Changes in respiratory function and physical performance in middle-aged and old inpatients recovering from COVID-19 after a rehabilitation program

Степень изменений дыхательной функции и физической подготовленности у пациентов, выздоравливающих после COVID-19, представляет интерес для реабилитационных мер. 56 пациентов (67 % - женщины), средний возраст - 64±11 лет, перенесшие COVID-19, прошли курс комплексной реабилитации (16,9±3,8 дня). После курса реабилитации пациенты показали улучшение дыхательной функции: проба Штанге - на 19 % (p=0,006), проба Генчи - на 25 % (p=0,026), улучшение самочувствия по результатам КТ легких (p<0,001); повышение физической подготовленности: скорость привычной ходьбы - на 80 % (р=0,025); толерантности к физической нагрузке: пройденное расстояние до первых признаков утомления - на 227 % (р<0,001), ЧСС в покое - на 1 % (р=0,011). Темпы изменений дыхательной функции и физической подготовленности были значительными и превышали подобные изменения, приводимые в литературе для относительно здоровых пожилых людей, которые приступают к физическим занятиям. Однако абсолютные показатели функции дыхания и физической подготовленности после реабилитационной программы были ниже нормированных значений для данного возраста. Данные результаты могут быть полезны для клиницистов при составлении программы реабилитации пациентов, перенёсших COVID-19. Changes in respiratory and physical performance in geriatric inpatients recovering from COVID-19 are of interest for rehabilitation interventions. 56 inpatients (67 % women), average age 64±11 years recovering from COVID-19 underwent a comprehensive rehabilitation program (16,9±3,8 days). After the rehabilitation program, the patients showed an improvement in respiratory function: voluntary breath-holding after inhalation - by 19 % (p=0,006), breath-holding after exhalation - by 25 % (p=0,026), lungs computed tomography (p<0,001); physical performance: handgrip strength - by 14 % (p=0,083), preferred walking speed - by 80 % (p=0,025); exercise tolerance: distance walked until the first signs of fatigue - by 227 % (p<0,001), resting heart rate - by 1 % (p=0,011). The interaction of rehabilitation time and patient sex was statically nonsignificant across all variables of interest. The rates of changes in respiratory function and physical performance were significant and exceeded similar changes recorded in healthy old people who begin an exercise program. However, in absolute values, respiratory function and physical performance values after the rehabilitation were lower than reference values for this age group. These results can be valuable for clinicians when designing a rehabilitation program for geriatric patients recovering from COVID-19.

Fatty Liver Index and Skeletal Muscle Density

Accumulation of fat in the liver and skeletal muscle is associated with obesity and poor health outcomes. Liver steatosis is a characteristic of non-alcoholic fatty liver disease (NAFLD) and myosteatosis, of poor muscle quality in sarcopenia. In this study of 403 men (33–96 years), we investigated associations between the fatty liver index (FLI) and muscle density, as markers of fat accumulation in these organs. We also investigated associations between the FLI and parameters of sarcopenia, including DXA-derived appendicular lean mass (ALM) and handgrip strength by dynamometry. Muscle density was measured using pQCT at the radius and tibia. FLI was calculated from BMI, waist circumference, and levels of triglycerides and gamma-glutamyltransferase. There was a pattern of decreasing muscle density across increasing quartiles of FLI. After adjusting for age and lifestyle, mean radial muscle density in Q4 was 2.1% lower than Q1 (p < 0.001) and mean tibial muscle density was 1.8% lower in Q3 and 3.0% lower in Q4, compared to Q1 (p = 0.022 and < 0.001, respectively). After adjusting for age and sedentary lifestyle, participants in the highest FLI quartile were sixfold more likely to have sarcopenia. In conclusion, our results suggest that fat accumulation in the liver co-exists with fat infiltration into skeletal muscle.

Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in 5 Spanish NHs. UI (measured with Minimum Data Set 3.0.), sociodemographic and health-related variables were collected. Chi- square (or Fisher&rsquo;s) or Student&rsquo;s t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6&ndash;77.2) and was significantly associated with frailty (PR 1.84; 95%CI 0.96&ndash;3.53), faecal incontinence (FI) (PR 1.65; 95%CI 1.02&ndash;2.65), anxiety (PR 1.64; 95%CI 1.01&ndash;2.66), physical performance (PR 1.77; 95%CI 1.00&ndash;3.11) and cognitive state (PR 1.95; 95%CI 1.05&ndash;3.60). Statistically significant differences between incontinent-continent groups were found for activities of daily living (ADL) limitations, mobility, quality of life, sedentary behaviour (SB) and handgrip strength. It can be concluded that 2/3 of the residents experienced UI, and its significant associated factors were mainly physical (SB, frailty, physical performance, ADL limitations, mobility, FI and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety and quality of life).

Routine cancer treatments and their impact on physical function, symptoms of cancer-related fatigue, anxiety, and depression

Background and purpose Breast cancer can be a major challenge for affected women. Knowledge of the physical function, symptoms of cancer-related fatigue, anxiety, and depression based on the cancer treatment may help to guide adequate support. Methods For this prospective observational study, we collected data from seventy-nine women with a mean age 54.6 ± 9.5 years prior to the onset of breast cancer treatment (T0) and after (T1/T2). Handgrip strength test (HGS), six-minute walk test (6MWT), the phase angle (PhA), the hospital anxiety and depression scale (HADS), and functional assessment of chronic illness therapy-fatigue (FACIT-F) were used to collect data from four treatment subgroups SC, surgery + chemotherapy; SCR, surgery + chemotherapy + radiation therapy; SR, surgery + radiation therapy; and S, surgery. Results A mixed ANOVA revealed a significant interaction between time and group for PhA, F = 8.55, p < 0.01; HGS, F = 3.59, p < 0.01; 6MWT, F = 4.47, p < 0.01; and FACIT-F, F = 2.77, p < 0.05 with most pronounced deterioration seen in group SCR (PhA 4.8°; HGS 27.5 kg, 6MWT 453.4 m, FACIT-F 33.8 points). HADS data displayed moderate anxiety and depression predominantly after treatment. Conclusion Our study showed that the extent of change in physical function, symptoms of fatigue, anxiety, and depression depends on the treatment conditions. The potentially higher risk of impaired function due to the prevalence of values below a critical threshold requires early initiated multidisciplinary support.

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 (&lt;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.

Effects of Reallocating Time Spent in Different Physical Activity Intensities on Sarcopenia Risk in Older Adults: An Isotemporal Substitution Analysis

The role of daily time spent sedentary and in different intensities of physical activity (PA) for the maintenance of muscle health currently remains unclear. Therefore, we investigated the impact of reallocating time spent in different PA intensities on sarcopenia risk in older adults, while considering PA type (muscle strengthening activities, MSA) and protein intake. In a sample of 235 community-dwelling older adults (65–70 years), a sarcopenia risk score (SRS) was created based on muscle mass assessed by bioimpedance, together with handgrip strength and performance on the five times sit-to-stand (5-STS) test assessed by standardized procedures. Time spent in light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and being sedentary was assessed by accelerometry, and PA type (MSA) by self-report. Linear regression models based on isotemporal substitution were employed. Reallocating sedentary time to at least LPA was significantly (p < 0.05) related to a lower SRS, which remained evident after adjustment by PA type (MSA) and protein intake. Similarly, reallocating time in LPA by MVPA was related to a significantly (p < 0.05) lower SRS. Our results emphasize the importance of displacing sedentary behaviours for more active pursuits, where PA of even light intensities may alleviate age-related deteriorations of muscle health in older adults.

Combined driving: task-specific position impacts grip strength of equestrian athletes

Background Loss of hand strength is a predictor of mortality in aging populations. Despite reliance on the hands to participate in equestrian driving activity, no existing studies focus on associations of hand strength to athletic performance. Therefore, this study 1) established baseline handgrip of equestrian combined drivers in standing and task-specific positions, 2) determined endurance of task-specific handgrip, 3) compared handgrip strength to normative data, and 4) evaluated associations of handgrip and equestrian-specific variables. Methods There were 51 combined drivers (9 males, 42 females) ages 21–78 who completed a survey, standing handgrip, and grip strength and endurance in a task-specific position. Sixty-three percent of participants were 50 years or older. The dynamometer grip bar was normalized by hand size for standing tests; to duplicate sport-specific tasks, the bar was set to the closest setting. Significances were determined at p < 0.05. Results Drivers with more than 30 years of experience demonstrated highest summed standing (73.1 ± 5.2 kg) and summed sitting (59.9 ± 6.3 kg) grip strength. Females 60-years and older had greater handgrip endurance (Χ2 = 8.323, df = 2, p = .0156) in non-dominant (left) hands. Males (60%) reported more cold weather fatigue than females. Glove wearing was associated with bilateral endurance balance; a higher proportion of endurance balance between dominant and non-dominant (49% high-high and 29% low-low; Χ2 = 11.047, df = 1, p = .0009) was realized. There were no associations of handgrip and prior injury. Conclusions Our results have implications in understanding task-specific and normative grip strengths in aging equestrian populations. Bilateral balance in handgrip strength and endurance is important particularly in maintaining strength in non-dominant hands over time. Equestrian driving sport promotes greater endurance in older females. Strength can be improved by participating in combined driving, and engagement in this sport over several years’ benefits hand strength over time. This cohort of equestrian participants provides evidence that participating in hand-specific activities promotes greater strength, which has been previously shown to improve aging outcomes.

Ultrasound-Derived Diaphragm Contractile Reserve as a Marker of Clinical Status in Patients With Cystic Fibrosis

Introduction: In patients with cystic fibrosis (CF), the monitoring of respiratory muscle activity using electromyography can provide information on the demand-to-capacity ratio of the respiratory system and act as a clinical marker of disease activity, but this technique is not adapted to routine clinical care. Ultrasonography of the diaphragm could provide an alternative, simpler and more widely available alternative allowing the real-time assessment of the diaphragm contractile reserve (DCR), but its relationship with recognized markers of disease severity and clinical outcomes are currently unknown.Methods: Stable patients with CF were prospectively recruited. Diaphragm ultrasound was performed and compared to forced expiratory volume in 1 s (FEV1), residual volume (RV), handgrip strength, fat-free mass index (FFMI), serum vitamin levels, dyspnea levels and rate of acute exacerbation (AE). Diaphragm activity was reported as DCR (the ratio of tidal-to-maximal thickening fractions, representing the remaining diaphragm contractility available after tidal inspiration) and TFmax (representing maximal diaphragm contractile strength). Inter-observer reliability of the measurement of DCR was evaluated using intra-class correlation analysis.Results: 110 patients were included [61 males, median (interquartile range), age 31 (27–38) years, FEV1 66 (46–82)% predicted]. DCR was significantly correlated to FEV1 (rho = 0.46, p &lt; 0.001), RV (rho = −0.46, p &lt; 0.001), FFMI (rho = 0.41, p &lt; 0.001), and handgrip strength (rho = 0.22, p = 0.02), but TFmax was not. In a multiple linear regression analysis, both RV and FFMI were independent predictors of DCR. DCR, but not TFmax, was statistically lower in patients with &gt; 2 exacerbations/year (56 ± 25 vs. 71 ± 17%, p = 0.001) and significantly lower with higher dyspnea levels. A ROC analysis showed that DCR performed better than FEV1 (mean difference in AUROC 0.09, p = 0.04), RV (mean difference in AUROC 0.11, p = 0.03), and TFmax at identifying patients with an mMRC score &gt; 2. Inter-observer reliability of DCR was high (ICC = 0.89, 95% CI 0.84–0.92, p &lt; 0.001).Conclusion: In patients with CF, DCR is a reliable and non-invasive marker of disease severity that is related to respiratory and extra-pulmonary manifestations of the disease and to clinical outcomes. Future studies investigating the use of DCR as a longitudinal marker of disease progression, response to interventions or target for therapy would further validate its translation into clinical practice.