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•About 50% of hospitalized Japanese elderly receiving convalescent rehabilitation had sarcopenia.•Sarcopenia on admission is associated with activities of daily living, dysphagia, and the rate of home discharge at the time of hospital discharge.•Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented in this population. The aim of this study was to evaluate the effect of sarcopenia on functional outcomes, including activities of daily living (ADLs); dysphagia status; and the rate of home discharge, among hospitalized adults receiving convalescent rehabilitation. A retrospective cohort study was conducted with 898 patients newly admitted to in-hospital convalescent rehabilitation wards at a single rehabilitation hospital in Japan. Baseline sarcopenia was diagnosed using muscle mass index and handgrip strength according to the criteria of the European Working Group on Sarcopenia in Older People, with the cutoff values of the Asian Working Group for Sarcopenia. The primary outcome was ADLs, assessed by Functional Independence Measure motor (FIM-motor) score at hospital discharge. The secondary outcomes included dysphagia, assessed by the Food Intake Level Scale (FILS), at discharge, and the rate of home discharge. Three multivariate analyses revealed an association between sarcopenia and the clinical outcomes. Each analysis adjusted for the following confounders: age, sex, time from onset, premorbid ADLs, comorbidities, cognitive level, nutritional status, major drugs, and admission diagnoses. After enrollment, 795 patients (mean age 74.9 ± 13.2 y; 59% women) were included in the final analysis. Admission diagnoses included stroke (n = 276; 34.7%), musculoskeletal disorders (n = 382; 48.1%), and hospital-associated deconditioning (n = 137; 17.2%). Of the 795 patients examined, 402 (50.6%) had sarcopenia. The multiple linear regression analysis showed that sarcopenia was independently associated with FIM motor score at discharge in patients with all disease types (β = –0.189 [stroke], –0.240 [musculoskeletal disorders], –0.230 [hospital-associated deconditioning]; all P < 0.05), with FILS score at discharge only in patients with musculoskeletal disorders (β = –0.271, P < 0.001), but not in patients with stroke (β = –0.061, P = 0.375) or those with hospital-associated deconditioning (β = –0.131, P = 0.070). The multiple logistic regression analysis showed that sarcopenia was associated with rate of home discharge in all disease types (odds ratio [OR], 0.201; 95% confidence interval [CI], 0.067–0.597 for stroke; OR, 0.242; 95% CI, 0.076–0.772 for musculoskeletal disorders; OR, 0.121; 95% CI, 0.110–0.347 for hospital-associated deconditioning; all P < 0.05). Sarcopenia is associated with worse recovery of ADLs and dysphagia and a lower rate of home discharge in hospitalized adults undergoing convalescent rehabilitation. Early detection of sarcopenia and treatment by rehabilitation nutrition should be implemented in this population.

Since the emergence of COVID-19, millions worldwide have continued to experience persistent symptoms months after infection. Among these, physical and cardiorespiratory impairments are frequently reported, but remain poorly understood. This systematic review aimed to identify and synthesize evidence regarding physical and cardiorespiratory impairments in individuals with long COVID, defined as symptoms persisting for at least three months post-infection. A structured search was conducted across the MEDLINE, Embase, CINAHL, and Web of Science databases to identify cross-sectional and longitudinal cohort studies on physical and cardiorespiratory deficits in adults with long COVID. Twenty-two studies involving 3,041 adults with long COVID were included. Critical appraisal using the JBI-APT indicated that most studies had clear inclusion criteria (17/22), well-defined study populations (17/22), and valid exposure measurements (16/22), though confounding factors were often unaddressed (9/22 unclear or not reported). Findings indicate that while adults with long COVID displayed normal pulmonary function at rest, including Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1), Total Lung Capacity (TLC), and resting Arterial oxygen saturation (SpO2), significant impairments in exercise capacity were identified. Notably, all studies assessing the 6-minute walk test (6MWT) reported reduced distances, consistently falling below the 50th percentile of normative values. Additionally, VO₂peak was decreased in most studies (7/10), falling below 80% of the predicted value, indicating impaired aerobic capacity. Lower Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) values were observed in three out of six studies, with values below 75% of predicted, suggesting impaired gas exchange efficiency during exertion. Despite preserved resting lung function, these findings highlight significant physical deconditioning in Long COVID adults, with substantial reduction in exercise capacity. Routine assessments should include more sensitive measures, such as the 6MWT and VO₂peak, to detect subtle exercise limitations, even in patients with normal resting SpO₂, to better inform rehabilitation interventions.

Head‐down tilt bedrest (HDBR) models the effects of mechanical unloading on neuromuscular function. The efficacy of exercise in preserving motor unit (MU) function in older adults during HDBR remains unclear. This study investigated the effects of 14‐day HDBR on MU properties in older adults and the protective role of exercise. Fifteen participants aged 55–65 years were randomized to Control group ( n  = 7, passive mobilization only) or Exercise group ( n  = 8, daily mixed resistance and aerobic training) during 14 days of strict HDBR. Knee extensor strength and leg lean mass were measured, and intramuscular EMG was used to record MU firing rate (MUFR), MU potential (MUP) area and complexity, and neuromuscular junction (NMJ) transmission instability during contractions normalized to 25% of pre‐bedrest strength. Plasma C‐terminal agrin fragment (CAF) was also measured. Following HDBR, knee extensor strength decreased more in the Control group (−33.4 N m; P  < 0.001; ∼18% decrease) than in the Exercise group (−14.5 N m; P  = 0.027; ∼8% decrease; interaction P  = 0.045). Leg lean mass decreased similarly in both groups (−0.418 kg; P  = 0.013). Exercise prevented the decrease in MUP area observed in Controls (−65 mV·ms, P  = 0.240 vs. −253 mV·ms, P  < 0.001) and led to a reduction in MUFR (−1.05 pulses/s, P  < 0.001) not seen in Controls. NMJ transmission stability and CAF levels were unchanged in both groups. HDBR reduced leg lean mass and strength. Exercise attenuated declines in strength and MUP area, likely by preserving muscle fibre size despite reduced MUFR, without evidence of NMJ disruption. Exercise effectively attenuates neuromuscular decrements following HDBR in older adults, with implications for clinical care and spaceflight. What is the central question of this study? What is the impact of 14 days of head‐down tilt bedrest on motor unit function in older adults, and can exercise attenuate these changes? What is the main finding and its importance? Bedrest reduced knee extensor strength and motor unit potential area, while exercise attenuated these declines. Neuromuscular junction transmission instability remained unchanged. These results demonstrate that exercise can protect neuromuscular health during short‐term disuse in older adults, informing strategies for clinical care and spaceflight.

Orthostatic hypertension, defined by an increase of systolic blood pressure (SBP) of ≥20 mmHg upon standing, harbors an increased cardiovascular risk. We pooled data from two rigorously conducted head-down tilt bedrest studies to test the hypothesis that cardiopulmonary deconditioning and hypovolemia predispose to orthostatic hypertension. With bedrest, peak VO 2 decreased by 6 ± 4 mlO 2 /min/kg ( p  < 0.0001) and plasma volume by 367 ± 348 ml ( p  < 0.0001). Supine SBP increased from 127 ± 9 mmHg before to 133 ± 10 mmHg after bedrest ( p  < 0.0001). In participants with stable hemodynamics following head-up tilt, the incidence of orthostatic hypertension was 2 out of 67 participants before bedrest and 2 out of 57 after bedrest. We conclude that in most healthy persons, cardiovascular deconditioning and volume loss associated with long-term bedrest are not sufficient to cause orthostatic hypertension.

Background Older adults, especially those with physical and social complexities are at risk of hospital-associated deconditioning. Hospital-associated deconditioning is linked to increased length of stay in hospital, stress, and readmission rates. To date, there is a paucity of research on the experiences and implications of deconditioning in hospital from different perspectives. Therefore, the objectives of this exploratory, descriptive qualitative study were to explore hospital-associated deconditioning from the views of different stakeholders and to develop an understanding of deconditioning from physical, social, and cognitive perspectives. Methods Between August 2018 and July 2019, in-depth, semi-structured interviews were conducted with patients 50 years or older, who had a hip fracture or delay in discharge, as well as caregivers, providers, and decision-makers who provided support or impacted care processes for these patients. Participants were recruited from one urban and one rural health region located in Ontario, Canada. All interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach. Results A total of 80 individuals participated in this study. Participants described insufficient activities in hospital leading to boredom and mental and physical deconditioning. Patients were frustrated with experiencing deconditioning and their decline in function seemed to impact their sense of self and identity. Deconditioning had substantive impacts on patients’ ability to leave hospital to their next point of care. Providers and decision-makers understood the potential for deconditioning but felt constrained by factors beyond their control. Factors that appeared to impact deconditioning included the hospital’s built environment and social capital resources (e.g., family, roommates, volunteers, staff). Conclusions Participants described a substantial lack of physical, cognitive, and social activities, which led to deconditioning. Recommendations to address deconditioning include: (1) measuring physical/psychological function and well-being throughout hospitalization; (2) redesigning hospital environments (e.g., create social spaces); and (3) increasing access to rehabilitation during acute hospital stays, while patients wait for the next point-of-care.

Objective This study aimed to evaluate aerobic capacity in children and adolescents following a diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C) compared to healthy matched controls. Design Prospective cohort study. Setting Quaternary Pediatric intensive care unit and Pediatric cardiology unit. Participants 14 children diagnosed with MIS-C. Interventions None. Measurements Cardiopulmonary fitness parameters at the time of post-Pediatric intensive care unit follow-up (mean 3.6 months) such as maximum oxygen uptake (VO 2max ) and the first ventilatory anaerobic threshold (VAT), as a marker of muscular deconditioning. Main Results A total of 14 patients (12 boys) with a confirmed diagnosis of MIS-C and 70 healthy children were included. The median age was 13.2 years (range 10.7-13.6 years). All participants had a normal echocardiogram and normal lung function at the time of cardiopulmonary exercise test. As measured by VO 2max Z-score, exercise capacity was significantly lower in the MIS-C group compared to healthy controls (median-0.91 vs 0.13, p < 0.01), and a significantly higher proportion of children in the MIS-C group had impaired aerobic capacity (VO 2max Z-score<-1.64) compared to controls (29% vs. 3%, p < 0.01). The VAT was also significantly lower in the MIS-C group with a higher proportion of children with an impaired VAT (VAT Z-score<-1.64) compared to controls (43% vs. 3%, p = 0.03). Impaired aerobic capacity in the MIS-C group was associated with higher BMI, higher PELOD 2 score and lower platelet count at the PICU admission, and lower hemoglobin level at the cardiopulmonary exercise test time. Conclusions This study suggests that children with MIS-C experience significant reductions in aerobic capacity compared to healthy controls, primarily due to muscular deconditioning. These findings highlight the importance of considering post-ICU consultations and implementing strategies to address physical deconditioning in this population.

Background Restrictions introduced in response to the COVID-19 pandemic led to increased risk of deconditioning in the general population. No empirical evidence of this effect however has been gathered in people living with dementia. This study aims to identify the causes and effects of COVID-19-related deconditioning in people living with dementia. Methods This is a longitudinal phenomenological qualitative study. Participants living with dementia, their caregivers and therapists involved in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation during the COVID-19 pandemic were qualitatively interviewed at two time points: the baseline 2 months after the national lockdown was imposed in England (i.e., May 2020), the follow up 2 months after the first set (i.e. July 2020). The data were analysed through deductive thematic analysis. Results Twenty-four participants living with dementia, 19 caregivers and 15 therapists took part in the study. Two themes were identified: Causes of deconditioning in people living with dementia during the COVID-19 pandemic and effects of deconditioning in people living with dementia during the COVID-19 pandemic. A self-reinforcing pattern was common, whereby lockdown made the person apathetic, demotivated, socially disengaged, and frailer. This reduced activity levels, which in turn reinforced the effects of deconditioning over time. Without external supporters, most participants lacked the motivation / cognitive abilities to keep active. Provided the proper infrastructure and support, some participants could use tele-rehabilitation to combat deconditioning. Conclusion The added risks and effects of deconditioning on people with dementia require considerable efforts from policy makers and clinicians to ensure that they initiate and maintain physical activity in prolonged periods of social distancing. Delivering rehabilitation in the same way as before the pandemic might not be feasible or sustainable and innovative approaches must be found. Digital support for this population has shown promising results but remains a challenge. Trial registration The PrAISED trial and process evaluation have received ethical approval number 18/YH/0059 from the Bradford/Leeds Ethics Committee. The ISRCTN Registration Number for PrAISED is  15320670 .

Background A sedentary lifestyle increases the risk of adverse health outcomes and frailty,particularly for older adults. To reduce transmission during the COVID-19 pandemic, people were instructed to stay at home, group sports were suspended, and gyms were closed, thereby limiting opportunities for physical activity. Whilst evidence suggests that physical activity levels reduced during the pandemic, it is unclear whether the proportion of older adults realising the recommended minimum level of physical activity changed throughout the various stages of lockdown. Methods We used a large sample of 3,660 older adults (aged ≥ 65) who took part in the UK Household Longitudinal Study’s annual and COVID-19 studies. We examined changes in the proportion of older adults who were realising the UK Chief Medical Officers’ physical activity recommendations for health maintenance at several time points before and after COVID-19 lockdowns were imposed. We stratified these trends by the presence of health conditions, age, neighbourhood deprivation, and pre-pandemic activity levels. Results There was a marked decline in older adults’ physical activity levels during the third national lockdown in January 2021. The proportion realising the Chief Medical Officers’ physical activity recommendations decreased from 43% in September 2020 to 33% in January 2021. This decrease in physical activity occurred regardless of health condition, age, neighbourhood deprivation, or pre-pandemic activity levels. Those doing the least activity pre-lockdown increased their activity during lockdowns and those doing the most decreased their activity levels. Conclusions Reductions in older adults’ physical activity levels during COVID-19 lockdowns have put them at risk of becoming deconditioned and developing adverse health outcomes. Resources should be allocated to promote the uptake of physical activity in older adults to reverse the effects of deconditioning.

Astronauts in microgravity experience multi-system deconditioning, impacting their inflight efficiency and inducing dysfunctions upon return to Earth gravity. To fill the sex gap of knowledge in the health impact of spaceflights, we simulate microgravity with a 5-day dry immersion in 18 healthy women (Clin-icalTrials.gov Identifier: NCT05043974). Here we show that dry immersion rapidly induces a sedentarily-like metabolism shift mimicking the beginning of a metabolic syndrome with a drop in glucose tolerance, an increase in the atherogenic index of plasma, and an impaired lipid profile. Bone remodeling markers suggest a decreased bone formation coupled with an increased bone resorption. Fluid shifts and muscular unloading participate to a marked cardiovascular and sensorimotor deconditioning with decreased orthostatic tolerance, aerobic capacity, and postural balance. Collected datasets provide a comprehensive multi-systemic assessment of dry immersion effects in women and pave the way for future sex-based evaluations of countermeasures.

Dry immersion, which is a ground-based model of prolonged conditions of microgravity, is widely used in Russia but is less well known elsewhere. Dry immersion involves immersing the subject in thermoneutral water covered with an elastic waterproof fabric. As a result, the immersed subject, who is freely suspended in the water mass, remains dry. For a relatively short duration, the model can faithfully reproduce most physiological effects of actual microgravity, including centralization of body fluids, support unloading, and hypokinesia. Unlike bed rest, dry immersion provides a unique opportunity to study the physiological effects of the lack of a supporting structure for the body (a phenomenon we call ‘supportlessness’). In this review, we attempt to provide a detailed description of dry immersion. The main sections of the paper discuss the changes induced by long-term dry immersion in the neuromuscular and sensorimotor systems, fluid–electrolyte regulation, the cardiovascular system, metabolism, blood and immunity, respiration, and thermoregulation. The long-term effects of dry immersion are compared with those of bed rest and actual space flight. The actual and potential uses of dry immersion are discussed in the context of fundamental studies and applications for medical support during space flight and terrestrial health care.