Early Outpatient Tele-rehabilitation Improves Functional Outcomes in Patients Following Hospitalization for COVID-19: A Case Series

Outpatient Rehabilitation ◽

Sit To Stand ◽

Impact Scale ◽

Fatigue Impact Scale ◽

Introduction: This study assesses the impact of early outpatient telerehabilitation on patients following hospitalization for COVID-19. To date, there have not been studies assessing this type of program, despite significant documentation of functional deficits that would benefit from outpatient rehabilitation services. Objective: To determine whether outcomes support the utilization of an early outpatient telerehabilitation based protocol. Design: Retrospective analysis, nonrandomized controlled trial. Setting: Academic healthcare center, secondary care. Patients: All patients discharged following hospitalization with COVID-19 between April and September of 2020 (n=50) were contacted to participate; 26 accepted, 19 completed the rehabilitation protocol. Inclusion criteria were: patient diagnosed with and hospitalized for COVID-19, patient willing to participate in study. Interventions: Patients were seen for 2-4 visits of physical therapy where they were assessed, screened to assess need for mental health, occupational therapy, and speech therapy services and placed into predetermined activity tolerance categories with corresponding exercises given. Main Outcome Measures: Outcome measures assessed were Borg Rating of Perceived Exertion (RPE) on selected tasks, 30 Second Sit to Stand Test, Daily Fatigue Impact Scale score, Resting Respiratory Rate, activity tolerance (based on averaging severity levels of previously identified functional scale scores), and patient-rated feelings of dyspnea on exertion. Results: Statistically significant improvements were found in resting respiratory rate (p<0.05), 30 Second Sit to Stand score (p<0.001), Daily Fatigue Impact Scale score (p<0.05), Borg RPE (p<0.05), and overall severity rating (p<0.01). Patient-rated dyspnea was not significantly different from first to last visit. Conclusions: 2-4 visits of telerehabilitation provided soon after hospital discharge resulted in significant improvements in functional outcome measures. This supports the utilization of outpatient rehabilitation following hospitalization for COVID-19 as well as the use of telerehabilitation to provide these services.

Disease progression in multiple sclerosis: combining physicians’ and patients’ perspectives?

Multiple Sclerosis Journal ◽

10.1177/1352458510385505 ◽

2010 ◽

Vol 17 (2) ◽

pp. 234-240 ◽

Cited By ~ 13

Author(s):

JJ Kragt ◽

JM Nielsen ◽

FAH van der Linden ◽

CH Polman ◽

BMJ Uitdehaag

Keyword(s):

Multiple Sclerosis ◽

Clinical Outcome ◽

Disease Progression ◽

Outcome Measures ◽

Added Value ◽

Impact Scale ◽

Disability Status ◽

The Impact ◽

Nine Hole Peg Test ◽

Combine Outcome

Background: To assess disease progression in multiple sclerosis (MS) several outcome measures are available. The interrelation of changes on different scales has not been studied extensively and the concept of combining scales has only recently been introduced in MS. Objective: To explore combining different clinical outcome measures in the evaluation of disease progression in MS. Methods: In 553 patients we studied the presence of relevant changes according to standard definitions on the Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW) and the Multiple Sclerosis Impact Scale (MSIS-29). We examined ‘exclusive worsening’ (worsening on one measure while not worsening on any other measure) and ‘opposing changes’ (worsening on one measure while improving on another measure). Finally, we investigated the impact of combining assessments. Results: Based on the EDSS alone, 140 patients progressed. However, almost twice as many (275) showed worsening on any of the clinical outcome measures. Exclusive worsening was observed in 37 patients on the EDSS, 13 on the 9HPT, 39 on the T25FW and 44 on the MSIS physical. Of all worsened patients 76 (28%) showed opposing changes, a phenomenon predominantly observed when combining physician-based and patient-derived outcome measures. Conclusion: When assessing disease progression in MS, sensitivity to change can be increased by combining different outcome measures. The added value is especially present when combining measures from different perspectives. However, further research is needed to evaluate the optimal way to combine outcome measures before implementing this strategy in clinical studies.

Influence of Personal Protective Equipment on Wildland Firefighters’ Physiological Response and Performance during the Pack Test

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105050 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5050

Author(s):

Belén Carballo-Leyenda ◽

Jorge Gutiérrez-Arroyo ◽

Fabio García-Heras ◽

Pilar Sánchez-Collado ◽

José G. Villa-Vicente ◽

...

Keyword(s):

Personal Protective Equipment ◽

Perceived Exertion ◽

Random Order ◽

Work Capacity ◽

Protective Equipment ◽

Physiological Strain ◽

Multiple Stepwise Regression Analysis ◽

Performance Reduction ◽

The Pack Test (PT) is a widely used test to establish readiness for work in wildland firefighting. It is common to perform this test dressed in regular exercise clothing. However, wildland firefighters (WFF) have to wear personal protective equipment (PPE) during their deployments, which increases the physiological strain and reduces their work capacity. This study aimed to analyse the impact of full PPE on PT performance. Nine male professional WFF performed in random order a PT walking at the fastest possible self-pace wearing two different clothing configurations: (i) traditional short sports gear (SG) and (ii) the PPE currently used by Spanish WFF. Heart rate (HR), rating of perceived exertion and lap time were recorded during the PT. In addition, oxygen uptake (VO2) was estimated through the individual VO2–HR relationship previously obtained during a graded exercise test. There was a significant decrease in the PT performance (i.e., completion time) (~12%, p < 0.05) in PPE. The physiological demands with this configuration were significantly higher (~10%, p < 0.05). WFF spent ~13 min above the anaerobic threshold in PPE vs. ~4 min in SG. A multiple stepwise regression analysis revealed that PT performance variation might be explained by the maximal aerobic velocity (84.5%) in PPE and the VO2max (75.9%) in SG. In conclusion, wearing complete PPE increases WFF’s physiological strain, which translates into a significant PT performance reduction. Performing the test walking at the fastest possible self-pace wearing the PPE would better reflect the high-intensity effort periods reported in real scenarios.

Carbohydrate Mouth Rinsing in the Fed State: Lack of Enhancement of Time-Trial Performance

International Journal of Sport Nutrition and Exercise Metabolism ◽

10.1123/ijsnem.19.4.400 ◽

2009 ◽

Vol 19 (4) ◽

pp. 400-409 ◽

Cited By ~ 82

Author(s):

Milou Beelen ◽

Jort Berghuis ◽

Ben Bonaparte ◽

Sam B. Ballak ◽

Asker E. Jeukendrup ◽

...

Keyword(s):

Heart Rate ◽

Power Output ◽

Perceived Exertion ◽

Average Power ◽

Time Trial ◽

Time Trial Performance ◽

Mouth Rinsing ◽

The Impact ◽

Trial Performance

It has been reported previously that mouth rinsing with a carbohydrate-containing solution can improve cycling performance. The purpose of the current study was to investigate the impact of such a carbohydrate mouth rinse on exercise performance during a simulated time trial in a more practical, postprandial setting. Fourteen male endurance-trained athletes were selected to perform 2 exercise tests in the morning after consuming a standardized breakfast. They performed an ~1-hr time trial on a cycle ergometer while rinsing their mouths with either a 6.4% maltodextrin solution (CHO) or water (PLA) after every 12.5% of the set amount of work. Borg’s rating of perceived exertion (RPE) was assessed after every 25% of the set amount of work, and power output and heart rate were recorded continuously throughout the test. Performance time did not differ between treatments and averaged 68.14 ± 1.14 and 67.52 ± 1.00 min in CHO and PLA, respectively (p = .57). In accordance, average power output (265 ± 5 vs. 266 ± 5 W, p = .58), heart rate (169 ± 2 vs. 168 ± 2 beats/min, p = .43), and RPE (16.4 ± 0.3 vs. 16.7 ± 0.3 W, p = .26) did not differ between treatments. Furthermore, after dividing the trial into 8s, no differences in power output, heart rate, or perceived exertion were observed over time between treatments. Carbohydrate mouth rinsing does not improve time-trial performance when exercise is performed in a practical, postprandial setting.

The Impact of 3 Different-Length Between-Matches Microcycles on Training Loads in Professional Rugby League Players

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2015-0100 ◽

2015 ◽

Vol 10 (6) ◽

pp. 767-773 ◽

Cited By ~ 3

Author(s):

Alexandre Moreira ◽

Tom Kempton ◽

Marcelo Saldanha Aoki ◽

Anita C. Sirotic ◽

Aaron J. Coutts

Keyword(s):

Perceived Exertion ◽

Training Session ◽

Rugby League ◽

Training Load ◽

Endurance Athletes ◽

Moderate Intensity ◽

High Intensity Zone ◽

Competition Period ◽

Purpose: To examine the impact of varying between-matches microcycles on training characteristics (ie, intensity, duration, and load) in professional rugby league players and to report on match load related to these between-matches microcycles. Methods: Training-load data were collected during a 26-wk competition period of an entire season. Training load was measured using the session rating of perceived exertion (session-RPE) method for every training session and match from 44 professional rugby league players from the same National Rugby League team. Using the category-ratio 10 RPE scale, the training intensity was divided into 3 zones (low <4 AU, moderate ≥4-≤7 AU, and high >7 AU). Three different-length between-matches recovery microcycles were used for analysis: 5−6 d, 7−8 d, and 9−10 d. Results: A total of 3848 individual sessions were recorded. During the shorter-length between-matches microcycles (5−6 d), significantly lower training load was observed. No significant differences for subsequent match load or intensity were identified between the various match recovery periods. Overall, 16% of the training sessions were completed at the low-intensity zone, 61% at the moderate-intensity zone, and 23% at the high-intensity zone. Conclusions: The findings demonstrate that rugby league players undertake higher training load as the length of between-matches microcycles is increased. The majority of in-season training of professional rugby league players was at moderate intensity, and a polarized approach to training that has been reported in elite endurance athletes does not occur in professional rugby league.

Intradialytic cycling does not exacerbate microparticles or circulating markers of systemic inflammation in haemodialysis patients

European Journal of Applied Physiology ◽

10.1007/s00421-021-04846-7 ◽

2021 ◽

Author(s):

Patrick J. Highton ◽

Daniel S. March ◽

Darren R. Churchward ◽

Charlotte E. Grantham ◽

Hannah M. L. Young ◽

...

Keyword(s):

Systemic Inflammation ◽

Perceived Exertion ◽

Venous Blood ◽

Moderate Intensity ◽

Inflammatory Status ◽

Intensity Rating ◽

Circulating Markers ◽

Post Hoc ◽

Abstract Purpose Patients receiving haemodialysis (HD) display elevated circulating microparticle (MP) concentration, tissue factor (TF) expression and markers of systemic inflammation, though regular intradialytic cycling (IDC) may have a therapeutic effect. This study investigated the impact of regular, moderate-intensity IDC on circulating MPs and inflammatory markers in unit-based HD patients. Methods Patients were cluster-randomised to intervention (n = 20, age: 51.4 ± 18.1 years, body mass: 77.6 ± 18.3 kg, mean ± SD) or no-exercise control (n = 20, 56.8 ± 14.0 years, 80.5 ± 26.5 kg). Intervention participants completed 30 min of moderate intensity (rating of perceived exertion [RPE] of 12–14) IDC, thrice weekly for 6 months. Pre-dialysis venous blood samples were obtained at 0, 3 and 6 months. Circulating MP phenotypes, cytokines, chemokine and MP TF expression were quantified using flow cytometry and cytometric bead array assays. Results Despite high exercise compliance (82%), no IDC-dependent effects were observed for any MP, cytokine or chemokine measure (p ≥ 0.051, ηρ2 ≤ 0.399) other than TNF-α (p = 0.001, ηρ2 = 0.186), though no significance was revealed upon post hoc analysis. Conclusion Six months of regular, moderate-intensity IDC had no effect on MPs, cytokines or chemokines. This suggests that the exercise did not exacerbate thrombotic or inflammatory status, though further functional assays are required to confirm this. Trial registration ISRCTN1129707, prospectively registered on 05/03/2015.

The Impact of Wrist Percooling on Physiological and Perceptual Responses during a Running Time Trial Performance in the Heat

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207559 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7559

Author(s):

Kelsey Denby ◽

Ronald Caruso ◽

Emily Schlicht ◽

Stephen J. Ives

Keyword(s):

Heart Rate ◽

Perceived Exertion ◽

Thermal Sensation ◽

Maximal Oxygen Consumption ◽

Time Trial ◽

Running Speed ◽

Running Time ◽

The Impact ◽

Trial Performance

Environmental heat stress poses significant physiological challenge and impairs exercise performance. We investigated the impact of wrist percooling on running performance and physiological and perceptual responses in the heat. In a counterbalanced design, 13 trained males (33 ± 9 years, 15 ± 7% body fat, and maximal oxygen consumption, VO2max 59 ± 5 mL/kg/min) completed three 10 km running time trials (27 °C, 60% relative humidity) while wearing two cooling bands: (1) both bands were off (off/off), (2) one band on (off/on), (3) both bands on (on/on). Heart rate (HR), HR variability (HRV), mean arterial pressure (MAP), core temperature (TCO), thermal sensation (TS), and fatigue (VAS) were recorded at baseline and recovery, while running speed (RS) and rating of perceived exertion (RPE) were collected during the 10 km. Wrist cooling had no effect (p > 0.05) at rest, except modestly increased HR (3–5 ∆beats/min, p < 0.05). Wrist percooling increased (p < 0.05) RS (0.25 ∆mi/h) and HR (5 ∆beats/min), but not TCO (∆ 0.3 °C), RPE, or TS. Given incomplete trials, the distance achieved at 16 min was not different between conditions (off/off 1.96 ± 0.16 vs. off/on 1.98 ± 0.19 vs. on/on 1.99 ± 0.24 miles, p = 0.490). During recovery HRV, MAP, or fatigue were unaffected (p > 0.05). We demonstrate that wrist percooling elicited a faster running speed, though this coincides with increased HR; although, interestingly, sensations of effort and thermal comfort were unaffected, despite the faster speed and higher HR.

Hemodynamic and Pressor Responses to Combination of Yoga and Blood Flow Restriction

International Journal of Sports Medicine ◽

10.1055/a-1171-1620 ◽

2020 ◽

Author(s):

Savannah V. Wooten ◽

Sten Stray-Gundersen ◽

Hirofumi Tanaka

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Perceived Exertion ◽

Oxygen Demand ◽

Blood Flow Restriction ◽

Myocardial Oxygen Demand ◽

Flow Restriction ◽

Pressor Responses ◽

AbstractA combination of yoga and blood flow restriction, each of which elicits marked pressor responses, may further increase blood pressure and myocardial oxygen demand. To determine the impact of a combination of yoga and blood flow restriction on hemodynamic responses, twenty young healthy participants performed 20 yoga poses with/without blood flow restriction bands placed on both legs. At baseline, there were no significant differences in any of the variables between the blood flow restriction and non-blood flow restriction conditions. Blood pressure and heart rate increased in response to the various yoga poses (p<0.01) but were not different between the blood flow restriction and non-blood flow restriction conditions. Rate-pressure products, an index of myocardial oxygen demand, increased significantly during yoga exercises with no significant differences between the two conditions. Rating of perceived exertion was not different between the conditions. Blood lactate concentration was significantly greater after performing yoga with blood flow restriction bands (p=0.007). Cardio-ankle vascular index, an index of arterial stiffness, decreased similarly after yoga exercise in both conditions while flow-mediated dilation remained unchanged. In conclusion, the use of lower body blood flow restriction bands in combination with yoga did not result in additive or synergistic hemodynamic and pressor responses.

Impact of Face Masks on Exercise Capacity and Lactate Thresholds in Healthy Young Adults

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2021-0198 ◽

2021 ◽

pp. 1-4

Author(s):

Wolf-Stephan Rudi ◽

Florian Maier ◽

Dominik Schüttler ◽

Antonia Kellnar ◽

Anna Katharina Strüven ◽

...

Keyword(s):

Perceived Exertion ◽

Cycle Ergometer ◽

Peak Performance ◽

Infection Rates ◽

Maximum Performance ◽

Healthy Female ◽

Blood Gas Parameters ◽

And Performance ◽

Background: Although many countries have introduced strict guidelines regarding mouth and nose coverage in public to contain infection rates during the SARS-CoV-2 pandemic, more information is needed regarding the impact of wearing face masks on lactate thresholds (LT) and performance parameters during exercise. Methods: Ten healthy male and 10 healthy female subjects (age = 33.4 [10.26] y, body mass index = 23.52 [2.36] kg/m2) performed 3 incremental performance tests, wearing no mask (NM), surgical mask (SM), and filtering face piece mask class 2 (FFP2), with a cycle ergometer. The authors analyzed changes in the LT, in blood gas parameters, and in the rating of perceived exertion (RPE). Results: Performance at LT remained unchanged in subjects wearing SM or FFP2 in comparison with NM (162.5 [50.6] vs 167.2 [58.9] vs 162.2 [58.4] W with NM, SM, and FFP2, respectively, P = .24). However, the peak performance was significantly reduced wearing FFP2 compared with NM (213.8 [71.3] vs 230.5 [77.27] W, FFP2 vs NM, respectively, P < .001). Capillary pCO2 was increased while wearing SM as well as FFP2 compared with NM (29 [3.1] vs 33.3 [4] vs 35.8 [4.9] mmHg with NM, SM, and FFP2, respectively; P < .001), and pO2 decreased under maximum performance (84 [6.7] vs 79.1 [7.5] vs 77.3 [8.2] mmHg with NM, SM, and FFP2, P < .01). Importantly, rating of perceived exertion was significantly increased by wearing FFP2 compared with NM at LT according to Mader (16.7 [2.7] vs 15.3 [1.8] FFP2 vs NM, respectively, P < .01). Conclusion: Wearing face masks during exercise showed no effect on LT, limited maximum performance, and induced discrete changes in capillary pCO2 and pO2 within the physiologic range while increasing RPE at LT.

Mechanisms of Performance Improvements Due to a Leading Teammate During Uphill Cycling

International Journal of Sports Physiology and Performance ◽

10.1123/ijspp.2017-0878 ◽

2018 ◽

Vol 13 (9) ◽

pp. 1215-1222 ◽

Cited By ~ 1

Author(s):

Theo Ouvrard ◽

Alain Groslambert ◽

Gilles Ravier ◽

Sidney Grosprêtre ◽

Philippe Gimenez ◽

...

Keyword(s):

Heart Rate ◽

Blood Lactate ◽

Perceived Exertion ◽

Lactate Concentration ◽

Blood Lactate Concentration ◽

Attentional Focus ◽

Strong Impact ◽

Competitive Cyclists ◽

Purpose: To identify the impact of a leading teammate in front of a cyclist on psychological, physiological, biomechanical, and performance parameters during an uphill maximal effort. Methods: After familiarization, 12 well-trained competitive cyclists completed 2 uphill time trials (UTTs, 2.7 km at 7.4%) in randomized order; that is, 1 performed alone (control condition) and 1 followed a simulated teammate during the entire UTT (leader condition). Performance (UTT time) and mean power output (PO) were recorded for each UTT. For physiological parameters, mean heart rate and postexercise blood lactate concentration were recorded. Psychological parameters (rating of perceived exertion, pleasure, and attentional focus) were collected at the end of each trial. Results: Performance (UTT time) significantly improved by 4.2% (3.1%) in the leader condition, mainly due to drafting decrease of the aerodynamic drag (58% of total performance gains) and higher end spurt (+9.1% [9.1%] of mean PO in the last 10% of the UTT). However, heart rate and postexercise blood lactate concentration were not significantly different between conditions. From a psychological aspect, higher pleasure was observed in the leader condition (+41.1% [51.7%]), but attentional focus was not significantly different. Conclusions: The presence of a leading teammate during uphill cycling had a strong impact on performance, enabling higher speed for the same mean PO and greater end spurt. These results explain why the best teams competing for the general classification of the most prestigious and contested races like the Grand Tours tend to always protect their leader with teammates during decisive ascents.

Effects of Physical Symptoms on Muscle Activity Levels in Skilled Violinists

Medical Problems of Performing Artists ◽

10.21091/mppa.2016.3024 ◽

2016 ◽

Vol 31 (3) ◽

pp. 125-131 ◽

Cited By ~ 5

Author(s):

JM McCrary ◽

Mark Halaki ◽

Bronwen J Ackermann

Keyword(s):

Muscle Activity ◽

Perceived Exertion ◽

Activity Patterns ◽

Trapezius Muscle ◽

Physical Symptoms ◽

Activity Levels ◽

Upper Trapezius ◽

Performance Results ◽

BACKGROUND: Physical symptoms present in a large percentage of instrumental musicians at all levels of expertise, yet the impact of these symptoms on patterns of muscle use and perceived exertion during performance is still unclear. PURPOSE: Quantify the effects of physical symptoms on muscle activity and perceived exertion in skilled violinists during a range of bowing actions. METHODS: Fifty-five professional or university (undergraduate or postgraduate) violinists performed 5 randomly ordered 45-second musical excerpts designed to elicit a range of right arm bowing actions. Surface electromyography data were obtained from 16 muscles of the trunk, shoulder, and right arm during each excerpt performance. Sites of current physical symptoms were reported using a pre-test questionnaire. Average rating of perceived exertion (RPE) for the excerpt performances was obtained immediately after the final excerpt performance. RESULTS: Right upper trapezius muscle activity levels were significantly reduced in participants reporting right shoulder symptoms (p<0.05). Violinists with right wrist symptoms displayed global increases in average muscle activity across all investigated muscles (p<0.03). RPE did not differ significantly between any groups of symptomatic and asymptomatic participants. CONCLUSION: Differential muscle activity patterns appear between right shoulder symptomatic, right wrist symptomatic, and asymptomatic violinists, presenting the possibility of altered biomechanical responses to physical symptoms that vary with symptom location.