COVID-19: Insights into long-term manifestations and lockdown impacts

Coronaviruses are pathogens thought to primarily affect the respiratory tracts of humans. The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019 was also marked mainly by its symptoms of respiratory illness, which were named coronavirus disease 2019 (COVID-19). Since its initial discovery, many other symptoms have been linked to acute SARS-CoV-2 infections as well as to the long-term outcomes of COVID-19 patients. Among these symptoms are different categories of cardiovascular diseases (CVDs), which continue to be the main cause of death worldwide. The World Health Organization estimates that 17.9 million people die from CVDs each year, accounting for ∼32% of all deaths globally. Physical inactivity is one of the most important behavioral risk factors for CVDs. The COVID-19 pandemic has affected CVDs as well as the physical activity in different ways. Here, we provide an overview of the current status as well as future challenges and possible solutions.     

Coronavirus disease-2019: A tocsin to our aging,unfit, corpulent,and immunodeficient society

Acute and chronic respiratory illnesses cause widespread morbidity and mortality, and this class of illness now includes the novel coronavirus severe acute respiratory syndrome that is causing coronavirus disease-2019 (COVID-19). The world is experiencing a major demographic shift toward an older, obese, and physically inactive populace. Risk factor assessments based on pandemic data indicate that those at higher risk for severe illness from COVID-19 include older males, and people of all ages with obesity and related comorbidities such as hypertension and type 2 diabetes. Aging in and of itself leads to negative changes in innate and adaptive immunity, a process termed immunosenescence. Obesity causes systemic inflammation and adversely impacts immune function and host defense in a way that patterns immunosenescence. Two primary prevention strategies to reduce the risk for COVID-19 at both the community and individual levels include mitigation activities and the adoption of lifestyle practices consistent with good immune health. Animal and human studies support the idea that, in contrast to high exercise workloads, regular moderate-intensity physical activity improves immunosurveillance against pathogens and reduces morbidity and mortality from viral infection and respiratory illnesses including the common cold, pneumonia, and influenza. The odds are high that infectious disease pandemics spawned by novel pathogens will continue to inflict morbidity and mortality as the world's population becomes older and more obese. COVID-19 is indeed a wake-up call, a tocsin, to the world that primary prevention countermeasures focused on health behaviors and hygiene demand our full attention and support.     

Social isolation and physical inactivity in older US adults: Results from the Third National Health and Nutrition Examination Survey

Abstract

Physical inactivity is a risk factor for cardiovascular and other chronic diseases. It has been shown that both physical inactivity and social isolation increase with age, and that these factors are detrimental to physical and mental well-being. The purpose of the present study was to examine the relationship between physical inactivity and social isolation in older US adults. Using data from a nationally representative cross-sectional survey, the Third National Health and Nutrition Examination Survey, 1988–1994, we assessed the age- and race-specific prevalence of no leisure-time physical activity in relation to various forms of social interaction. The prevalence of no leisure-time physical activity increases with age in both men and women. In non-Hispanic whites, non-Hispanic blacks, and Mexican Americans, the prevalence of no leisure-time physical activity is increased in older US adults who are socially isolated. Social isolation is related to physical inactivity among persons 60 years and older. Longitudinal and intervention studies are needed to establish whether increased social support translates to a more active population of older adults.     

The BASES expert statement on exercise therapy for people with chronic kidney disease

Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease, which is the leading cause of morbidity and mortality in this patient population. Physical inactivity has emerged as a significant and independent risk factor for accelerated deterioration of kidney function, physical function, cardiovascular function and quality of life in people in all stages of CKD. CKD specific research evidence, combined with the strong evidence on the multiple health benefits of regular and adequate amounts of PA in other cardiometabolic conditions, has resulted in physical inactivity being identified by national and international CKD clinical practice guidelines as one of the multiple risk factors that require simultaneous and early intervention for optimum prevention/management of CKD. Despite this realisation, physical inactivity is not systematically addressed by renal care teams. The purpose of this expert statement is therefore to inform exercise and renal care specialists about the clinical value of exercise therapy in CKD, as well as to provide some practical recommendations on how to more effectively translate the existing evidence into effective clinical practice.     

Physical activity and nutrition guidelines to help with the fight against COVID-19

ABSTRACT

As the world is witnessing the epidemic of coronavirus disease 2019, emerging genetics and clinical pieces of evidence suggest a similar immunopathology to those of severe acute respiratory syndrome and Middle East respiratory syndrome. Staying at home to prevent the spread of the virus and consequently being largely inactive is associated with unintended consequences. These can actually enhance the infection risk and exacerbate poor health conditions including impaired immune function. Physical activity is a feasible way of improving health, particularly physical and mental health in a time of social isolation. However, people with certain health conditions in these circumstances may need a special physical activity programme in addition to any exercise they may already be performing via online programmes. This review aims to provide practical guidelines during the COVID-19 quarantine period. We suggest performing aerobic, resistance training, respiratory muscle training and yoga in the healthy, and in those with upper respiratory tract illness, patients with lower respiratory tract illness should be restricted to respiratory muscle training and yoga. In addition, vitamins D and C, omega-3 fatty acids, and regular consumption of fruit and vegetables might be considered as nutritional aids to support the immune system in those affected by COVID-19.     

Mechanics of Batting: Effect of Stride Technique on Ground Reaction Forces and Bat Velocities

The benefits associated with being physically active are well documented, but a significant proportion of the population is insufficiently active. Physical inactivity is a major health risk factor in our society, and physical education programs are consistently identified as a means to address this concern. The purpose of this article is to use the social-ecological model as a framework to examine ways in which physical education programs can play an important role in promoting physical activity. Policies that require time allocations and resources for physical education and physical activity in schools and community designs that provide infrastructure that makes being physically active accessible and convenient are important factors in making schools and communities healthier spaces. It is clear, however, that policies alone are not sufficient to address concerns about physical inactivity. We must consider individual factors that influence decisions to be physically active in efforts to engage children in physical education programs that promote active lifestyles. The learning climate that teachers create determines what students do and learn in physical education classes. Ensuring that students see value in the content presented and structuring classes so that students believe they can experience success when they exert effort are key elements in an effective motivational climate. Efforts to address public health concerns about physical inactivity require a comprehensive approach including quality physical education. It is critical that kinesiology professionals emerge as leaders in these efforts to place physical education programs at the center of promoting children's physical activity.     

Women and exercise in aging

Aging is associated with physiological declines, notably a decrease in bone mineral density (BMD) and lean body mass, with a concurrent increase in body fat and central adiposity. Interest in women and aging is of particular interest partly as a result of gender specific responses to aging, particularly as a result of menopause. It is possible that the onset of menopause may augment the physiological decline associated with aging and inactivity. More so, a higher incidence of metabolic syndrome (an accumulation of cardiovascular disease risk factors including obesity, low-density lipoprotein cholesterol, high blood pressure, and high fasting glucose) has been shown in middle-aged women during the postmenopausal period. This is due in part to the drastic changes in body composition, as previously discussed, but also a change in physical activity (PA) levels. Sarcopenia is an age related decrease in the cross-sectional area of skeletal muscle fibers that consequently leads to a decline in physical function, gait speed, balance, coordination, decreased BMD, and quality of life. PA plays an essential role in combating physiological decline associated with aging. Maintenance of adequate levels of PA can result in increased longevity and a reduced risk for metabolic disease along with other chronic diseases. The aim of this paper is to review relevant literature, examine current PA guidelines, and provide recommendations specific to women based on current research.     

体力活动不足、久坐行为与糖代谢异常检出率的关系

目的：探讨体力活动（PA）不足和久坐行为（SB）与糖代谢异常检出率的关系。方法：对30~69岁具有至少3项DM危险因素者进行糖耐量筛查,采用国际体力活动问卷（IPAQ-SF）调查PA水平和SB,并利用加速度计对问卷进行效度检验。结果：研究纳入195人,平均年龄（51.92±10.64）岁。糖代谢异常检出率为67.18%,检出率随DM危险因素数量的增多而升高。IPAQ-SF中MPA、MVPA以及SB时间与加速度计测量结果的相关系数r分别为0.35、0.37和0.43。受试者中75.9%属于PA不足,同时具有"PA不足+（年龄≥ 40岁）+超重/肥胖"三项的受试者最多（48.21%）。在调整了混杂因素之后,与SB ≤ 6h/d组相比,SB>6h/d组受试者的糖耐量异常检出率更高（OR=2.37,95% CI：1.12~5.02）。结论：多种DM危险因素聚集者中糖代谢异常检出率较高,PA不足者较多,SB增加糖代谢异常风险,IPAQ-SF适用于对该人群进行PA评价。建议对糖尿病多危险因素聚集者,尤其是PA不足、SB较多、超重/肥胖者及时筛查并重点关注,降低糖代谢异常发病率。     

Obesity paradoxes

Abstract

In this review, we examine the original obesity paradox phenomenon (i.e. in cardiovascular disease populations, obese patients survive better), as well as three other related paradoxes (pre-obesity, “fat but fit” theory, and “healthy” obesity). An obesity paradox has been reported in a range of cardiovascular and non-cardiovascular conditions. Pre-obesity (defined as a body mass index of 25.0–29.9 kg · m^?2) presents another paradox. Whereas “overweight” implies increased risk, it is in fact associated with decreased mortality risk compared with normal weight. Another paradox concerns the observation than when fitness is taken into account, the mortality risk associated with obesity is offset. The final paradox under consideration is the presence of a sizeable subset of obese individuals who are otherwise healthy. Consequently, a large segment of the overweight and obese population is not at increased risk for premature death. It appears therefore that low cardiorespiratory fitness and inactivity are a greater health threat than obesity, suggesting that more emphasis should be placed on increasing leisure time physical activity and cardiorespiratory fitness as the main strategy for reducing mortality risk in the broad population of overweight and obese adults.     

《体育之研究》:揭示体育的力量,修身立志的篇章

青年毛泽东在23岁时发表的文章《体育之研究》,思想宏大深邃,涵盖了哲学、古今中外历史、文化教育、人生观等诸多方面内容,已超越一般意义上的体育文章。写作此文时,青年毛泽东的体育实践水平尚处于初级阶段,通过对体育本质的研究,他对体育的理解发生了质的飞跃,从而产生了一系列独特的,不拘一格的锻炼方式。对比《体育之研究》写作发表前后青年毛泽东的体育活动形式和内容的巨大变化,青年毛泽东认识体育的足迹,也是青年毛泽东走向伟大的路径,清晰可见。     

No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

BackgroundRegular physical activity (PA) has been postulated to improve, or at least maintain, immunity across the life span. However, the link between physical (in)activity and coronavirus disease 2019 (COVID-19) remains to be established. This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19.MethodsHospitalized patients with COVID-19 (mean age: 54.9 years) were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo (a quaternary referral teaching hospital) and from Ibirapuera Field Hospital, both located in Sao Paulo, Brazil. PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity. The primary outcome was hospital length of stay. The secondary outcomes were mortality, admission to the intensive care unit (ICU), and mechanical ventilation requirement.ResultsThe median hospital length of stay was 7.0 ± 4.0 days, median ± IQR; 3.3% of patients died, 13.8% were admitted to the ICU, and 8.6% required mechanical ventilation. Adjusted linear regression models showed that PA indices were not associated with hospital length of stay (work index: β = –0.57 (95% confidence interval (95%CI): –1.80 to 0.65), p = 0.355; sport index: β = 0.43 (95%CI: –0.94 to 1.80), p = 0.536; leisure-time index: β = 1.18 (95%CI: –0.22 to 2.59), p = 0.099; and total activity index: β = 0.20 (95%CI: –0.48 to 0.87), p = 0.563). None of the PA indices were associated with mortality, admission to the ICU, or mechanical ventilation requirement (all p > 0.050).ConclusionAmong hospitalized patients with COVID-19, PA did not independently associate with hospital length of stay or any other clinically relevant outcomes. These findings should be interpreted as meaning that, among already hospitalized patients with more severe forms of COVID-19, being active is a potential protective factor likely outweighed by a cluster of comorbidities (e.g., type 2 diabetes, hypertension, weight excess) and older age, suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.     

Physical inactivity and muscle oxidative capacity in humans

Abstract

Physical inactivity is associated with a high prevalence of type 2 diabetes and is an independent predictor of mortality. It is possible that the detrimental effects of physical inactivity are mediated through a lack of adequate muscle oxidative capacity. This short review will cover the present literature on the effects of different models of inactivity on muscle oxidative capacity in humans. Effects of physical inactivity include decreased mitochondrial content, decreased activity of oxidative enzymes, changes in markers of oxidative stress and a decreased expression of genes and contents of proteins related to oxidative phosphorylation. With such a substantial down-regulation, it is likely that a range of adenosine triphosphate (ATP)-dependent pathways such as calcium signalling, respiratory capacity and apoptosis are affected by physical inactivity. However, this has not been investigated in humans, and further studies are required to substantiate this hypothesis, which could expand our knowledge of the potential link between lifestyle-related diseases and muscle oxidative capacity. Furthermore, even though a large body of literature reports the effect of physical training on muscle oxidative capacity, the adaptations that occur with physical inactivity may not always be opposite to that of physical training. Thus, it is concluded that studies on the effect of physical inactivity per se on muscle oxidative capacity in functional human skeletal muscle are warranted.     

幼儿体质影响因素的决策树研究

目的:基于决策树模型探讨幼儿体质的影响因素及其交互关系。方法:募集学龄前儿童4621名(36~83月龄)。参照《国民体质测定标准手册(幼儿部分)》进行体质测试与综合评级(合格、不合格);问卷调查幼儿出生信息、育儿方式、静坐与身体活动、膳食营养、睡眠、父母情况6个一级指标下分的59个二级指标变量信息;采用IBM SPSS modeler创建CHAID决策树模型。结果:幼儿体质的重要影响因素排序依次为周末身体活动(PA)、周末静坐行为(SB)、性别、周末中-大强度身体活动(MVPA)、上学日PA、钙、上学日SB。决策树模型显示,根节点变量周末PA“>3 h/天”(95.35%)的幼儿体质合格率与“1~3 h/天”(91.43%)、“≤0.5 h/天”(85.43%)相比具有非常显著性差异(P=0.000)。周末PA“>3 h/天”的第2、3层叶节点变量分别为周末SB、上学日PA,“1~3 h/天”“≤0.5 h/天”的第2层叶节点变量均为性别。其中,“1~3 h/天”的3~5层叶节点变量包括周末与上学日MVPA、上学日SB、钙等。结论:周末PA是影响幼儿体质的最关键因素。幼儿周末PA应超过3 h/天的国际推荐量标准,并在此基础上减少周末SB时间、增加上学日PA时间。身体活动与静坐行为、性别、钙摄入等对不同层次类型幼儿的体质促进具有决策意义。     

American adults' knowledge of exercise recommendations

Physical inactivity is a major risk factor for cardiovascular disease, stroke, hypertension, diabetes, obesity, osteoporosis, and some cancers. Approximately 950,000 Americans die annually from cardiovascular diseases. The purpose of this study was to determine whether American adults know which traditional and lifestyle physical activities affect health and how they should be physically active to achieve a health benefit. Secondary purposes were to determine whether this knowledge is a function of gender, ethnicity, education, or age and if those who are sufficiently active for a health benefit possess different knowledge levels than those not sufficiently active for a health benefit. Items based on the Centers for Disease Control and Prevention/American College of Sports Medicine principles included knowledge of exercise guidelines and traditional and lifestyle physical activities. This information was obtained from 20 questions that were part of a national random telephone survey of 2,002 American households in the 48 contiguous states and the District of Columbia. Respondents were most aware of traditional physical activities (M = 94%) that provide a health benefit and less aware of specific exercise guidelines (M = 68%) and lifestyle physical activities (M = 71%) that can result in a health benefit. Knowledge was not related to physical activity behavior sufficient for a health benefit and only slightly related to ethnicity, education, and age. These data suggest that physical activity knowledge alone is not sufficient to elicit a behavior; however, it provides educators with an understanding of the public's physical activity knowledge that could be helpful in developing health promotion and physical activity interventions.     

Typologies of Greek inactive older adults based on reasons for abstaining from exercise and conditions for change

Abstract

The main purpose of this study was to examine typologies of non-exercisers based on reasons for physical inactivity and conditions reported to be necessary to change exercise behaviour. These typologies were then compared on psychological variables of interest and exercise history. Questionnaires were distributed to Greek older adults aged 60 and above who were recruited from social clubs and city cafés. Only individuals engaging in no regular exercise were recruited (n = 188). The results of hierarchical and k-means cluster analyses revealed two clusters for males (“approachable” and “unconvinced”) and three for females (“unconcerned”, “approachable”, and “unconvinced”). The clusters differed significantly on psychological variables not used in the cluster solution. Exercise history distinguished between clusters only among males. The results reveal that physically inactive older adults are not a homogeneous group of individuals. Implementers of physical activity interventions should probably use a range of strategies that take into consideration that some sedentary older adults are more amenable to consider taking up exercise than others.     

Position statement: Testing physical condition in a population – how good are the methods?

Abstract

A poor physical condition – expressed as physical inactivity and poor physical fitness – is associated with the development of chronic diseases and premature death. Our aim was to evaluate the methods currently available for measuring physical activity and physical fitness in the general population.

Physical activity is determined by duration, frequency, and intensity and derives from many different domains, making it difficult to assess over long periods and no feasible general criterion measure exists. Both objective and subjective methods are available. Of the objective methods, accelerometry is the most attractive technology, and is well enough developed for general use in large populations. The advantage of accelerometry is that it is not dependent on the memory of the individual, but its main disadvantage is that it grossly underestimates energy expenditure, due to the lack of registration of certain activities. This may be overcome to a certain extent by combining accelerometry with heart rate monitoring, although this still does not measure activity in different domains. Of the subjective methods, self-report questionnaires are inexpensive and easy to administer. Many questionnaires have been developed, but we require (1) consensus on which measures to use for validation and (2) further development of internationally standardized questionnaires for use in different settings and to address different scientific questions. Many questionnaires correlate well with biological markers and development of chronic diseases, but subjective measurement will always entail a certain degree of misclassification. Furthermore, unstructured physical activity such as housework and gardening may be subject to recall bias. No method appears better to any other, and the choice of instrument will depend on the research question being asked. Future research should combine information from both objective and subjective methods.

Physical fitness comprises several components, including cardiorespiratory endurance and muscle strength and endurance. Direct measurement of oxygen consumption is the criterion measure for cardiorespiratory endurance. As regards muscle strength and endurance, only test–retest reliability is available. Hand-held dynamometers greatly facilitate field testing for maximal isometric muscle strength assessment, while force plate measurements can be used for the lower extremities. For endurance, simple tests such as push-ups and sit-ups are reliable.     

The Effects of Physical Education on the Behavior of Second Grade Children

Abstract

The effects of six weeks of physical education on the negative impulse behavior of second grade children in a “difficult class” and a “usual class” were studied. The instruments used were teacher rating and observation. The results showed that physical education significantly reduced the number and severity of observed impulse behavior in the difficult classroom, although the numbers of individuals involved remained relatively the same; the teacher ratings of the children's behavior did not significantly change as a result of physical education but some tendencies, both positive and negative, were evident. Physical education did not significantly change the usual class in terms of either observed behavior or teacher ratings.     

太极拳对老年人身心健康影响的研究进展

大量研究表明老年人更易患新型冠状病毒肺炎(COVID-19)在内的呼吸道传染病,新型冠状病毒的爆发对老年人的心理和生理都造成了严重的损害。太极拳刚柔并济,具有独特的呼吸和动作节奏,对老年人的心理、生理健康都有积极的促进作用,相关研究分散于文献中。文章总结分析了太极拳对老年人心理、生理健康的影响及其机制并提供了相应的太极拳练习方式以供老年人练习时参考,为疫情常态化防控状态下老年人的健康促进提供借鉴。     

基于知识图谱的国外身体锻炼与新冠肺炎的相关研究进展分析

该文以SCI、SSCI和A&HCI所收录的国外关于身体锻炼与COVID-19的454篇文献为研究对象,引入CiteSpaceⅤ可视化分析工具,探测国外关于身体锻炼与COVID-19的相关研究热点及主流观点。分析表明：现阶段国外关于身体锻炼与COVID-19的相关研究热点主要集中在身体锻炼与COVID-19的内在关联、身体锻炼适应性、身体锻炼实例等方面。针对处于后防疫时期的中国,提出如下对策：聚焦重点领域技术攻克,强化科技引领;研发多元运动处方库,提高锻炼效应;构建多维保障体系,强化风险防控;打造健康教育新格局,确保长远效应。     

健康中国视域中的运动处方库构建

以人民健康为中心,主动健康为导向,发挥全民科学健身在健康促进、慢性病预防和康复等方面的积极作用,把健康关口前移到健康维护和疾病防控,推动形成“体医融合”的疾病管理与健康服务模式,是健康中国行动的目标与任务。国家运动处方库建设是在健康中国战略指引下,在借鉴学习国外运动处方研究、推广和应用先进成果的基础上,通过对我国运动处方内容系统、运动处方师培训系统、运动处方应用系统的构建,通过健康人群、疾病风险人群、慢性疾病人群、功能受损人群、发展性障碍人群运动处方的制定及运动处方推广应用路径的选择,将我国运动处方的研究、推广和应用向着科学、严谨、规范、深入推进,让具有科学性、针对性、有效性、可操作性并适合中国人体质特点的运动处方惠及我国亿万民众,为增强国民体质、增进国民健康,实现健康中国目标做出应有贡献,为世界运动处方的理论与实践提供中国经验与借鉴。