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BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING: Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

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BACKGROUND: The non-invasive assessment of maximal respiratory pressures (MRP) reflects the strength of the respiratory muscles. OBJECTIVE: To evaluate the studies which have established normative values for MRP in healthy children and adolescents and to synthesize these values through a meta-analysis. METHODS: The searches were conducted until October 2023 in the following databases: ScienceDirect, MEDLINE, CINAHL, SciELO, and Web of Science. Articles that determined normative values and/or reference equations for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in children and adolescents published in English, Portuguese, or Spanish regardless of the year of publication were included. Two reviewers selected titles and abstracts, in case of conflict, a third reviewer was consulted. Articles that presented sufficient data were included to conduct the meta-analysis. RESULTS: Initially, 252 studies were identified, 28 studies were included in the systematic review and 19 in the meta-analysis. The sample consisted of 5798 individuals, and the MIP and MEP values were stratified by sex and age groups of 4-11 and 12-19 years. Values from females 4-11 years were: 65.8 cmH2O for MIP and 72.8 cmH2O for MEP, and for males, 75.4 cmH2O for MIP and 84.0 cmH2O for MEP. In the 12-19 age group, values for females were 82.1 cmH2O for MIP and 90.0 cmH2O for MEP, and for males, they were 95.0 cmH2O for MIP and 105.7 cmH2O for MEP. CONCLUSIONS: This meta-analysis suggests normative values for MIP and MEP in children and adolescents based on 19 studies.

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ABSTRACT BACKGROUND: The magnitude of economic losses attributed to sleep problems and insufficient physical activity (PA) remains unclear. This study aimed to investigate the association between insufficient PA, sleep problems, and direct healthcare costs. OBJECTIVE: To investigate the association between insufficient physical activity (PA), sleep problems, and direct healthcare costs among adults. DESIGN AND SETTING: Adults aged ≥ 50 years attended by the Brazilian National Health Service were tracked from 2010 to 2014. METHODS: Direct healthcare costs were assessed using medical records and expressed in US$. Insufficient PA and sleep problems were assessed through face-to-face interviews. Differences were identified using the analysis of covariance and variance for repeated measures. RESULTS: In total, 454 women and 166 men were enrolled. Sleep problems were reported by 28.9% (95%CI: 25.2% to 32.4%) of the sample, while insufficient PA was reported by 84.8% (95%CI: 82.1% to 87.6%). The combination of sleep problems and insufficient PA explained 2.3% of all healthcare costs spent on these patients from 2010 to 2014, which directly accounts for approximately US$ 4,765.01. CONCLUSION: The combination of sleep problems and insufficient PA plays an important role in increasing direct healthcare costs in adults. Public health stakeholders, policymakers, and health professionals can use these results to reinforce the need for strategies to improve sleep quality and increase PA, especially in nations that finance their National Health Systems.

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AIM: To investigate the association between physical activity and immunogenicity among SARS-CoV-2 seropositive patients with autoimmune rheumatic diseases prior to and following a 2-dose schedule of CoronaVac (Sinovac inactivated vaccine). METHODS: This was a prospective cohort study within an open-label, single-arm, phase 4 vaccination trial conducted in Sao Paulo, Brazil. In this substudy, only SARS-CoV-2 seropositive patients were included. Immunogenicity was assessed by seroconversion rates of total anti-SARS-CoV-2 S1/S2 immunoglobulin G (IgG), geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity before and after vaccination. Physical activity was assessed through a questionnaire. Model-based analyses were performed controlling for age (<60 or ≥60 y), sex, body mass index (<25, 25-30, and >30 kg/m2), and use of prednisone, immunosuppressants, and biologics. RESULTS: A total of 180 seropositive autoimmune rheumatic disease patients were included. There was no association between physical activity and immunogenicity before and after vaccination. CONCLUSIONS: This study suggests that the positive association between physical activity and greater antibody responses seen in immunocompromised individuals following vaccination is overridden by previous SARS-CoV-2 infection, and does not extend to natural immunity.

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Introduction: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. Methods: Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. Results: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). Discussion: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

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INTRODUCTION: Cardiopulmonary exercise testing (CPET) may capture potential impacts of COVID-19 during exercise. We described CPET data on athletes and physically active individuals with or without cardiorespiratory persistent symptoms. METHODS: Participants' assessment included medical history and physical examination, cardiac troponin T, resting electrocardiogram, spirometry and CPET. Persistent symptoms were defined as fatigue, dyspnea, chest pain, dizziness, tachycardia, and exertional intolerance persisting >2 months after COVID-19 diagnosis. RESULTS: A total of 46 participants were included; sixteen (34.8%) were asymptomatic and thirty participants (65.2%) reported persistent symptoms, with fatigue and dyspnea being the most reported ones (43.5 and 28.1%). There were a higher proportion of symptomatic participants with abnormal data for slope of pulmonary ventilation to carbon dioxide production (VE/VCO2 slope; p<0.001), end-tidal carbon dioxide pressure at rest (PETCO2 rest; p=0.007), PETCO2 max (p=0.009), and dysfunctional breathing (p=0.023) vs. asymptomatic ones. Rates of abnormalities in other CPET variables were comparable between asymptomatic and symptomatic participants. When assessing only elite and highly trained athletes, differences in the rate of abnormal findings between asymptomatic and symptomatic participants were no longer statistically significant, except for expiratory air flow-to-percent of tidal volume ratio (EFL/VT) (more frequent among asymptomatic participants) and dysfunctional breathing (p=0.008). DISCUSSION: A considerable proportion of consecutive athletes and physically active individuals presented with abnormalities on CPET after COVID-19, even those who had had no persistent cardiorespiratory symptomatology. However, the lack of control parameters (e.g., pre-infection data) or reference values for athletic populations preclude stablishing the causality between COVID-19 infection and CPET abnormalities as well as the clinical significance of these findings.

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BACKGROUND: Physical activity associates with improved immunogenicity following a 2-dose schedule of CoronaVac (Sinovac's inactivated SARS-CoV-2 vaccine) in patients with autoimmune rheumatic diseases (ARD). This study evaluates whether physical activity impacts vaccine-induced antibody responses to a booster dose in this population. METHODS: This was a phase-4 trial conducted in São Paulo, Brazil. Patients with ARD underwent a 3-dose schedule of CoronaVac. One month after the booster, we assessed seroconversion rates of anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG, frequency of positive neutralizing antibodies, and neutralizing activity. Physical activity was assessed through questionnaire. RESULTS: Physically active (n = 362) and inactive (n = 278) patients were comparable for most characteristics; however, physically active patients were younger (P < .01) and had a lower frequency of chronic inflammatory arthritis (P < .01). Adjusted models showed that physically active patients had ∼2 times odds of seroconversion rates (OR: 2.09; 95% confidence interval, 1.22 to 3.61), ∼22% greater geometric mean titers of anti-S1/S2 IgG (22.09%; 95% confidence interval, 3.91 to 65.60), and ∼7% greater neutralizing activity (6.76%; 95% confidence interval, 2.80 to 10.72) than inactive patients. CONCLUSIONS: Patients with ARD who are physically active have greater odds of experiencing better immunogenicity to a booster dose of CoronaVac. These results support the recommendation of physical activity to improve vaccination responses, particularly for immunocompromised individuals.

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To investigate the association between physical activity (PA) domains and chronic low back pain (LBP) in older adults. A cross-sectional study where sociodemographic, behavioral, and health variables; PA; and presence of chronic LBP were collected. Higher scores of PA defined the "more active" participants. Binary logistic regression was used to test the association between PA domains and chronic LBP. A total of 516 participants were included. The mean age was 71.8 (95% confidence interval, CI, [71.1, 72.5]) years, and 29%, 27%, 25%, and 31% were identified as "more active" in the household, sports, leisure-time, and total PA domains, respectively. "More active" participants in sports (odds ratio = 0.62, 95% CI [0.40, 0.97]), leisure-time (odds ratio = 0.54, 95% CI [0.35, 0.85]) and total (odds ratio = 0.60, 95% CI [0.39, 0.92]) PA domains were less likely to report chronic LBP. High levels of sports, leisure-time, and total PA were inversely associated with chronic LBP.

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BACKGROUND: High prevalence of back pain has been observed in adolescents. Sedentary behavior (SB) is considered a risk factor for musculoskeletal pain. The association between back pain and SB in the pediatric/adolescent population is not well established. OBJECTIVE: To investigate the association between SB and low back and neck pain in adolescents according to sex. METHODS: This is a cross-sectional study with children and adolescents aged 10-17 years, randomly recruited from public and private schools in Presidente Prudente, Brazil. All students enrolled in the selected schools were eligible to participate. SB was evaluated by adding the number of hours of use of screen devices, such as television, computer, video game, and smartphone/tablet. To assess neck and low back pain, the Nordic Musculoskeletal Questionnaire was used. Physical activity and socioeconomic status were assessed by the Baecke Questionnaire and the Brazilian Criteria for Economic Classification (ABEP), respectively. Odds ratio (OR) from Binary Logistic Regression in the unadjusted and adjusted model (physical activity, abdominal obesity, and socioeconomic status) showed the relationship between musculoskeletal pain and SB. RESULTS: A total of 1011 adolescents (557 girls) with a mean ± standard deviation age of 13.2±2.4 years were included. Moderate (OR = 1.80; 95%CI: 1.00, 3.23) and high (OR = 1.91; 95%CI: 1.02, 3.53) SB were associated with neck pain in girls. In boys, moderate SB (OR = 2.75; 95%CI: 1.31, 5.78) were associated with neck pain. Moderate (OR = 2.73; 95%CI: 1.45, 5.02) and high (OR = 2.49; 95%CI: 1.30, 4.76) SB were associated with low back pain only in girls. CONCLUSION: Moderate and high SB were associated with neck pain in girls and boys, while moderate and high SB were associated with low back pain only in girls.

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This prospective cohort study within an open-label, single-arm, phase 4 vaccination trial (clinicaltrials.gov #NCT04754698) aimed to investigate the association between physical activity and persistent anti-SARS-CoV-2 antibodies 6 months after two-dose schedule of CoronaVac in autoimmune rheumatic diseases (ARD) patients (n = 748). Persistent immunogenicity 6 months after the full-course vaccination was assessed using seroconversion rates of total anti-SARS-CoV-2 S1/S2 IgG, geometric mean titers of anti-S1/S2 IgG (GMT), and frequency of positive neutralizing antibodies (NAb). Physical activity was assessed trough questionnaire. Adjusted point estimates from logistic regression models indicated that physically active patients had greater odds of seroconversion rates (OR: 1.5 [95%CI: 1.1 to 2.1]) and NAb positivity (OR: 1.5 [95%CI: 1.0 to 2.1]), and approximately 43% greater GMT (42.8% [95%CI: 11.9 to 82.2]) than inactive ones. In conclusion, among immunocompromised patients, being physically active was associated with an increment in antibody persistence through 6 months after a full-course of an inactivated SARS-CoV-2 vaccine.

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