Factors Associated with Fatigue in COVID-19 ICU Survivors.

PURPOSE: Approximately 30% of people infected with COVID-19 require hospitalization and 20% of them are admitted to an intensive care unit (ICU). Most of these patients experience symptoms of fatigue weeks post-ICU, so understanding the factors associated with fatigue in this population is crucial. METHODS: Fifty-nine patients [38-78 yr] hospitalized in ICU for COVID-19 infection for 32 [6-80] days including 23 [3-57] days of mechanical ventilation, visited the laboratory on two separate occasions. The first visit occurred 52 ± 15 days after discharge and was dedicated to questionnaires, blood sampling and cardiopulmonary exercise testing, while measurements of the knee extensors neuromuscular function and performance fatigability were performed in the second visit 7 ± 2 days later. RESULTS: Using the FACIT-F questionnaire, 56% of patients were classified as fatigued. Fatigued patients had worse lung function score than non- fatigued (i.e. 2.9 ± 0.8 L vs 3.6 ± 0.8 L; 2.4 ± 0.7 l vs 3.0 ± 0.7 L for forced vital capacity and forced expiratory volume in one second, respectively) and forced vital capacity was identified as a predictor of being fatigued. Maximal voluntary activation was lower in fatigued patients than non-fatigued patients (82 ± 14% vs 91 ± 3%) and was the only neuromuscular variable that discriminated between fatigued and non-fatigued patients. Patient-reported outcomes also showed differences between fatigued and non-fatigued patients for sleep, physical activity, depression and quality of life (p < 0.05). CONCLUSIONS: COVID-19 survivors showed altered respiratory function 4 to 8 weeks after discharge, that was further deteriorated in fatigued patients. Fatigue was also associated with lower voluntary activation and patient-reported impairments (i.e. sleep satisfaction, quality of life or depressive state). The present study reinforces the importance of exercise intervention and rehabilitation to counteract cardiorespiratory and neuromuscular impairments of COVID-19 patients admitted in ICU, especially individuals experiencing fatigue.

Athletes who have already experienced an injury are more prone to adhere to an injury risk reduction approach than those who do not: an online survey of 7870 French athletics (track and field) athletes.

Objective: To compare the perception towards injury risk reduction approach between athletes who have already experienced an injury and those who have not. Methods: We conducted a cross-sectional study using a one-time online survey asking athletics athletes licensed at the French Federation of Athletics (http://www.athle.fr) about their perceptions regarding injuries and injury risk reduction behaviours. We statistically compared athletes who already experienced an injury and those who did not. Results: A total of 7870 athletes were included. 90% of athletes declared having experienced at least one injury. They (1) were proportionally more men than women, (2) had significantly more years of experience in athletics, (3) had a significant difference in disciplines (more hurdles, jumps and combined events and fewer sprint athletes), (4) had a significant difference in competition levels (more national and less departmental levels) and (5) reported significantly higher values or agreements in favour of injury risk reduction approach, compared with uninjured athletes. There were significantly more athletes declaring following injury risk reduction programmes among athletes who experienced at least one injury than those who did not. Conclusions: Athletes who experienced at least one injury during their lifetime were more prone to adhere to injury risk reduction strategies than athletes who have never experienced an injury. Their entourage (coaches and health professionals) should use this fertile ground to implement injury risk reduction strategies. In addition, their experience should be disseminated to uninjured athletes to help them adhere to injury risk reduction without injury experience.

Cardiorespiratory Fitness and Neuromuscular Function of Mechanically Ventilated ICU COVID-19 Patients.

OBJECTIVES: The aim of the current study was to investigate the level of cardiorespiratory fitness and neuromuscular function of ICU survivors after COVID-19 and to examine whether these outcomes are related to ICU stay/mechanical ventilation duration. DESIGN: Prospective nonrandomized study. SETTING: Patients hospitalized in ICU for COVID-19 infection. PATIENTS: Sixty patients hospitalized in ICU (mean duration: 31.9 ± 18.2 d) were recruited 4-8 weeks post discharge from ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients visited the laboratory on two separate occasions. The first visit was dedicated to quality of life questionnaire, cardiopulmonary exercise testing, whereas measurements of the knee extensors neuromuscular function were performed in the second visit. Maximal oxygen uptake (V o2 max) was 18.3 ± 4.5 mL·min -1 ·kg -1 , representing 49% ± 12% of predicted value, and was significantly correlated with ICU stay/mechanical ventilation (MV) duration ( R = -0.337 to -0.446; p < 0.01 to 0.001), as were maximal voluntary contraction and electrically evoked peak twitch. V o2 max (either predicted or in mL· min -1 ·kg -1 ) was also significantly correlated with key indices of pulmonary function such as predicted forced vital capacity or predicted forced expiratory volume in 1 second ( R = 0.430-0.465; p ≤ 0.001) and neuromuscular function. Both cardiorespiratory fitness and neuromuscular function were correlated with self-reported physical functioning and general health status. CONCLUSIONS: V o2 max was on average only slightly above the 18 mL·min -1 ·kg -1 , that is, the cut-off value known to induce difficulty in performing daily tasks. Overall, although low physical capacities at admission in ICU COVID-19 patients cannot be ruled out to explain the association between V o2 max or neuromuscular function and ICU stay/MV duration, altered cardiorespiratory fitness and neuromuscular function observed in the present study may not be specific to COVID-19 disease but seem applicable to all ICU/MV patients of similar duration.

Determinants of the adoption of injury risk reduction programmes in athletics (track and field): an online survey of 7715 French athletes.

OBJECTIVES: To identify individual characteristics associated with the adoption of injury risk reduction programmes (IRRP) and to investigate the variations in sociocognitive determinants (ie, attitudes, subjective norms, perceived behavioural control and intentions) of IRRP adoption in athletics (track and field) athletes. METHODS: We conducted a cross-sectional study using an online survey sent to athletes licensed with the French Federation of Athletics to investigate their habits and sociocognitive determinants of IRRP adoption. Sociodemographic characteristics, sports practice and history of previous injuries were also recorded. Logistic regression analyses and group comparisons were performed. RESULTS: The final sample was composed of 7715 athletes. From the multivariable analysis, competing at the highest level was positively associated with IRRP adoption (adjusted OR (AOR)=1.66; 99.9% CI 1.39 to 1.99 and AOR=1.48; 99.9% CI 1.22 to 1.80) and presenting a low number of past injuries was negatively associated with IRRP adoption (AOR=0.48; 99.9% CI 0.35 to 0.65 and AOR=0.61; 99.9% CI 0.44 to 0.84), both during their lifetime and the current season, respectively. These results were supported by higher scores of sociocognitive determinants among athletes who reported IRRP adoption compared with other athletes. CONCLUSION: Some characteristics of athletes seem to be associated with IRRP adoption either positively (competing at the highest level) or negatively (presenting a lower number of past injuries), whereas all the sociocognitive determinants tested appear to be linked to IRRP adoption. Since many athlete characteristics are difficult or impossible to change, IRRP promotion may be enhanced by targeting athletes' beliefs and intentions to adopt an IRRP.

French Translation and Validation of the Rating-of-Fatigue Scale.

BACKGROUND: The Rating of Fatigue (ROF) scale can measure changes in perceived fatigue in a variety of contexts. OBJECTIVE: The aim of the present study was to translate and subsequently validate the ROF scale in the French language. METHODS: The study was composed of three phases. Phase 1 involved a comprehensive translation, back-translation, and consolidation process in order to produce the French ROF scale. During phase 2, the face validity of the French ROF scale was assessed. A cohort of 60 native French speaking participants responded to a range of Likert scale items which probed the purposes of the ROF scale and what it is intended to measure. During phase 3, the convergent and divergent validity of the ROF scale was assessed during ramped cycling to exhaustion and 10 min of resting recovery. RESULTS: The results from phase 1 demonstrated comparability and interpretability between the original and back-translated ROF scale. In phase 2, participants reported a high face validity, with a score of 3.48 ± 0.70 out of 4 when given the item probing whether the scale "measures fatigue". This score further improved (3.67 ± 0.57, P = 0.01) after participants read the accompanying instructions. Participants were able to distinguish the purposes of the scale for measuring fatigue rather than exertion. In phase 3, strong correlations were found between ROF and heart rate (HR) both during exercise (r = 0.91, P < 0.01) and recovery (r = 0.92, P < 0.01), while discriminant validity between ROF and rating of perceived exertion (RPE) was found during recovery. CONCLUSION: The present study permits the applications of the ROF scale in the French language.

Illnesses during 11 international athletics championships between 2009 and 2017: incidence, characteristics and sex-specific and discipline-specific differences.

BACKGROUND: Illnesses impair athletes' participation and performance. The epidemiology of illness in athletics is limited. OBJECTIVE: To describe the occurrence and characteristics of illnesses during international athletics championships (indoor and outdoor), and to analyse differences with regards to athletes' sex and participation in explosive and endurance disciplines. METHODS: During 11 international championships held between 2009 and 2017, physicians from both national medical teams and the local organising committees reported daily on all athlete illnesses using a standardised report form. Illness frequencies, incidence proportions (IPs) and rates (IRs), and relative risks (RR) with 95% CIs were calculated. RESULTS: During the 59 days of the 11 athletics championships, 546 illnesses were recorded in the 12 594 registered athletes equivalent to IP of 43.4 illnesses per 1000 registered athletes (95% CI 39.8 to 46.9) or IR of 1.2 per 1000 registered athlete days (95% CI 1.1 to 1.2). The most frequently reported illnesses were upper respiratory tract infections (18.7%), exercise-induced fatigue/hypotension/collapse (15.4%) and gastroenteritis (13.2%). No myocardial infarction was recorded. A total of 28.8% of illnesses were expected to lead to time loss from sport. The illness IP was similar in male and female athletes, with few differences in illness characteristics. During outdoor championships, the illness IP was higher in endurance than explosive disciplines (RR=1.87; 95% CI 1.58 to 2.23), with a considerably higher IP of exercise-induced illness in endurance disciplines, but a similar upper respiratory tract infection IP in both discipline groups. CONCLUSIONS: Illness prevention strategies during international athletics championships should be focused on the most frequent diagnoses in each discipline group.

[Re-entrainment to physical activity in the global management of breast cancer: pilot study in a mono-institutional experience]. / Réentraînement à l'activité physique dans la prise en charge globale du cancer du sein: étude pilote monocentrique.

The objective of the present study is to report the pilot experience at the "Loire cardiorespiratory readaptation center" of re-entrainment of physical activity for patients suffering from breast cancer. Between January 2012 and February 2013, 63 patients took the program at the readaptation center. The program is composed of three sessions a week during seven weeks. During the care, a medical team intervenes. It is composed of a cardiologist, a physiotherapist, a sophrologist, a psychologist and a dietician who take part in turns and/or together. During the first session of the program, the warm-up power chosen on the exercise bike was on average of 14.72 watts (min = 5; max = 30), and it went up to 44.84 watts (min = 15; max = 85) on average during the last session. The maximal power used by the patient was on average of 39.08 watts (min = 10; max = 70) during the first session. On the last day of training, the average maximal power between the patients was of 76.03 watts (min = 30; max = 110). The tests used into practice tend to confirm a physical progression between the beginning and the end of the re-training program. This study particularly shows that it is possible today to propose this type of program to the patients in daily practice.