Demystifying roles of exercise in immune response regulation against acute respiratory infections: A narrative review.

The benefits of physical activity and exercise, especially those classified as moderate-to-vigorous activity (MVPA), have been well-established in preventing non-communicable diseases and mental health problems in healthy adults. However, the relationship between physical activity and exercise and the prevention and management of acute respiratory infection (ARI), a global high-burden disease, has been inconclusive. There have been debates and disagreements among scientific publications regarding the relationship between exercise and immune response against the causative agents of ARI. This narrative review aims to explore the theory that sufficiently explains the correlation between exercise, immune response, and ARI. The potential root causes of discrepancies come from research associated with the "open window" hypothesis. The studies have several limitations, and future improvements to address them are urgently needed in the study design, data collection, exercise intervention, subject recruitment, biomarkers for infection and inflammation, nutritional and metabolism status, and in addressing confounding variables. In conclusion, data support the clinical advantages of exercise have a regulatory contribution toward improving the immune response, which in turn potentially protects humans fromARI. However, the hypothesis related to its negative effect must be adopted cautiously.

The physiological effect of prone positioning and lateral decubitus in non-intubated patients with severe COVID-19: a prospective cohort study.

Introduction: Prone positioning is one type of postural lung recruitment manoeuvre that has been widely studied regarding the benefits and physiological changes of the cardiorespiratory system. However, prone positioning is not very comfortable for the patients because they have to lie on their stomachs for a while when the oxygen therapy and other monitoring devices are still attached. Based on patient observations, some patients will change to more comfortable positions, namely using the right/left lateral decubitus position. The purpose of this research was to examine the physiological impact of prone and lateral decubitus position in non-intubated patients who were diagnosed with severe COVID-19. Methods: It was a prospective cohort study in subsequent people with severe COVID-19 who obtained a non-rebreathing mask or high-flow nasal cannula at a University Hospital between 1 June and 10 September 2021. The study lasted for a total of 2021 days and involved 48 patients. The patients assumed the prone positioning or lateral decubitus every morning and afternoon for 4 h and were measured for cardiorespiratory parameters and blood gas analysis. It has been reported in line with the STROCSS criteria. Results: Dynamic changes based on cardiorespiratory parameters and blood gas analysis parameters in patients with prone and lateral decubitus position in patients with severe COVID-19 receiving conventional oxygen therapy (via non-rebreathing mask) or high-flow nasal cannula did not show any significant difference. Conclusion: The physiological effect of prone positioning and lateral decubitus in non-intubated patients with severe COVID-19 are similar. Accordingly, lateral decubitus can be an alternative for postural lung recruitment manoeuvres and warrants further randomized trials.

The mediation role of physical fitness in association between muscle-strengthening physical activities and its component with blood pressure among young adults: considering gender and abnormal blood pressure as moderators, moderate-vigorous physical activity, sleep behavior, sedentary behavior, mental wellbeing and BMI as covariates.

Background: Global burden of hypertension among young people continues to increase. There have been many studies examining the effect of aerobic and muscle-strengthening physical activity on blood pressure, many of them didn't consider interdependence between them. Conflicting results of health-related fitness, particularly handgrip strength, as intermediate outcomes of muscle-strengthening physical activity on blood pressure also emerged. This research will carry out a mediation-moderation analysis to find out the relationship between muscle strengthening physical activity and blood pressure among young adults by considering health-related fitness and 24-hour movement behavior. Methods: A cross-sectional study among 221 Indonesian young adults attending a physical activity intervention collected participant's muscle-strengthening physical activity, and 24 h movement behavior, including aerobic physical activity, sedentary and sleep behavior, and mental well-being using validated questionnaires. Mediation and moderation analyses were conducted using Process Macro model 10 on SPSS 25 to investigate the association of muscle-strengthening physical activity on blood pressure, with gender and blood pressure as moderator, mediators consist of handgrip strength, muscle mass percentage and cardiorespiratory fitness. A subgroup analysis was conducted based on participant's cardiorespiratory fitness level. Results: Volume of muscle-strengthening physical activities in a week have a direct association with systolic blood pressure among prehypertensive male with an effect of 0,00989359 (95% CI 0,0046488 to 0,00336478). Considering its volume as mediator, the frequency of muscle-strengthening physical activity contributed to a significant direct effect on diastolic blood pressure in both genders, but the duration of MSPA has a significant direct effect on systolic blood pressure in male subjects. There is no component of physical fitness that provides a significant mediating effect. After a subgroup analysis, the relationship between MSPA Volume and blood pressure is not significant for individuals with a high level of cardiorespiratory fitness. Conclusions: This study shows that increased participation in muscle strengthening physical activity, especially in subject with low cardiorespiratory fitness, could increase blood pressure in prehypertensive young adult male population without mediation by physical fitness. Further research is needed to investigate other mechanisms that influence this relationship.

Physical activity virtual intervention for improving mental health among university students during the COVID-19 pandemic: A Co-creation process and evaluation using the Behavior Change Wheel.

Background: During the COVID-19 pandemic, there were reductions in university students' physical activity, which further increased their mental distress, calling for technology-based physical activity interventions to address the challenges in delivering in-person interventions. This study aimed to develop a technology-based physical activity intervention and pilot test it. Methods: We developed a virtually-delivered team-based physical activity challenge using the Behavior Change Wheel and Co-creation Framework based on Self-determination Theory. A pilot study was conducted in the evaluation phase to measure the recruitment rate, dropout rate, change in physical activity, and mental distress while identifying problems and collecting participants' opinions regarding the challenge. Wilcoxon signed-rank tests were conducted to assess the change in physical activity and mental distress. Qualitative data were analyzed using thematic analysis. Results: A three-week physical activity challenge comprising five identified intervention functions was held with 480 participants. The recruitment rate was 84.8% resulting from 407 virtual challenge participants who were conveniently joined as research participants. The dropout rate for the pilot study was 10.96% resulting from the incompatibility problems with the application. Among sample participants who lacked physical activity, participation in this challenge improved their physical activity by 52.5 min of moderate-intensity physical activity per week and reduced their mental distress by three points of self-reporting questionnaire-20 score. Issues regarding the virtual application and the influence of participation in the challenge on basic psychological needs emerged. Participants' opinions identified lack of time as the main barrier to physical activity. Conclusion: A co-created physical activity intervention developed using the Behavioral Change Wheel Framework inspired high interest from university students and may increase their physical activity and improve their mental health. Several suggestions were discussed to address the identified problems and improve the internal and external validity of the evaluation phase. Trial registration: TCTR20220720004 (retrospectively registered on July 19, 2022).

A longitudinal controlled signage intervention to increase stair use at university buildings: Process and impact evaluation using RE-AIM framework.

Introduction: Stair climbing intervention could be suggested to address low occupational physical activity amongst university students and employees. Strong evidence showed the effectiveness of signage intervention in increasing stair use in public areas. However, evidence in worksite settings, including university settings, was inconclusive. This study aimed to evaluate the process and impact of a signage intervention to increase stair use at a university building using the RE-AIM framework. Method: We conducted a non-randomised controlled pretest-posttest study to examine the effect of signage intervention placed in university buildings in Yogyakarta (Indonesia) between September 2019 and March 2020. The process of designing the signage involved the employees in the intervention building. The main outcome was the change in the proportion of stair use to elevator use measured by manual observations of video recordings from closed-circuit television. A linear mixed model examined the intervention effect by controlling the total visitor count as a confounder. RE-AIM framework was used in the process and impact evaluation. Results: The change in the proportion of stair climbing from baseline to the 6th-month phase at the intervention building (+0.067 (95% CI = 0.014-0.120)) was significantly higher than that of the control building. However, the signs did not change the proportion of the stair descending at the intervention building. The signs were potentially viewed 15,077-18,868 times/week by visitors. Conclusion: Signage intervention using portable posters could easily be adopted, implemented, and maintained in similar settings. A co-produced low-cost signage intervention was found to have a good reach, effectiveness, adoption, implementation, and maintenance dimension.

Prevalence of Health-Risk Behaviors and Mental Well-Being of ASEAN University Students in COVID-19 Pandemic.

The prevalence of epidemiological health-risk behaviors and mental well-being in the COVID-19 pandemic, stratified by sociodemographic factors in Association of South East Asian Nations (ASEAN) university students, were examined in the research. Data were collected in March-June 2021 via an online survey from 15,366 university students from 17 universities in seven ASEAN countries. Analyzed data comprised results on physical activity, health-related behaviors, mental well-being, and sociodemographic information. A large proportion of university students consumed sugar-sweetened beverages (82.0%; 95%CI: 81.4, 82.6) and snacks/fast food daily (65.2%; 95%CI: 64.4, 66.0). About half (52.2%; 95%CI: 51.4, 53.0) consumed less than the recommended daily amounts of fruit/vegetable and had high salt intake (54%; 95%CI: 53.3, 54.8). Physical inactivity was estimated at 39.7% (95%CI: 38.9, 40.5). A minority (16.7%; 95%CI: 16.1, 17.3) had low mental well-being, smoked (8.9%; 95%CI: 8.4, 9.3), and drank alcohol (13.4%; 95%CI: 12.8, 13.9). Country and body mass index had a significant correlation with many health-risk behaviors and mental well-being. The research provided important baseline data for guidance and for the monitoring of health outcomes among ASEAN university students and concludes that healthy diet, physical activity, and mental well-being should be key priority health areas for promotion among university students.

The Effect of Yoga on Health-Related Fitness among Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

BACKGROUND: There is a need for a type of physical activity that could address the challenging cycle of physical inactivity, impaired health-related fitness, and type 2 diabetes mellitus (T2DM) conditions. Yoga could be one type of exercise to overcome the barriers to adhere to regular physical activity. The current study aimed to systematically review the effect of yoga on health-related fitness, including cardiorespiratory fitness, muscle strength, body composition, balance, and flexibility, among patients with T2DM. METHODS: We systematically searched four databases and two registries (Pubmed, Scopus, Cochrane, Embase, WHO-ITCRP, and Clinicaltrials.gov) in September 2021, following a registered protocol on PROSPERO (CRD42022276225). Study inclusion criteria were T2DM patients with or without complication, yoga intervention as a single component or as a complement compared to other kinds of exercise or an inactive control, health-related fitness, and a randomized, controlled trial or quasi-experimental with control group design. The ROBINS-I tool and ROB 2.0 tool were used to assess the risk of bias in the included studies. A vote-counting analysis and meta-analysis computed using random effects' models were conducted. RESULTS: A total of 10 records from 3 quasi-experimental and 7 randomized, controlled trials with 815 participants in total were included. The meta-analysis favored yoga groups compared to inactive controls in improving muscle strength by 3.42 (95% confidence interval 2.42 to 4.43), repetitions of chair stand test, and improving cardiorespiratory fitness by 6.6% (95% confidence interval 0.4 to 12.8) improvement of baseline forced vital capacity. The quality of evidence for both outcomes was low. CONCLUSION: Low-quality evidence favored yoga in improving health-related fitness, particularly muscle strength and cardiorespiratory fitness, among patients with T2DM. FUNDING: All authors in this systematic review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Reaction Times among Batik Workers: The Influence of Gender and Occupational Lead Exposure.

(1) Background: Neglected occupational health and safety aspects in batik industries cause their workers to have an increased risk of lead exposure. The effect of occupational lead exposure on neurocognitive performance is inconclusive. Therefore, we conducted an observational study to examine the difference in simple reaction time between lead-exposed batik workers and non-exposed referents. (2) Methods: This cross-sectional study was conducted in seven batik enterprises in Lendah District, Indonesia, excluding workers with medical conditions impairing reaction time. Simple reaction time tests were conducted using an online tool. Two-way model ANCOVAs examined interactions between gender and job types on the mean differences in reaction time. (3) Results: After controlling for age and body mass index, we observed longer reaction times among lead-exposed batik workers than non-exposed referents with an adjusted mean difference of 0.19 (95% CI: 0.016-0.368) seconds. A more prominent detrimental effect of lead exposure on reaction time among female workers than among male workers was observed. (4) Conclusions: Our results suggest that occupational lead exposure could contribute to longer reaction time, notably among female workers. Thus, occupational health and safety precautions are vital to protect batik workers and preserve their important contributions to cultural heritage.

Possible silent hypoxemia in a COVID-19 patient: A case report.

INTRODUCTION: It has been hypothesized that silent hypoxemia is the cause of rapid progressive respiratory failure with severe hypoxia that occurs in some COVID-19 patients without warning. PRESENTATION OF CASE: A 60-year-old male presented cough without any breathing difficulty. Vital signs showed blood pressure 130/75 mmHg, pulse 84x/minute, respiratory rate (RR) 21x/minute, body temperature 36.5C, and oxygen saturation (SpO2) 75% on room air. RT-PCR for COVID-19 were positive. On third day, he complained of worsening of breath shortness, but his RR was still normal (22x/minute) with SpO2 of 98% on 3 L/minute oxygen via nasal cannula. On fifth day, he experienced severe shortness of breath with RR 38x/minute. He was then intubated using a synchronized intermittent mandatory ventilation. Blood gas analysis showed pH 7.54, PaO2 58.9 mmHg, PaCO2 31.1 mmHg, HCO3 26.9mEq/L, SaO2 94.7%, FiO2 30%, and P/F ratio 196 mmHg. On eighth day, his condition deteriorated with blood pressure 80/40 mmHg with norepinephrine support, pulse 109x/minute, and SpO2 72% with ventilator. He experienced cardiac arrest and underwent basic life support, then resumed strained breathing with return of spontaneous circulation. Blood gas analysis showed pH 7.07, PaO2 58.1 mmHg, PaCO2 108.9 mmHg, HCO3 32.1mEq/L, SaO2 78.7%, FiO2 90%, and P/F ratio 65 mmHg. Three hours later, he suffered cardiac arrest again and eventually died. DISCUSSION: Possible mechanisms of silent hypoxemia are V/Q mismatch, intrapulmonary shunting, and intravascular microthrombi. CONCLUSIONS: Silent hypoxemia might be considered as an early sign of deterioration of COVID-19 patients, thus, physician may be able to intervene early and decrease its morbidity and mortality.

Moderate intensity intermittent exercise upregulates neurotrophic and neuroprotective genes expression and inhibits Purkinje cell loss in the cerebellum of ovariectomized rats.

Decreases in estrogen levels due to menopause or ovariectomy may disrupt cerebellar motor functions. This study aimed at investigating the effects of Moderate Intensity Intermittent Exercise (MIEx) on the cerebellum of ovariectomized rats by analyzing neurotrophic and neuroprotective markers, as well as cerebellar motor functions. Thirty-two female Sprague Dawley rats were divided into four groups, i.e. Sham and ovariectomy (Ovx) of non-MIEx (NMIEx) groups, and Sham and Ovx with MIEx groups. MIEx was performed 5 days a week on treadmill for 6 weeks. Motor functions were assessed using rotarod, footprint, open field, and wire hanging tests. Real-time polymerase chain reaction was performed to determine messenger RNA (mRNA) expressions of Pgc-1α, BDNF, synaptophysin, Bcl-2, and Bax. Unbiased stereology was used to estimate the total number of cerebellar Purkinje cells. The Ovx MIEx group had higher Pgc-1α and Bcl-2 mRNA expressions, and number of Purkinje cells, but lower Bax mRNA expression than the Ovx NMIEx group. All motor functions of MIEx groups were better than the Sham and Ovx groups without MIEx. Motor functions on rotarod task, OFT, and FPT correlated significantly with the mRNAs expression of Bcl-2, Bax, BDNF, synaptophysin, Pgc-1α, and the number of cerebellar Purkinje cells in ovariectomized rats. MIEx improves cerebellar neurotrophic and neuroprotective markers, as well as motor functions of ovariectomized rats.

The Effects of Light and Moderate Intensity Exercise on the Femoral Bone and Cerebellum of d-Galactose-Exposed Rats.

Aging causes the degeneration of organs of the locomotor system, including the cerebellum and bones. Exercise may reverse this deterioration. d-galactose has been frequently used in rodents to accelerate aging. The present study aimed at investigating the effects of exercise on cerebellar and serum growth factors, motor activity, and the number of bone cells of the femoral head of d-galactose-treated rats. Twenty-four male Wistar rats were divided randomly into four groups, that is, three treated groups injected with 300 mg/(mL·kg) body weight (bw) d-galactose solution daily for 4 weeks, and a control group injected with normal saline. Following the 4-week administration of d-galactose solution, two of the treated groups performed light- (45% VO2max) and moderate- (55% VO2max) intensity exercise, by running on a treadmill 4 × a week for 4 weeks. Locomotor activity was examined in rotarod and open field tests. The cerebellar and serum Insulin-like Growth Factor 1 (IGF-1) and Brain-Derived Neurotrophic Factor (BDNF) levels were measured using enzyme-linked immunosorbent assay (ELISA). The number of osteoblasts and osteoclasts of femoral head was estimated using unbiased stereological methods. It was found that the number of osteoclasts was higher in the d-galactose-treated group than the normal control and moderate-intensity exercise groups. No significant difference between groups was found in the rotarod and open field test performance, IGF-1 and BDNF levels, as well as number of osteoblasts. In conclusion, a 4-week administration of high-dosed-galactose caused the increase of the number of osteoclasts. A subsequent 4-week moderate-intensity exercise reversed this increase to the normal level.