting young athletes.

Training for Power and Speed: Effects of Increasing or Decreasing Jump Squat Velocity in Elite Young Soccer Players.

The aim of this study was to test the effects of 2 different velocity-oriented power training regimens by either increasing or decreasing the jump squat velocity during jump training sessions applied 3 times a week for 6 weeks in soccer players. Twenty-four elite under-20 soccer players were randomly assigned to an increased bar velocity group (IVG) or a reduced bar velocity group (RVG). Athletes had their countermovement jump heights, mean propulsive velocities (MPVs) in jump squat, leg press maximum dynamic strength (1 repetition maximum [RM]), 20-m sprint times, and zig-zag change of direction (COD) abilities assessed before and after the intervention. Performance in all tests improved after training in both groups. However, greater gains in 1RM and MPV using 50-90% of body mass (BM) were noted for the RVG. The IVG demonstrated greater improvements in speed at 5, 10, and 20 m and MPV with no additional external load and with 40% BM. Both groups improved similarly in countermovement jumps and COD. To conclude, both velocity-oriented power training regimens were effective in eliciting neuromechanical adaptations, leading to better strength/power/speed performances, and the choice as to the most suitable method should be tailored according to players' needs/deficiencies.

Predicting punching acceleration from selected strength and power variables in elite karate athletes: a multiple regression analysis.

This study investigated the relationship between punching acceleration and selected strength and power variables in 19 professional karate athletes from the Brazilian National Team (9 men and 10 women; age, 23 ± 3 years; height, 1.71 ± 0.09 m; and body mass [BM], 67.34 ± 13.44 kg). Punching acceleration was assessed under 4 different conditions in a randomized order: (a) fixed distance aiming to attain maximum speed (FS), (b) fixed distance aiming to attain maximum impact (FI), (c) self-selected distance aiming to attain maximum speed, and (d) self-selected distance aiming to attain maximum impact. The selected strength and power variables were as follows: maximal dynamic strength in bench press and squat-machine, squat and countermovement jump height, mean propulsive power in bench throw and jump squat, and mean propulsive velocity in jump squat with 40% of BM. Upper- and lower-body power and maximal dynamic strength variables were positively correlated to punch acceleration in all conditions. Multiple regression analysis also revealed predictive variables: relative mean propulsive power in squat jump (W·kg-1), and maximal dynamic strength 1 repetition maximum in both bench press and squat-machine exercises. An impact-oriented instruction and a self-selected distance to start the movement seem to be crucial to reach the highest acceleration during punching execution. This investigation, while demonstrating strong correlations between punching acceleration and strength-power variables, also provides important information for coaches, especially for designing better training strategies to improve punching speed.

Can Muscular Parameters Predict Symptoms of Anxiety and Depression?

Major depressive disorder and anxiety disorders are among the major public health issues. Therefore, identifying predictors of symptoms of depression and anxiety holds fundamental importance to avoid the aggravation of these conditions. Muscle strength and function (e.g., handgrip strength and timed-stands test) are widely recognized predictors of health outcomes; however, their association with symptoms of depression and anxiety is still not completely understood. This study investigated the associations between handgrip strength and timed-stands test scores with symptoms of depression and anxiety. In addition, we examined whether individuals exhibiting greater strength levels demonstrate reduced symptoms of anxiety and depression compared to those with lower levels of strength. This is a community-based, cross-sectional study. Participants were recruited through social media and underwent a semi-structured interview to record sociodemographic characteristics, comorbidities, use of tobacco and medication, and symptoms of anxiety (Beck's Anxiety Inventory [BAI]) and depression (Beck's Depressive Inventory [BDI]). Subsequently, anthropometric characteristics, handgrip strength, and functionality (i.e., timed-stands test) were assessed. In all, 216 individuals were evaluated. The adjusted regression model showed an inverse association between handgrip strength and anxiety (ß = -0.22; 95% CI [-0.38, -0.07]; R2 = 0.07, p = .005) and depression symptoms (ß = -0.25; 95% CI [-0.42, -0.07]; R2 = 0.05, p = .006). Similarly, timed-stands test scores were associated with anxiety (ß = -0.33; 95% CI [-0.54, -0.13]; R2 = 0.09, p = .002) and depression (ß = -0.32; 95% CI [-0.56, -0.09]; R2 = 0.06, p = .008). Furthermore, the low-strength group showed higher values on the BAI (9.5 vs. 5.9 arbitrary units; p = .0008) and BDI than the high-strength group (10.8 vs. 7.9 arbitrary units; p = .0214). When individuals were stratified by the timed-stands test, the low timed-stands group demonstrated higher values on the BAI (9.9 vs. 5.5 arbitrary units; p = .0030) and BDI than the high timed-stands group (11.2 vs. 7.5 arbitrary units; p < .0001). The results highlight muscular parameters as significant predictors associated with anxiety and depression symptoms.

Can plyometric training change the pacing behaviour during 10-km running?

The effects of plyometric training (PT) on middle- and long-distance running performances are well established. However, its influence on pacing behaviour is still unclear. The aim of this study was to evaluate the effects of PT on pacing behaviour. In addition, verify whether the adaptations induced by PT would change ratings of perceived exertion (RPE) and/or affective feelings during the race. Twenty-eight male runners were assigned to two groups: control (C) and PT. PT held two weekly PT sessions for eight weeks. Drop jump (DJ) performance, 10-km running performance, pacing behaviour, RPE and affective feelings, VO2peak, ventilatory thresholds (VT1 and VT2), peak treadmill speed (PTS), and running economy (RE) were measured. For group comparisons, a mixed model analysis for repeated measures, effect size (ES) and 90% confidence interval (90% CI) were calculated for all dependent variables. Significant differences pre-to-post was observed for PT group in DP (7.2%; p ≤ 0.01; ES = 0.56 (0.28-0.85)) and RE (4.5%; p ≤ 0.05; ES = -0.52 ((-0.73 to -0.31)) without changes in pacing behaviour. While PT was effective for improving DJ and RE, there is no evidence that pacing behaviour, RPE or affective feelings are directly affected by these adaptations during a 10-km time trial run.

Exercise training and DNA methylation profile in post-bariatric women: Results from an exploratory study.

Exercise training and bariatric surgery have been shown to independently modulate DNA methylation profile in clusters of genes related to metabolic and inflammatory pathways. This study aimed to investigate the effects of a 6-month exercise training program on DNA methylation profile in women who underwent bariatric surgery. In this exploratory, quasi-experimental study, we analyzed DNA methylation levels by array technology in eleven women who underwent Roux-en-Y Gastric Bypass and a 6-month, three-times-a-week, supervised exercise training program. Epigenome Wide Association Analysis showed 722 CpG sites with different methylation level equal to or greater than 5% (P < 0.01) after exercise training. Some of these CpGs sites were related to pathophysiological mechanisms of inflammation, specially Th17 cell differentiation (FDR value < 0.05 and P < 0.001). Our data showed epigenetic modification in specific CpG sites related to Th17 cell differentiation pathway in post-bariatric women following a 6-months exercise training program.

Sleep quality is a predictor of muscle mass, strength, quality of life, anxiety and depression in older adults with obesity.

We aimed to investigate associations between sleep quality with selected quantitative and qualitative parameters of health in older individuals with obesity. Cross-sectional assessment (n = 95 men/women; ≥ 65 years; BMI ≥ 30 kg/m2) of sleep quality, body composition, handgrip strength, quality-of-life, anxiety/depression. Mean PSQI score was 6.3. Poor sleepers (n = 49) presented lower appendicular lean mass (ALM) (16.2 vs 17.8 kg; p = 0.0273), ALM/BMI (0.47 vs 0.53 kg/BMI; p = 0.0085), fat mass (48.6 vs 46.6%; p = 0.0464), handgrip strength (19.7 vs 22.0 kgf; p = 0.0542) and handgrip/BMI (0.57 vs 0.66 kgf/BMI; p = 0.0242) than good sleepers. They also had higher anxiety (8.6 vs 5.6; p = 0.0100) and depression (4.8 vs 3.2; p = 0.0197) scores, worse health-related quality-of-life and lower scores in mental (62.8 vs 73.0; p = 0.0223) and physical (52.9 vs 67.3; p = 0.0015) domains. Adjusted models showed that PSQI was negatively associated with ALM (ß = - 0.13, 95% CI - 0.25; - 0.01) and health-related quality of life on physical (ß = - 2.76, 95% CI - 3.82; - 1.70) and mental (ß = - 2.25, 95% CI - 3.38; - 1.12) domains, and positively associated with anxiety (ß = 0.57; 95% CI 0.26; 0.87) and depression (ß = 0.31; 95% CI 0.13; 0.49). Poor sleep quality associates with impaired selected quantitative and qualitative parameters of health. Additionally, sleep quality was shown as an independent predictor of ALM, health-related quality-of-life, anxiety and depression in older individuals with obesity.

Acute Muscle Mass Loss Predicts Long-Term Fatigue, Myalgia, and Health Care Costs in COVID-19 Survivors.

OBJECTIVE: We examined the impact of loss of skeletal muscle mass in post-acute sequelae of SARS-CoV-2 infection, hospital readmission rate, self-perception of health, and health care costs in a cohort of COVID-19 survivors. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Tertiary Clinical Hospital. Eighty COVID-19 survivors age 59 ± 14 years were prospectively assessed. METHODS: Handgrip strength and vastus lateralis muscle cross-sectional area were evaluated at hospital admission, discharge, and 6 months after discharge. Post-acute sequelae of SARS-CoV-2 were evaluated 6 months after discharge (main outcome). Also, health care costs, hospital readmission rate, and self-perception of health were evaluated 2 and 6 months after hospital discharge. To examine whether the magnitude of muscle mass loss impacts the outcomes, we ranked patients according to relative vastus lateralis muscle cross-sectional area reduction during hospital stay into either "high muscle loss" (-18 ± 11%) or "low muscle loss" (-4 ± 2%) group, based on median values. RESULTS: High muscle loss group showed greater prevalence of fatigue (76% vs 46%, P = .0337) and myalgia (66% vs 36%, P = .0388), and lower muscle mass (-8% vs 3%, P < .0001) than low muscle loss group 6 months after discharge. No between-group difference was observed for hospital readmission and self-perceived health (P > .05). High muscle loss group demonstrated greater total COVID-19-related health care costs 2 ($77,283.87 vs. $3057.14, P = .0223, respectively) and 6 months ($90,001.35 vs $12, 913.27, P = .0210, respectively) after discharge vs low muscle loss group. Muscle mass loss was shown to be a predictor of total COVID-19-related health care costs at 2 (adjusted ß = $10, 070.81, P < .0001) and 6 months after discharge (adjusted ß = $9885.63, P < .0001). CONCLUSIONS AND IMPLICATIONS: COVID-19 survivors experiencing high muscle mass loss during hospital stay fail to fully recover muscle health. In addition, greater muscle loss was associated with a higher frequency of post-acute sequelae of SARS-CoV-2 and greater total COVID-19-related health care costs 2 and 6 months after discharge. Altogether, these data suggest that the loss of muscle mass resulting from COVID-19 hospitalization may incur in an economical burden to health care systems.

Physically Inactive Undergraduate Students Exhibit More Symptoms of Anxiety, Depression, and Poor Quality of Life than Physically Active Students.

BACKGROUND: The World Health Organization (WHO) recommends at least 150 min of moderate or vigorous activity (MVPA) per week for health benefits. However, meeting WHO guidelines for physical activity has been shown to be a great challenge for general populations and it may be even more difficult for undergraduate students due to elevated academic demand, thus negatively affecting general health status. Thus, this study investigated whether undergraduate students meeting WHO guidelines for physical activity show greater scores for symptoms of anxiety, depression, and poor quality of life than their counterparts not meeting guideline recommendations. Additionally, symptoms of anxiety, depression, and poor quality of life among academic areas were compared. METHODS: This is a cross-sectional study. The participants were recruited through messaging apps or institutional e-mail. The participants filled out an online consent form, questionnaires to assess demographic and academic characteristics, the International Physical Activity Questionnaire, the Beck depression and anxiety inventory, and the short-form 36-item health survey questionnaire. The participants were classified as physically active (MVPA > 150 min/week) or inactive (MVPA < 150 min/week) according to WHO Guidelines. RESULTS: A total of 371 individuals were included in the analysis. Physically inactive students demonstrated higher scores of depression (17.96 vs. 14.62; 95% CI: -5.81 to -0.86; p = 0.0083) than physically active ones. SF-36 analyses revealed that physically inactive students had lower values in mental (45.68 vs. 52.77; 95% CI: 2.10 to 12.06; p = 0.0054) and physical (59.37 vs. 67.14; 95% CI: 3.24 to 12.30; p = 0.0015) domains compared with physically active ones. As for SF-36 subscales, physically inactive students showed lower scores in function capacity (70.45 vs. 79.70; 95% CI: 4.27 to 14.49; p = 0.0003), mental health (45.57 vs. 55.60; 95% CI: 5.28 to 14.76; p < 0.0001), social aspects (48.91 vs. 57.69; 95%CI: 3.47 to 14.08; p = 0.0012), vitality (42.19 vs. 50.61; 95% CI: 3.47 to 13.35; p = 0.0009), pain (61.85 vs. 68.00; 95% CI: 1.27 to 11.02; p = 0.0135), and general health status (53.82 vs. 63.81; 95% CI: 5.21 to 14.75; p < 0.0001) than their physically active peers. CONCLUSIONS: The findings suggest that undergraduate students who do not meet WHO guidelines for physical activity display higher scores of anxiety, depression, and poor quality of life in comparison with their counterparts meeting physical activity guidelines. Collectively, these data suggest the need for academic institutions and policy makers to monitor and promote in-campus interventions to encourage physical activity.

Post-acute sequelae of SARS-CoV-2 associates with physical inactivity in a cohort of COVID-19 survivors.

The aim of this study was to determine whether Post-acute Sequelae of SARS-CoV-2 Infection (PASC) are associated with physical inactivity in COVID-19 survivors. This is a cohort study of COVID-19 survivors discharged from a tertiary hospital in Sao Paulo, Brazil. Patients admitted as inpatients due to laboratory-confirmed COVID-19 between March and August 2020 were consecutively invited for a follow-up in-person visit 6 to 11 months after hospitalization. Ten symptoms of PASC were assessed using standardized scales. Physical activity was assessed by questionnaire and participants were classified according to WHO Guidelines. 614 patients were analyzed (age: 56 ± 13 years; 53% male). Frequency of physical inactivity in patients exhibiting none, at least 1, 1-4, and 5 or more symptoms of PASC was 51%, 62%, 58%, and 71%, respectively. Adjusted models showed that patients with one or more persistent PASC symptoms have greater odds of being physically inactive than those without any persistent symptoms (OR: 1.57 [95% CI 1.04-2.39], P = 0.032). Dyspnea (OR: 2.22 [1.50-3.33], P < 0.001), fatigue (OR: 2.01 [1.40-2.90], P < 0.001), insomnia (OR: 1.69 [1.16-2.49], P = 0.007), post-traumatic stress (OR: 1.53 [1.05-2.23], P = 0.028), and severe muscle/joint pain (OR: 1.53 [95% CI 1.08-2.17], P = 0.011) were associated with greater odds of being physically inactive. This study suggests that PASC is associated with physical inactivity, which itself may be considered as a persistent symptom among COVID-19 survivors. This may help in the early identification of patients who could benefit from additional interventions tailored to combat inactivity (even after treatment of PASC), with potential beneficial impacts on overall morbidity/mortality and health systems worldwide.

Home-Based Exercise Training in the Recovery of Multisystem Inflammatory Syndrome in Children: A Case Series Study.

OBJECTIVE: To assess the potential therapeutic role of exercise on health-related quality of life, assessed by the Pediatric Outcomes Data Collection Instrument (PODCI), coronary flow reserve (CFR), cardiac function, cardiorespiratory fitness, and inflammatory and cardiac blood markers in multisystemic inflammatory syndrome in children (MIS-C) patients. METHODS: This is a case series study of a 12-wk, home-based exercise intervention in children and adolescents after MIS-C diagnosis. From 16 MIS-C patients followed at our clinic, 6 were included (age: 7-16 years; 3 females). Three of them withdrew before the intervention and served as controls. The primary outcome was health-related quality of life, assessed PODCI. Secondary outcomes were CFR assessed by 13N-ammonia PET-CT imaging, cardiac function by echocardiography, cardiorespiratory fitness, and inflammatory and cardiac blood markers. RESULTS: In general, patients showed poor health-related quality of life, which seemed to be improved with exercise. Additionally, exercised patients showed improvements in coronary flow reserve, cardiac function, and aerobic conditioning. Non-exercised patients exhibited a slower pattern of recovery, particularly in relation to health-related quality of life and aerobic conditioning. CONCLUSIONS: Our results suggest that exercise may play a therapeutic role in the treatment of post-discharge MIS-C patients. As our design does not allow inferring causality, randomized controlled trials are necessary to confirm these preliminary findings.