Cardiorespiratory abnormalities in ICU survivors of COVID-19 with postacute sequelae of SARS-CoV-2 infection are unrelated to invasive mechanical ventilation.

Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) often leads to exertional intolerance and reduced exercise capacity, particularly in individuals previously admitted to an intensive care unit (ICU). However, the impact of invasive mechanical ventilation (IMV) on PASC-associated cardiorespiratory abnormalities during exercise remains poorly understood. This single-center, cross-sectional study aimed to gather knowledge on this topic. Fifty-two patients with PASC recruited ∼6 mo after ICU discharge were clustered based on their need for IMV (PASC + IMV, n = 27) or noninvasive support therapy (PASC + NIS, n = 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL, n = 19) comprising individuals of both sexes with similar age, comorbidities, and physical activity levels but without a history of COVID-19 illness. Individuals with PASC, irrespective of support therapy, presented with higher rates of cardiorespiratory abnormalities than CONTROL, especially dysfunctional breathing patterns, dynamic hyperinflation, reduced oxygen uptake and oxygen pulse, and blunted heart rate recovery (all P < 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (P = 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all P > 0.05). These findings indicate significant involvement of both central and peripheral factors, leading to exertional intolerance in individuals with PASC previously admitted to the ICU, regardless of their need for IMV.NEW & NOTEWORTHY We found cardiorespiratory abnormalities in ICU survivors of severe-to-critical COVID-19 with PASC to be independent of IMV need. Overall, both group of patients experienced dysfunctional breathing patterns, dynamic hyperinflation, lower oxygen uptake and oxygen pulse, and blunted heart rate responses to CPX. PASC seems to impact exertional tolerance and exercise capacity due to ventilatory inefficiency, impaired aerobic metabolism, and potential systolic and autonomic dysfunction, all of these irrespective of support therapy during ICU stay.

Association between ultra-processed food and flavonoid intakes in a nationally representative sample of the US population.

Consumption of ultra-processed food (UPF) has been associated with several chronic diseases and poor diet quality. It is reasonable to speculate that the consumption of UPF negatively associates with flavonoid dietary intake; however, this assumption has not been previously examined. The present study aims to assess association between the dietary contribution of UPF and flavonoid intake in the US population aged 0 years and above. We performed a cross-sectional analysis of dietary data collected by 24-h recalls from 7640 participants participating in the National Health and Nutrition Examination Survey 2017-2018. Foods were classified according to the Nova classification system. The updated US Department of Agriculture (USDA) Database for the Flavonoid Content of Selected Foods (Release 3.3) database was used to estimate total and six classes of flavonoid intakes. Flavonoid intakes were compared across quintiles of dietary contribution of UPF (% of total energy intake) using linear regression models. The total and five out of six class flavonoid intakes decreased between 50 and 70 % across extreme quintiles of the dietary contribution of UPF (Pfor linear trend < 0·001); only isoflavones increased by over 260 %. Our findings suggest that consumption of UPF is associated with lower total and five of six class flavonoid intakes and with higher isoflavone intakes, supporting previous evidence of the negative impact of UPF consumption on the overall quality of the diet and health outcomes.

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.

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.

Lower-Body Resistance Training Reduces Interleukin-1ß and Transforming Growth Factor-ß1 Levels and Fatigue and Increases Physical Performance in Breast Cancer Survivors.

ABSTRACT: Martins, FM, Santagnello, SB, de Oliveira Junior, GN, de Sousa, JdFR, Michelin, MA, Nomelini, RS, Murta, EFC, and Orsatti, FL. Lower-body resistance training reduces interleukin-1ß and transforming growth factor-ß1 levels and fatigue and increases physical performance in breast cancer survivors. J Strength Cond Res 37(2): 439-451, 2023-This article ascertains whether resistance training (RT) improves inflammatory markers, fatigue (sensations and fatigability), and physical performance in breast cancer survivors (BCS) and investigates whether the changes in the inflammatory markers, fatigue, and physical performance are associated with each other. Volunteers were randomly divided into 2 groups: control group (n = 11) and RT group (n = 11). Resistance training (3 sets of 8-12 repetitions with 80% 1 repetition maximum (1RM) on 4 exercises-leg extension, leg curl, 45° leg press, and calf raise) was performed 3 times a week for 12 weeks. Self-reported fatigue (SRF), fatigability (critical torque [CT] and W prime [W']), muscle strength, and circulating inflammatory markers were assessed using the Brief Fatigue Inventory, iDXA, 1RM test, protocol of 60 maximal voluntary isometric contractions, and enzyme-linked immunosorbent assay, respectively. Resistance training reduced interleukin (IL)-1ß, transforming growth factor (TGF)-ß1, and SRF score and increased muscle strength, 6-minute walk test (6MWT), CT, and W'. In the RT group, the changes in SRF were positively associated with the changes in IL-1ß. The changes in muscle strength were associated with the changes in CT and W', and the changes in the 6MWT were associated with the changes in CT, W', muscle strength, and SRF. Resistance training improved fatigue and physical performance and reduced IL-1ß, and TGF-ß1 in BCS. Although improvement in fatigability seems to be dependent on the increase in muscle strength, improvement in the sensation of fatigue seems to be dependent on the reduction in IL-1ß after RT. Increase in physical performance seems to be dependent on improvement in muscle strength and fatigue.

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.

Oxygen uptake kinetics and chronotropic responses to exercise are impaired in survivors of severe COVID-19.

The post-acute phase of coronavirus disease 2019 (COVID-19) is often marked by several persistent symptoms and exertional intolerance, which compromise survivors' exercise capacity. This was a cross-sectional study aiming to investigate the impact of COVID-19 on oxygen uptake (V̇o2) kinetics and cardiopulmonary function in survivors of severe COVID-19 about 3-6 mo after intensive care unit (ICU) hospitalization. Thirty-five COVID-19 survivors previously admitted to ICU (5 ± 1 mo after hospital discharge) and 18 controls matched for sex, age, comorbidities, and physical activity level with no prior history of SARS-CoV-2 infection were recruited. Subjects were submitted to a maximum-graded cardiopulmonary exercise test (CPX) with an initial 3-min period of a constant, moderate-intensity walk (i.e., below ventilatory threshold, VT). V̇o2 kinetics was remarkably impaired in COVID-19 survivors as evidenced at the on-transient by an 85% (P = 0.008) and 28% (P = 0.001) greater oxygen deficit and mean response time (MRT), respectively. Furthermore, COVID-19 survivors showed an 11% longer (P = 0.046) half-time of recovery of V̇o2 (T1/2V̇o2) at the off-transient. CPX also revealed cardiopulmonary impairments following COVID-19. Peak oxygen uptake (V̇o2peak), percent-predicted V̇o2peak, and V̇o2 at the ventilatory threshold (V̇o2VT) were reduced by 17%, 17%, and 12% in COVID-19 survivors, respectively (all P < 0.05). None of the ventilatory parameters differed between groups (all P > 0.05). In addition, COVID-19 survivors also presented with blunted chronotropic responses (i.e., chronotropic index, maximum heart rate, and heart rate recovery; all P < 0.05). These findings suggest that COVID-19 negatively affects central (chronotropic) and peripheral (metabolic) factors that impair the rate at which V̇o2 is adjusted to changes in energy demands.NEW & NOTEWORTHY Our findings provide novel data regarding the impact of COVID-19 on submaximal and maximal cardiopulmonary responses to exercise. We showed that V̇o2 kinetics is significantly impaired at both the onset (on-transient) and the recovery phase (off-transient) of exercise in these patients. Furthermore, our results suggest that survivors of severe COVID-19 may have a higher metabolic demand at a walking pace. These findings may partly explain the exertional intolerance frequently observed following COVID-19.

Effect of an exercise bout before the booster dose of an inactivated SARS-CoV-2 vaccine on immunogenicity in immunocompromised patients.

This randomized controlled study aimed to investigate whether a single bout of exercise before the homologous booster dose of a SARS-CoV-2 inactivated vaccine could enhance immunogenicity in patients with spondyloarthritis. We selected 60 consecutive patients with spondyloarthritis (SpA). Patients assigned to the intervention group performed an exercise bout comprising three exercises. Then, they remained at rest for 1 h before vaccination. The control group remained at rest before vaccination. Immunogenicity was assessed before (Pre) and 1 mo after (Post) the booster using seropositivity rates of total anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG (GMT), frequency of neutralizing antibodies (NAb) positivity, and NAb activity. At Pre, 16 patients from the exercise group and 16 patients from the control group exhibited seropositivity for IgG (59% vs. 57.1%), and 1 mo after the booster dose, seropositivity occurred in 96% versus 100% of the cases. Only 10 patients from the exercise group and 12 patients from the control group showed positive NAb serology at Pre (37% vs. 42.8%). One month following the booster, NAb positivity was 96% versus 93%. GMT was comparable between groups at Pre. At Post, GMT increased similarly in both groups. Likewise, NAb activity was similar between groups at Pre and increased similarly in both of them as a result of the booster (47.5% vs. 39.9%). In conclusion, a single bout of exercise did not enhance immunogenicity to a homologous booster dose of an inactivated SARS-CoV-2 vaccine among patients with spondyloarthritis.NEW & NOTEWORTHY We tested the role of exercise as an adjuvant to a booster of a COVID-19 vaccine. Immunocompromised patients were immunized after an acute bout of exercise or not. Patients exhibited an excellent immunogenicity in response to the booster dose. Exercise did not add to the vaccine effects on IgG or neutralizing antibodies.

Effects of Resistance Training at Different Loads on Inflammatory Biomarkers, Muscle Mass, Muscular Strength, and Physical Performance in Postmenopausal Women.

ABSTRACT: Carneiro, MAS, de Oliveira Júnior, GN, de Sousa, JFR, Murta, EFC, Orsatti, CL, Michelin, MA, Cyrino, ES, and Orsatti, FL. Effects of resistance training at different loads on inflammatory biomarkers, muscle mass, muscular strength, and physical performance in postmenopausal women. J Strength Cond Res 36(6): 1582-1590, 2022-It has been suggested that the effect of resistance training (RT) on circulating proinflammatory biomarkers may be dependent on muscle mass gain. A few recent studies have suggested that lower-load RT (LLRT; loads <50% of 1 repetition maximum [1RM] and repetition performed until, or close to, voluntary concentric failure) may be superior to higher-load RT (HLRT; loads >70% of 1RM) in increasing muscle mass. Hence, this study aimed to test whether LLRT is superior to HLRT for increasing muscle mass (total fat-free mass [TFFM] and leg fat-free mass [LFFM]) and improving circulating inflammatory biomarkers (interleukin [IL]-6, IL1-ra, tumor necrosis factor [TNF]-α, and extracellular heat shock protein [eHSP]70) in postmenopausal women (PW) (primary outcome). The secondary outcome was to compare the changes in muscular strength and physical performance (4-meter walking test [4-M], timed-up-and-go [TUG] test, and sit-to-stand [STS] test) between the LLRT and HLRT. The PW were randomized into 2 groups: LLRT (n = 14; loads necessary to perform 30-35 repetitions) and HLRT (n = 15; loads necessary to perform 8-12 repetitions). The greater magnitude of increase in LFFM (p = 0.033) was observed in LLRT when compared with HLRT. Moreover, there was a trend for a greater increase in TFFM in LLRT over HLRT (p = 0.070). However, there were similar improvements in TNF-α and muscular strength (p < 0.001). Furthermore, there was no significant difference between the RT schemes on IL-6, IL-1ra, and eHSP70 levels. Thus, although performing LLRT until, or close to, voluntary concentric failure seems to provide a greater stimulus for an increase in muscle mass than HLRT, it does not seem to affect the responses in circulating inflammatory biomarkers, muscular strength, and physical performance in PW.

Resistance Training Volume Enhances Muscle Hypertrophy, but Not Strength in Postmenopausal Women: A Randomized Controlled Trial.

ABSTRACT: Nascimento de Oliveira Júnior, G, de Freitas Rodrigues de Sousa, J, Augusto da Silva Carneiro, M, Martins, FM, Santagnello, SB, Campos Souza, MV, and Orsatti, FL. Resistance training volume enhances muscle hypertrophy, but not strength in postmenopausal women: a randomized controlled trial. J Strength Cond Res 36(5): 1216-1221, 2022-Among several possible resistance training (RT) variables to be manipulated, the training volume has been considered as a critical variable to maximize RT-induced hypertrophy. Many of the studies that compared one set of RT with 3 sets have failed to show a difference in muscle hypertrophy in older adults. However, it is not clear whether further increases in RT volume (i.e., 6 sets) would result in even greater RT-related hypertrophy than 3 sets in older adults. This study aimed to investigate whether higher-volume RT (HV-RT) maximizes gains in lean body mass and muscle strength (MS) when compared with lower-volume RT (LV-RT) in postmenopausal women (PW). Fifty-eight PW were randomized into 1 of the 3 groups: control group (CT, no exercise), HV-RT (6 sets per exercise), and LV-RT (3 sets per exercise). Volunteers took part in a supervised training program (leg press 45°, leg extension, leg curl and standing calf raises) and were assessed for leg lean mass (LLM; dual X-ray absorptiometry) and lower limb MS (leg press and leg extension; 1 repetition maximum [1RM]) before and after 12 weeks of RT. Both HV-RT and LV-RT groups increased (p < 0.05) LLM and MS when compared with the CT group. Higher increases in LLM gains were observed for the HV-RT group when compared with the LV-RT group (6.1 and 2.3%, p < 0.001). Both HV-RT and LV-RT groups similarly increased 1RM in the leg press and leg extension. Thus, there seems to be a dose-response relationship between RT volume and muscle hypertrophy, but not for MS gains in PW.

Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study.

BACKGROUND: Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients. METHODS: We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses. RESULTS: The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m2 . The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07-2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06-1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03-1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46-0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates. CONCLUSIONS: Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease.

Home-Based Exercise Training During COVID-19 Pandemic in Post-Bariatric Patients: a Randomized Controlled Trial.

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Effect of whole-body resistance training at different load intensities on circulating inflammatory biomarkers, body fat, muscular strength, and physical performance in postmenopausal women.

The primary purpose of this study was to identify the impact of whole-body resistance training (RT) at different load intensities on adipokines, adhesion molecules, and extracellular heat shock proteins in postmenopausal women. As secondary purpose, we analyzed the impact of RT at different load intensities on body fat, muscular strength, and physical performance. Forty participants were randomized into lower-load intensity RT (LIRT, n = 20, 30-35 repetition maximum in the first set of each exercise) or higher-load intensity RT (HIRT, n = 20, 8-12 repetition maximum in the first set of each exercise). Adipokines (adiponectin and leptin), adhesion molecules (MCP-1 and ICAM-1), extracellular heat shock proteins (HO-1 and eHSP60), body fat, muscular strength (1RM), and physical performance [400-meter walking test (400-M) and 6-minute walking test (6MWT)] were analyzed at baseline and after 12-weeks RT. There was a significant time-by-group interaction for eHSP60 (P = 0.049) and 400-M (P = 0.003), indicating superiority of HIRT (d = 0.47 and 0.55). However, both groups similarly improved adiponectin, ICAM-1, HO-1, body fat, 1RM, and 6MWT (P < 0.05). Our study suggests that load intensity does not seem to determine the RT effect on several obesity-related pro-inflammatory and chemotactic compounds, body fat, 1RM, and 6MWT in postmenopausal women, although a greater improvement has been revealed for eHSP60 and 400-M in HIRT. Novelty: Higher-load intensity resistance training improves eHSP60 and 400-M in postmenopausal women. Resistance training improves the inflammatory profile, body fat, muscle strength, and 6MWT, regardless of load intensity.

Benefits of Home-Based Exercise Training Following Critical SARS-CoV-2 Infection: A Case Report.

In the current scenario, in which an elevated number of COVID-19 survivors present with severe physical deconditioning, exercise intolerance, persistent symptoms, and other post-acute consequences, effective rehabilitation strategies are of utmost relevance. In this study, we report for the first time the effect of home-based exercise training (HBET) in a survivor patient from critical COVID-19 illness. A 67-year-old woman who had critical COVID-19 disease [71 days of hospitalization, of which 49 days were in the intensive care unit (ICU) with invasive mechanical ventilation due to respiratory failure] underwent a 10-week HBET aiming to recovering overall physical condition. Before and after the intervention, we assessed cardiopulmonary parameters, skeletal muscle strength and functionality, fatigue severity, and self-reported persistent symptoms. At baseline (3 months after discharge), she presented with severe impairment in cardiorespiratory functional capacity (<50% age predicted VO2peak). After the intervention, remarkable improvements in VO2peak (from 10.61 to 15.48 mL·kg-1·min-1, Δ: 45.9%), oxygen uptake efficiency slope (OUES; from 1.0 to 1.3 L·min-1, Δ: 30.1%), HR/VO2 slope (from 92 to 52 bpm·L-1, Δ: -43.5%), the lowest VE/VCO2 ratio (from 35.4 to 32.9 L·min-1, Δ: -7.1%), and exertional dyspnea were observed. In addition, handgrip strength (from 22 to 27 kg, Δ: 22.7%), 30-s Sit-to-Stand (30-STS; from 14 to 16 repetitions, Δ:14.3%), Timed-Up-and-Go (TUG; from 8.25 to 7.01 s, Δ: -15%) performance and post-COVID functional status (PCFS) score (from 4 to 2) were also improved from baseline to post-intervention. Self-reported persistent symptoms were also improved, and Fatigue Severity Scale (FSS) score decreased (from 4 to 2.7) from baseline to post-intervention. This is the first evidence that a semi-supervised, HBET program may be safe and potentially effective in improving cardiorespiratory and physical functionality in COVID-19 survivors. Controlled studies are warranted to confirm these findings.

Influence of Adherence to Social Distancing Due to the COVID-19 Pandemic on Physical Activity Level in Post-bariatric Patients.

We assessed physical activity using accelerometers and a questionnaire in 33 post-bariatric patients who reported to be adherent (n = 15) or not (n = 18) to social distancing due to the COVID-19 pandemic. Patients adherent to social distancing spent more time in sedentary behavior (1.1 h/day, 0.1, 2.2; p = 0.045) and less time in moderate-to-vigorous physical activity (- 12.2 min/day, - 23.8, - 0.6; p = 0.040) vs. non-adherent ones. Bland-Altman analysis comparing objective and subjective physical activity estimates showed a bias for time spent in sedentary behavior and moderate-to-vigorous activity of 2.8 h/day and 8.5 min/day. In conclusion, post-bariatric patients who were adherent to social distancing measures were more inactive and sedentary than non-adherent ones. Strategies to increase physical activity in post-bariatric patients exposed to social distancing are necessary during the COVID-19 pandemic.

Resistance training-induced improvement in exercise tolerance is not dependent on muscle mass gain in post-menopausal women.

Menopause transition may impair muscle function, decreasing exercise tolerance. The torque-duration relationship (hyperbolic curve) forms a practical framework within which exercise tolerance may be explored. In this regard, resistance training (RT) increases the curvature constant of this relationship (W'). Muscle hypertrophy and strength gains have been suggested as possible mediators of RT-induced improvement in W', however, it is unclear what the main mediator is. Higher-volume RT (HV-RT), beyond that recommended by RT-guidelines (i.e. three sets per exercise), may promote greater hypertrophy, but not higher strength gains. Hence, this study aimed to investigate whether greater hypertrophy in HV-RT maximises W' gain when compared to LVRT in postmenopausal women (PW). Fifty-eight PW were randomised to the control group (CTRL), HV-RT (six sets per exercise) or LV-RT (three sets per exercise). They underwent a 12-week RT program and were assessed for W', thigh lean body mass (TLBM) and maximal isometric voluntary contraction (MIVC). The TLBM gain was higher (P < 0.001) in the HV-RT (9.4%) than LV-RT (3.7%). However, both HV-RT and LV-RT similarly increased MIVC (9.7% vs. 16.5%, P = 0.063) and W' (26.4% vs. 34.6% P = 0.163). Additionally, the changes in W' were associated with the changes in TLBM (31%, P = 0.003) and MIVC (52%, P= <0.001). However, when the changes in TLBM and MIVC were inserted into the predictive model, only the MIVC (33%, P = 0.002) was a predictor of W'. Thus, although HV-RT promoted greater hypertrophy than LV-RT, HV-RT does not seem to maximise W' in PW.

Improvements in muscle strength, power, and size and self-reported fatigue as mediators of the effect of resistance exercise on physical performance breast cancer survivor women: a randomized controlled trial.

PURPOSE: To gain more knowledge about the mechanism (i.e., mediators) of resistance exercise (RE)-induced improvements in physical performance (PP), we seek to investigate whether improvements in muscle strength (MS), muscle power (MP), and lean body mass (LBM) and (or) self-reported fatigue (SRF) are mediators of the effect of RE on PP in breast cancer survivor women (BCSW). METHODS: The volunteers were randomly divided into two groups: control group (CT; n = 9) and resistance exercise (RE; n = 11). The RE protocol consisted of three sets in each exercise (leg extension, leg curl, 45° leg press, and calf raise), between 8 and 12 repetitions per set, with an estimated load of 80% of one-repetition maximum (1RM), and three times a week on non-consecutive days for 12 weeks. The CT group performed only stretching exercises twice a week. SRF, maximal muscle power (Pmax), MP, LBM, and PP were assessed using the Brief Fatigue Inventory Questionnaire; 1RM test; isoinertial dynamometer; DXA; and walking speed, sit-to-stand (STS), and timed up and go (TUG) test, respectively. RESULTS: Following 12 weeks, the RE group reduced SRF and increased MP, Pmax, LBM, and performance in all tests (walking speed, STS, and TUG) when compared with the CT group. There were significant associations of the changes in LBM, MS, Pmax, and SRF with changes in physical performance tests only in the RE group. CONCLUSION: Our findings suggest that improvements in LBM, MS, MP, and self-reported fatigue mediate the effect of resistance exercise on physical performance in BCSW.

Atividade física no lazer como critério discriminante do menor nível de estresse percebido em adolescentes / Leisure-time physical activity as discriminant criterion of low level perceived stress in adolescents

O objetivo do presente estudo foi identificar os pontos de corte do tempo de realização de atividades físicas no lazer (AFL) de diferentes intensidades como critério discriminante do menor nível de estresse percebido (MEP) em adolescentes. Trata-se de um estudo transversal com amostra composta por adolescentes de 14 a 18 anos, de ambos os sexos, do ensino médio regular. Dados da atividade física e do MEP foram obtidos por meio de autorrelato, utilizando-se o questionário COMPAC. O MEP (respostas: "raramente" + "às vezes") foi considerado variável de classificação, enquanto minutos em AFL de intensidade moderada (AFLM), vigorosa (AFLV) e moderada a vigorosa (AFLMV) as variáveis de teste. Na análise dos dados foi usada a curva ROC, complementadas por valores de sensibilidade (SE) e especificidade (ES), adotando-se área sob a curva (AUC) > 0,50 e fixando-se p < 0,05. A amostra final deste estudo foi de 984 adolescentes (idade: homens = 15,93 ± 1,10 anos; moças = 15,87 ± 1,04 anos) com maior participação de moças (55,3%). O tempo de realização de AFLM ≥ 40 min/sem (AUC = 0,59; SE = 41,7%; ES = 75,7%; p < 0,002) e AFLMV ≥ 80 min/sem (AUC = 0,58; SE = 83,2%; ES = 36,2%; p < 0,04) para os rapazes apresentou poder discriminante para MEP. Neste estudo transversal, os minutos de realização de AFLM e AFLMV foram discriminantes do MEP para os rapazes. As AUC, para ambas as intensidades de AFL, foram baixas e com desequilíbrio entre valores de SE e ES. É sugerido que outros delineamentos de pesquisa sejam empregados a fim de estabelecer a relação causa e efeito entre a prática de AFL de diferentes intensidades e os níveis de estresse em adolescentes...(AU)

The aim of this study was to identify the cutoffs of the leisure-time physical activity (LPA), at different intensities, as discriminant criterion of lowest level of perceived stress (LLPS) in adolescents (14-18 years). This is a population-based, cross-sectional study, including regular high school students. PA and LLPS data was self-reported through questionnaire COMPAC. The classification variable was the LLPS (rarely + sometimes). The test variables were the minutes of LPAL of moderate intensity (LPAM) and vigorous (LPAV) and moderate to vigorous (LPAMV). The cutoffs were analyzed by ROC curves, complemented by sensitivity (SE) and specificity (ES) values, adopting area under the curve (AUC > 0.50; p < 0.05). The final sample of 984 adolescents (boys = 15.93 ± 1.10 years; girls = 15.87 ± 1.04 years) with a higher proportion of girls (55.3%). The time spent in LPAM ≥ 40 min/week (SE = 41.7%, ES = 75.7% AUC = 0.59; p < 0.002) and LPAMV ≥ 80 min/week (SE = 83.2%; ES = 36.2%; AUC = 0.58; p < 0.04) for the boys presented discriminant power to LLPS. In this cross-sectional study, LPAM and LPAMV minutes showed discriminatory power for LLPS in male. However, the AUCs for both LPA intensities were low and with imbalance between SE and ES values. Other research designs should be used to establish the cause-effect relationship between PAL and stress levels in adolescents...(AU)