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The effects of exercise therapy on the prognosis of patients with COVID-19

At the end of 2019, a pneumonia caused by a new pneumonia virus declares its fast spread throughout the World, and thus brings a great impact on global public Health, Health care system and economic development. On February 7, 2020, the World Health Organization (WHO) designated COVID-19 as Corona Virus Disease 2019 (COVID-19). Genome sequencing has confirmed that COVID-19 is similar to SARS-CoV and bat coronavirus, but the main source, mode of transmission, and mechanisms associated with human pathogenicity of this pandemic outbreak are unknown. At the beginning, COVID-19 is characterized by fever, dry cough, fatigue, and then dyspnea. In severe cases, it may progress to acute respiratory distress syndrome, septic shock, or even death Pneumonia often affects both lungs and presents mainly in the lower lobe, it is more severe in elderly patients over 70 years of age and in patients with various complications. Most children and young adults with SARS-COV-2 develop mild to moderate influenza-like symptoms and have a good prognosis. In addition to respiratory symptoms, some patients also experience digestive problems such as vomiting and diarrhea. The transmission mode of the virus is to enter the human body through mucous membranes, especially the mucous membranes of the nose and throat, and reach the lungs through the respiratory tract, and quickly replicate and spread. virus can be asymptomatic infection close (2 meters) cough or sneeze droplets spread, this is the main way for the spread of the virus. The fecal-oral route may also be a route of infection, as tests have shown that the virus is present in the feces and urine of COVID-19 patients. The main treatment for COVID-19 is symptomatic treatment, with critical patients receiving organ support. The use of drugs by antiviral drugs, protease inhibitors and a variety of drugs combined application, the purpose is to reduce the patient’s clinical symptoms. Traditional Chinese medicine (TCM) has also been widely used in COVID-19 patients in China. In clinical treatment, combined with conventional symptomatic treatment, good therapeutic effect has been achieved.

Exercise therapy refers to the use of equipment, freehand or patient’s own strength, exercise therapy through some means of movement (active or passive movement, etc.), so that patients get the whole body or local motor function, sensory function recovery training methods. Long-term outcomes for COVID-19 are not fully understood. Based on existing clinical studies, the possible results can be briefly categorized as follows:

  • 1. Lung injury that may develop, especially in severe cases of pneumonia or acute respiratory distress syndrome (ARDS);
  • 2. Complications during intensive care, such as fixation;
  • 3. Possible consequences and complications of neurological symptoms or disease caused by COVID-19;
  • 4. Lack of exercise, changes in eating habits, insomnia and psychological problems during isolation or isolation.

For patient rehabilitation exercise and abdominal breathing training exercise therapy can effectively increase the patient breathe out capacity, improve lung function. Through training exercise therapy in patients with upper limb muscles, lower limb muscles, walking training, breathing training, etc., can reduce patients with dyspnea condition, improve the patients’ pulmonary ventilation, pulmonary ventilation function, reduce the patients’ sputum, cough, improve function of limbs movement, make the patients life self-care ability, the effect of COVID – 19 has a benign prognosis.

Methods and analysis: 

The scheme was systematically reviewed in accordance with the preferred reporting items. We searched the following experimental databases: Cochrane Library, PubMed, EMBASE, Web of Science, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure Database (CNKI), China Science and Wanfang Database. All trials using exercise therapy for rehabilitation of COVID-19 patients in the above database should be considered for inclusion. Relevant randomised controlled trials(RCTS), controlled before and after, interrupted time series and prospective analytic cohort studies regardless of publication date, language and geographic location, will be included. To summarize the therapeutic effect of exercise therapy on COVID-19 patients, high-quality literature was selected for data extraction and analysis. Two reviewers will independently screen titles, abstracts and full-text articles against inclusion criteria; perform data extraction and assess risk of bias in included studies. We will assess the certainty of the overall evidence using the Grading of Recommendations Assessment, Development and Evaluation approach and report findings accordingly.


Since the COVID-19 outbreak in 2020, more than 20 million people worldwide have been diagnosed with COVID-19, and all health care workers are looking for ways to improve the cure rate of the disease. As an important method of rehabilitation therapy, exercise therapy has been proved to improve the level of human function, promote the recovery of diseases, and improve the human immune ability. The main objective of this study was to provide reliable methods and credible evidence for exercise therapy to improve the prognosis of COVID-19 patients.

 December 18, 2020

Qiu, Guorong PhDJi, Yu PhD; Tan, Yajun PhDHe, Benxiang MDTan, Chunfeng BS; Wang, Zhuoling BS Gao, Hongpan BS

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Effects of interrupting prolonged sitting on postprandial glycemia and insulin responses: A network meta-analysis

  • Cardiovascular disease (CVD) is the leading cause of death worldwide. CVD survivors often experience a low quality of life and high cost of medical treatment and rehabilitation, which may cause great psychological and financial burden on patients and their families. Therefore, effective early interventions in the modifiable risk factors for CVD is of great significance to clinical and public health practice. Postprandial hyperglycemia and hyperinsulinemia are considered as independent predictors for the development of future CVD, and thus effective interventions to lower postprandial hyperglycemia and hyperinsulinemia could be important for CVD prevention.
  • Excessive sitting time is widespread and has been shown to be independently associated with the risk of CVD. Since observational studies have shown that interrupting prolonged sitting (PS) is associated with better cardiovascular risk factor profile, many experimental studies have assessed the effects of interrupting PS with physical activity (PA) breaks on postprandial glycemia and insulin responses among various populations. Most, if not all, studies have suggested that interrupting PS with moderate-intensity PA (MPA) to vigorous-intensity PA (VPA) breaks—and even light-intensity PA (LPA) breaks—can lead to positive effects on postprandial glycemia and/or insulin responses. Three pairwise meta-analyses conducted in 2015, 2018, and 2019 synthesized the findings of 6, 20, and 37experimental studies, respectively, and concluded that interrupting PS had positive effects on postprandial glycemia and insulin responses. For the following reason, however, additional research, using a novel network meta-analysis (NMA), is needed to quantitatively review and summarize the latest literature: (1) the conclusions of previous meta-analyses should be revisited given the increased numbers of new publications issued since the meta-analyses were conducted; (2) the optimal strategy for reducing postprandial glycemia and insulin responses among the different interventions should be identified using NMA, which allows for comparing multiple treatments sharing one common comparator treatment that were not directly compared with one another in head-to-head studies; and (3) NMA can integrate evidence retrieved from direct and indirect comparisons and thus has potential to improve the precision of intervention effect estimates.
  • Therefore, our review aims to perform an NMA to systematically evaluate the potential effects of various interventions that interrupt PS with PA on the postprandial glycemia and insulin responses among adults without chronic diseases. Identification of the effect of different characteristics of PA interventions that are optimally, or at least minimally, effective as strategies for postprandial glycemia and insulin control will help narrow the range of intervention strategies employed in future research and practice.
  • Purpose
  • This study aimed to evaluate the effectiveness of physical activity (PA) interrupting prolonged sitting (PS) on postprandial glycemia and insulin responses among adults.
  • Methods
  • PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, PsycINFO, and the China National Knowledge Infrastructure databases were searched through September 30, 2020. Randomized controlled trials (RCTs) that examined the effect of all forms of PA interrupting PS on postprandial glycemia and/or insulin responses among adults without chronic diseases were included in this study. The risk of bias of included studies was evaluated based on the Cochrane tool. A network meta-analysis was performed to estimate the summary standardized mean differences (SMDs) with 95% confidence intervals (95%CIs) with random effects.
  • Results
  • Thirty crossover RCTs were included in our review. These RCTs included 9 types of interventions that interrupted PS. When compared to PS by itself, light-intensity PA intermittent interrupting (LPA-INT) PS and moderate-intensity PA intermittent interrupting (MPA-INT) PS significantly lowered postprandial glycemia (SMD = –0.46, 95%CI: –0.70 to –0.21; SMD = –0.69, 95%CI: –1.00 to –0.37, respectively) and significantly reduced postprandial insulin response (SMD = –0.46, 95%CI: –0.66 to –0.26; SMD = –0.47, 95%CI: –0.77 to –0.17, respectively). Results of the clustered ranking plot indicated that MPA-INT was the most effective intervention in lowering postprandial glycemia and insulin responses.

July 2021


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Immediate effect of high-intensity exercise on brain-derived neurotrophic factor in healthy young adults: A systematic review and meta-analysis

  • Brain-derived neurotrophic factor (BDNF), a protein member of the neurotrophin family of growth factors, has been associated with the modulation of cognition, neuroplasticity, angiogenesis, and neural connectivity. The role of BDNF in the improvement of metabolic and cardiovascular functions and in delaying the onset of neurodegenerative diseases has received increased attention. Current evidence has pointed out the influence of BDNF levels on structural and functional brain changes, including hippocampal neurogenesis, long-term potentiation, increased hippocampal volume, and survival of new born hippocampal neurons. Thus, higher BDNF levels have been associated with better cognitive performance, attention, and spatial memory. Indeed, reduced BDNF concentrations have been found in patients with dementia, mild cognitive impairment, Alzheimer’s disease, and major depression.
  •  A previous meta-analysis reported that aerobic exercise programs with moderate-to-vigorous intensity in adolescents did not result in a significant increase in BDNF levels. Another systematic review reported a dose response in terms of the frequency and intensity of the programmed sessions in samples including people with a variety of health conditions (i.e., healthy individuals, chronic patients). However, neither of these explored the immediate effect of exercise at different intensities on BDNF levels. Although it is known that exercise intensity is correlated with heart rate (which has been linked to BDNF levels) and that the abovementioned reviews suggest the intensity of exercise is positively related to increases in BDNF levels, there is a lack of evidence about whether or not there is a threshold of exercise intensity from which a significant increase in BDNF concentrations can be observed. This information could be relevant to guide individual exercise prescriptions aimed at improving cognitive performance.
  • Therefore, the aim of the present study was to estimate the immediate changes in BDNF levels after exercise interventions at different intensities based on clinical trials in healthy young adults. Additionally, we explored whether acute changes in BDNF levels varied based on time spent on HIE (i.e., ≥30 or <30 min) or with respect to baseline cardiorespiratory fitness.
  • Background
  • Although brain-derived neurotrophic factor (BDNF) has been identified as a molecular biomarker of the neurophysiological effects induced by exercise, the acute effects of high-intensity exercise (HIE) on BDNF levels are inconclusive. This study aims to estimate the immediate effects of HIE on BDNF levels in healthy young adults.

·        Methods

  • A systematic search was conducted in the MEDLINE, Embase, Cochrane CENTRAL, and SportDiscus databases up to December 2020. Randomized controlled trials (RCTs) and non-RCTs reporting pre–post changes in serum or plasma BDNF after an acute intervention of HIE compared to a control condition were included. Pooled effect sizes (p-ESs) and 95% confidence intervals (95%CIs) were calculated for RCTs using a random effects model with Stata/SE (Version 15.0; StataCorp, College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PROPERO registration number: CRD42020221047.

·        Results

  • A total of 22 studies with 552 individuals (age range: 20–31 years; 59.1% male) were included. The meta-analysis included 10 RCTs that reported valid outcome data. Higher BDNF levels were observed when HIE interventions were compared with non-exercise (p-ES = 0.55, 95%CI: 0.12–0.98; I2 = 25.7%; n = 4 studies) and light-intensity exercise (p-ES = 0.78, 95%CI: 0.15–1.40; I2 = 52.4%; n = 3 studies) but not moderate-intensity exercise (p-ES = 0.93, 95%CI: –0.16 to 2.02; I2 = 88.5%; n = 4 studies) conditions

Available online 1 September 2021

RubénFernández-RodríguezaCeliaÁlvarez-BuenoIsabel A.Martínez-OrtegaVicenteMartínez-VizcaínoArthur EumannMesasBlancaNotario-Pacheco