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BackgroundRecent studies have revealed that many discharged patients with COVID-19 experience ongoing symptoms months later. Rehabilitation interventions can help address the consequences of COVID-19, including medical, physical, cognitive, and psychological problems. To our knowledge, no studies have investigated the effects of rehabilitation following discharge from hospital for patients with COVID-19. ObjectiveThe specific aims of this project are to investigate the effects of a 12-week exercise program on pulmonary fibrosis in patients recovering from COVID-19. A further aim will be to examine how Chinese herbal medicines as well as the gut microbiome and its metabolites regulate immune function and possibly autoimmune deficiency in the rehabilitation process. MethodsIn this triple-blinded, randomized, parallel-group, controlled clinical trial, we will recruit adult patients with COVID-19 who have been discharged from hospital in Hong Kong and are experiencing impaired lung function and pulmonary function. A total of 172 eligible patients will be randomized into four equal groups: (1) cardiorespiratory exercise plus Chinese herbal medicines group, (2) cardiorespiratory exercise only group, (3) Chinese herbal medicines only group, and (4) waiting list group (in which participants will receive Chinese herbal medicines after 24 weeks). These treatments will be administered for 12 weeks, with a 12-week follow-up period. Primary outcomes include dyspnea, fatigue, lung function, pulmonary function, blood oxygen levels, immune function, blood coagulation, and related blood biochemistry. Measurements will be recorded prior to initiating the above treatments and repeated at the 13th and 25th weeks of the study. The primary analysis is aimed at comparing the outcomes between groups throughout the study period with an α level of .05 (two-tailed). ResultsThe trial has been approved by the university ethics committee following the Declaration of Helsinki (approval number: REC/19-20/0504) in 2020. The trial has been recruiting patients. The data collection will be completed in 24 months, from January 1, 2021, to December 31, 2022. ConclusionsGiven that COVID-19 and its sequelae would persist in human populations, important findings from this study would provide valuable insights into the mechanisms and processes of COVID-19 rehabilitation. Trial RegistrationClinicalTrials.gov NCT04572360; https://clinicaltrials.gov/ct2/show/NCT04572360 International Registered Report Identifier (IRRID)PRR1-10.2196/25556

Summary: Mounting evidence shows that bisphenol A (BPA) is associated with metabolic risk factors. The aim of this study was to review related epidemiologic studies and conduct a meta‐analysis to quantitatively estimate the association between BPA and metabolic syndrome. Four electronic databases were systematically searched to identify suitable articles. A total of 47 published studies were finally included. Two studies involved metabolic syndrome. Of the 17, 17, 14, and 13 studies on the relationship between BPA with abdominal obesity, blood pressure, fasting plasma glucose, and dyslipidemia, 10, 6, 3, and 4 studies were included in the meta‐analysis, respectively. The results showed that the risk of abdominal obesity increased with the increase of BPA exposure, especially in the group with higher BPA exposure levels (Quartile 2 vs. Quartile 1, pooled OR = 1.16, 95%CI: 1.01, 1.33; Q3 vs. Q1, pooled OR = 1.31, 95%CI: 1.13, 1.51; Q4 vs. Q1, pooled OR = 1.40, 95%CI: 1.21, 1.61). However, there was no significant correlation between BPA exposure and metabolic syndrome components including hypertension, abnormal fasting plasma glucose, and dyslipidemia. The present study found that BPA exposure is significantly associated with a higher risk of abdominal obesity. However, the relationship between BPA with metabolic syndrome and its other components needs further longitudinal studies to verify. [ABSTRACT FROM AUTHOR]

This study examined the hypothesis that chronic (training) and acute (warm-up) loaded ventilatory activities applied to the inspiratory muscles (IM) in an integrated manner would augment the training volume of an interval running program. This in turn would result in additional improvement in the maximum performance of the Yo-Yo intermittent recovery test in comparison with interval training alone. Eighteen male nonprofessional athletes were allocated to either an inspiratory muscle loading (IML) group or control group. Both groups participated in a 6-week interval running program consisting of 3-4 workouts (1-3 sets of various repetitions of selected distance [100-2,400 m] per workout) per week. For the IML group, 4-week IM training (30 inspiratory efforts at 50% maximal static inspiratory pressure [[P.sub.o]] per set, 2 sets x [d.sup.-1], 6 d x [wk.sup.-1]) was applied before the interval program. Specific IM warm-up (2 sets of 30 inspiratory efforts at 40% [P.sub.o]) was performed before each workout of the program. For the control group, neither IML was applied. In comparison with the control group, the interval training volume as indicated by the repeatability of running bouts at high intensity was approximately 27% greater in the IML group. Greater increase in the maximum performance of the Yo-Yo test (control: 16.9 [+ or -] 5.5%; IML: 30.7 [+ or -] 4.7% baseline value) was also observed after training. The enhanced exercise performance was partly attributable to the greater reductions in the sensation of breathlessness and whole-body metabolic stress during the Yo-Yo test. These findings show that the combination of chronic and acute IML into a high-intensity interval running program is a beneficial training strategy for enhancing the tolerance to high-intensity intermittent bouts of running. KEY WORDS inspiratory muscle training, inspiratory muscle warm-up, breathlessness, metabolic

Introduction: COVID-19 lockdown measures have been sources of both potential stress and possible psychological and addiction complications. A lack of activity and isolation during lockdown are among the factors thought to be behind the growth in the use of psychoactive substances and worsening addictive behaviors. Previous studies on the pandemic have attested to an increase in alcohol consumption during lockdowns. Likewise, data suggest there has also been a rise in the use of cannabis, although it is unclear how this is affected by external factors. Our study used quantitative data collected from an international population to evaluate changes in cannabis consumption during the lockdown period between March and October, 2020. We also compared users and non-users of the drug in relation to: (1) socio-demographic differences, (2) emotional experiences, and (3) the information available and the degree of approval of lockdown measures. Methods: An online self-report questionnaire concerning the lockdown was widely disseminated around the globe. Data was collected on sociodemographics and how the rules imposed had influenced the use of cannabis and concerns about health, the economic impact of the measures and the approach taken by government(s). Results: One hundred eighty two respondents consumed cannabis before the lockdown vs. 199 thereafter. The mean cannabis consumption fell from 13 joints per week pre-lockdown to 9.75 after it (p < 0.001). Forty-nine respondents stopped using cannabis at all and 66 admitted to starting to do so. The cannabis users were: less satisfied with government measures; less worried about their health; more concerned about the impact of COVID-19 on the economy and their career; and more frightened of becoming infected in public areas. The risk factors for cannabis use were: age (OR = 0.96); concern for physical health (OR = 0.98); tobacco (OR = 1.1) and alcohol consumption during lockdown (OR = 1.1); the pre-lockdown anger level (OR = 1.01); and feelings of boredom during the restrictions (OR = 1.1). Conclusion: In a specific sub-population, the COVID-19 lockdown brought about either an end to the consumption of cannabis or new use of the drug. The main risk factors for cannabis use were: a lower age, co-addictions and high levels of emotions. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has initiated an upheaval in society and has been the cause of considerable stress during this period. Healthcare professionals have been on the front line during this health crisis, particularly paramedical staff. The aim of this study was to assess the high level of stress of healthcare workers during the first wave of the pandemic. Materials and methods: The COVISTRESS international study is a questionnaire disseminated online collecting demographic and stress-related data over the globe, during the pandemic. Stress levels were evaluated using non-calibrated visual analog scale, from 0 (no stress) to 100 (maximal stress). Results: Among the 13,537 individuals from 44 countries who completed the survey from January to June 2020, we included 10,051 workers (including 1379 healthcare workers, 631 medical doctors and 748 paramedical staff). The stress levels during the first wave of the pandemic were 57.8 ± 33 in the whole cohort, 65.3 ± 29.1 in medical doctors, and 73.6 ± 27.7 in paramedical staff. Healthcare professionals and especially paramedical staff had the highest levels of stress (p < 0.001 vs non-healthcare workers). Across all occupational categories, women had systematically significantly higher levels of work-related stress than men (p < 0.001). There was a negative correlation between age and stress level (r = -0.098, p < 0.001). Healthcare professionals demonstrated an increased risk of very-high stress levels (>80) compared to other workers (OR = 2.13, 95% CI 1.87–2.41). Paramedical staff risk for very-high levels of stress was higher than doctors' (1.88, 1.50–2.34). The risk of high levels of stress also increased in women (1.83, 1.61–2.09; p < 0.001 vs. men) and in people aged <50 (1.45, 1.26–1.66; p < 0.001 vs. aged >50). Conclusions: The first wave of the pandemic was a major stressful event for healthcare workers, especially paramedical staff. Among individuals, women were the most at risk while age was a protective factor. [ABSTRACT FROM AUTHOR]

Background: Kinetics, moderators and reference limits for exercise-induced cardiac troponin T (cTnT) elevations are still unclear. Methods: A systematic review of published literature was conducted adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies reporting high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after a bout of exercise in athletes were included and analyzed. The final dataset consisted of 62 estimates from 16 bouts in 13 studies of 5–1,002 athletes (1,421 in total). Meta-analysis was performed using general linear mixed modeling and Bayesian inferences about effect magnitudes. Modifying fixed-effect moderators of gender, age, baseline level, exercise duration, intensity and modalities were investigated. Simulation was used to derive 99th percentile with 95% limits of upper reference ranges for hs-cTnT of athletic populations. Results: The mean and upper reference limits of hs-cTnT before exercise were 4.4 and 19 ng.L−1. Clear increases in hs-cTnT ranging from large to very large (factor changes of 2.1–7.5, 90% compatibility limits, ×/÷1.3) were evident from 0.7 through 25 h, peaking at 2.9 h after the midpoint of a 2.5-h bout of running, when the mean and upper reference limit for hs-cTnT were 33 and 390 ng L−1. A four-fold increase in exercise duration produced a large clear increase (2.4, ×/÷1.7) in post-exercise hs-cTnT. Rowing exercise demonstrated an extremely large clear reduction (0.1 ×/÷2.4). Conclusions: The kinetics of cTnT elevation following exercise, the positive effect of exercise duration, the impact of exercise modality and 99th upper reference limits for athletic populations were reasonably well defined by this meta-analysis. [ABSTRACT FROM AUTHOR]

We examined the effects of descending (DSE) or ascending (ASE) stair exercise on body composition, insulin sensitivity, and inflammatory markers in young Chinese women with obesity. Thirty-six participants were randomly assigned into three groups DSE, ASE and a control group. The DSE and ASE groups performed three sessions of stair walking per week for 12 weeks with a gradual increase in repetitions. Following the exercise interventions, body composition related variables obtained by Dual-energy X-ray absorptiometry scans significantly decreased. Abdominal fat decreased in the DSE group only. Moreover, Insulin sensitivity improved significantly 3.5-fold in the DSE group compared with ASE group (insulin: −33.2% vs. −9.8%, homoeostasis model assessment for insulin resistance: −35.6% vs. −10.8%). Pro-inflammatory factors showed significant decreases in tumour necrosis factor-α (TNF-α) (−39.9% vs. −23.2%) for both intervention groups. The reduction in TNF-α concentrations in the DSE group was significantly different compared to the other two groups. Interleukin-6 significantly decreased in both exercise protocols. Our results show that 12-weeks induced stair walking improved body composition parameters in Chinese females with obesity. The results also demonstrate the superiority of the DSE protocol for improving insulin sensitivity. These findings may be attributable to the decreases observed in TNF- α levels. [ABSTRACT FROM AUTHOR]

Childhood obesity continues to be a serious problem. The outbreak of the COVID-19 pandemic has led to great life-changing challenges amongst schoolchildren, which might subsequently aggravate existing childhood obesity issues. We suggest that educators and schools need to provide solutions to the problem. [ABSTRACT FROM AUTHOR]

The article examines long-term comprehension of the effects of the pandemic, to create effective preventive strategies. Topics discussed include ways in which COVID-19 pandemic also exacerbated the inequalities in public health, impact of prolonged period of social distancing aiming to reduce transmission of SARS-CoV2, and increase in boredom and sadness experienced in lockdown situations.

Highlights • Different factor structures of the SFT were observed among women and men older adults. • The factor structure of the SFT was better represented by a second-order 4-factor model for men sample. • The factor structure of the SFT was better represented by a second-order 5-factor model for women sample. • BMI was not significantly associated with the latent variable of functional fitness in the men sample. • Normal body weight and overweight participants responded to the SFT testing items in similar ways. Abstract Objectives This study examined the factor structure of the Senior Fitness Test and examined its measurement and structural invariance across participants with normal body weight and participants who were overweight. Methods Eight hundred and forty-five community-dwelling older adults in Hong Kong participated in this study. Their functional fitness was assessed using the Senior Fitness Test. Confirmatory factor analysis was conducted to examine and compare two competing models: a one-factor model and a second-order model. Multiple-group confirmatory factor analysis was conducted to evaluate the measurement and structural invariance of the SFT measurement model. Multiple fit indices were used to evaluate the adequacy of the model fit to the data. Results The second-order model outperformed the one-factor model. For men participants, the second-order 4-factor model was indicated, while for women participants, the second-order 5-factor model was evidenced. The measurement and structural invariance of the SFT measurement model across normal weight and overweight participants were also supported. Conclusion This study provided initial evidence for the construct validity of the SFT. However, there were some differences in the factor structure of the SFT for men and women participants. Body composition did not necessarily reflect the functional fitness of men participants. All of the older adults responded to the testing items in a similar way regardless of body weight status in both men and women samples. The significance of each component for functional fitness was also similar for participants with different body weight statuses. [ABSTRACT FROM AUTHOR]

The purposes of the current study were (a) to assess the reliability of reproducing exercise intensity at a given effort rating during cycle ergometry using the Cantonese translated Borg's standard 6-20 rating of perceived exertion (RPE) scale and the 1-10 Children's Effort Rating (CERT) scale, and (b) to determine whether there is gender difference in the exercise responses at a given level of CERT or RPE ratings. Thirty boys and 30 girls aged 9-12 years were randomly assigned equally in gender to one of the following two groups: RPE and CERT. Each child performed two trials of four exercise bouts in either at CERTs 3, 5, 7 and 9 or at RPEs 8, 12, 15 and 18 in random order and on two separate days. Heart rate (HR), oxygen consumption (VO2 ) and the final regulated power output (PO) at each rating level were measured. The results suggested that the boys and girls were able to comprehend both scales and use them to guide the regulation of exercise power output. The increase in power output reported by the children at each scale level coincided with the increase in power output regulated by the children, with concomitant increases in HR and VO 2 providing evidence that the children understood and were able to differentiate the concept of the scale level. This study was the first with the Cantonese translated RPE and CERT scales using production cycling protocol. The findings provided evidence for the validity of the Cantonese CERT and RPE scale. [ABSTRACT FROM AUTHOR]

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Objective This study aimed to explore the relationship between the functional fitness (FF) and health-related quality of life (HRQoL) in older adults, and to identify the key subdimensions of FF and HRQoL influencing their overall relationship. Methods This cross-sectional study was performed among 851 independent community members (65–84 years; men = 402). The Senior Fitness Test and the Short Form 36 Health Survey were used to measure FF and HRQoL, respectively. A canonical correlation analysis was conducted using seven fitness variables as predictors of eight HRQoL variables to examine the relationship between FF and HRQoL. Results The overall FF was positively correlated with the overall HRQoL in both men (canonical correlation = 0.350) and women (canonical correlation = 0.456). The up-and-go and 2-min step contributed the most to FF, and physical functioning contributed the most to HRQOL among men. Conversely, the up-and-go and 30-s chair stand contributed the most to FF, and physical functioning contributed the most to HRQoL in women. Conclusions There were positive and moderate relationships between overall FF and overall HRQOL in older adults. The FF has a significant influence on HRQoL, particularly physical functioning. The main FF components influencing the relationship between FF and HRQoL in men are balance and agility and aerobic endurance, whereas in women they are balance and agility and lower extremity muscle strength. Results from this study facilitate comprehensively understanding the relationship between FF and HRQoL, and generating critical insight into HRQoL improvement from the perspective of FF enhancement. [ABSTRACT FROM AUTHOR]

Objective This study aimed to establish normative data for older adults in Hong Kong and explore age and sex differences in functional fitness. Methods A sample of 944 independent community-dwellers, aged 65–74 years, was evaluated using the Senior Fitness Test battery in addition to hand grip and single leg stance tests. Normative data were reported for the 10th, 25th, 50th, 75th, and 90th percentiles in 5-year age groups. Results Except for upper extremity muscle strength in women and body mass index (BMI) in both sexes, ageing-associated degradation was observed in all testing parameters especially in flexibility, balance, and agility. Significant sex differences were found in all testing parameters with the exception of BMI and static balance with eyes open. Moreover, men demonstrated higher capacities for muscle strength, agility, balance, and aerobic endurance, whereas women showed superior flexibility. Conclusion The normative values enable the evaluation of individual performance regarding the fitness status of older adults in Hong Kong. [ABSTRACT FROM AUTHOR]