Out of concern that COVID19 has created a situation in which at-risk patients are confined with little or no access to face-to-face health care, we performed an out-of-hospital screening of health ...status and lifestyle habits remotely among patients who recently underwent bariatric surgery, a condition that requires systematic health care follow-up to ensure the safety and the benefits of the surgical procedure. Reference values were < 120 mmHg and/or < 80 mmHg for systolic and diastolic blood pressure; < 80 cm and < 94 cm for waist circumference for men and women, respectively; <99 mg/dL for fasting glucose level; < 150 mg/dL, > 40 mg/dL, < 129 mg/dL, and < 190 mg/dL for triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol, respectively; and < 5.0 mg/dL for CRP. Through phone calls, participants responded to a questionnaire about adherence to daily vitamin/mineral supplementation, binge eating (1), depression symptoms (2), anxiety (3), health-related quality of life (4), and physical activity level (5).
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,
= 27) or noninvasive support therapy (PASC + NIS,
= 25). Patients underwent pulmonary function and cardiopulmonary exercise testing (CPX) and were compared with a reference group (CONTROL,
= 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
< 0.05). Only the rate of abnormal oxygen pulse was greater among PASC + IMV group than PASC + NIS group (
= 0.05). Mean estimates for all CPX variables were comparable between PASC + IMV and PASC + NIS groups (all
> 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.
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.
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.
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.
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 VO
). After the intervention, remarkable improvements in VO
(from 10.61 to 15.48 mL·kg
·min
, Δ: 45.9%), oxygen uptake efficiency slope (OUES; from 1.0 to 1.3 L·min
, Δ: 30.1%), HR/VO
slope (from 92 to 52 bpm·L
, Δ: -43.5%), the lowest VE/VCO
ratio (from 35.4 to 32.9 L·min
, 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.
Santagnello, SB, Martins, FM, de Oliveira Junior, GN, de Sousa, JdeFR, Nomelini, RS, Murta, EFC, and Orsatti, FL. Resistance training-induced gains in muscle strength and power mediate the ...improvement in walking speed in middle-aged women who are breast cancer survivors. J Strength Cond Res 38(4): 773-782, 2024-(a) Ascertain whether lower muscle mass, strength (1 repetition maximum 1RM), and power (Pmax) in middle-aged women who are breast cancer survivors (BCS), when compared with women of a similar age never diagnosed with cancer (WNC), are related with lower walking speed (WS). (b) Ascertain whether changes in WS are associated with changes in muscle mass, 1RM, and (or) Pmax after resistance training (RT) in middle-aged BCS. A cross-section study was performed. Twenty WNC and 21 BCS were evaluated for lean mass of legs (LLM), 1RM (knee extension), muscle quality index (MQI = 1RM/LLM), Pmax (maximum muscle power-knee extension), and fast WS (10 and 400-meters). Randomized clinical trial was performed. The BCS were randomly divided into the control group ( n = 9) and the RT group ( n = 11). Breast cancer survivors exhibited lower 1RM (24.2%, p ˂ 0.001), Pmax (30.6%, p ˂ 0.001), MQI (22.2%, p = 0.001), and WS (10-m = 17.0%, p ˂ 0.001 and 400-m = 10.5%, p = 0.002) than WNC. Resistance training increased 1RM (31.6%, p = 0.001), MP (29.0%, p = 0.012), MQI (28.5%, p = 0.008), and WS (10-m = 9.4%, p = 0.009 and 400-m = 6.2%, p = 0.006) in BCS. The changes in WS were positively associated with 1RM (10-m = 68%, p = 0.001 and 400-m = 37%, p = 0.036) and Pmax (10-m = 56%, p = 0.005 and 400-m = 40%, p = 0.027) and MQI (10-m = 63%, p = 0.043 and 400-m = 37%, p = 0.035). Resistance training-induced gains in muscle strength and power mediate the improvement in WS in middle-aged BCS. Resistance training is an effective strategy to improve WS in middle-aged BCS.
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